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The effects of anhedonia and depression on hedonic responses
Psychiatry Research 179 (2010) 176–180
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Psychiatry Research j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p s yc h r e s
The effects of anhedonia and depression on hedonic responses Yulia Chentsova-Dutton a,⁎, Kaitlin Hanley b a b
Department of Psychology, Georgetown University, 306 White-Gravenor Hall, 3700 O Street, NW, Washington, DC 20057, USA Department of Clinical Psychology, The Pennsylvania State University, 535 Moore Building, University Park, PA 16802, USA
a r t i c l e
i n f o
Article history: Received 17 July 2008 Received in revised form 2 April 2009 Accepted 18 June 2009 Keywords: Depression Anhedonia Hedonic response Anticipation Recall
a b s t r a c t Anhedonia is one of the key symptoms of major depression. The present study examined whether depressive symptoms and trait anhedonia are associated with deficits in anticipated, experienced, or recalled pleasure and satisfaction (hedonic responses, HR). Sixty-one college students tasted chocolate samples in the lab. Participants' anticipated, experienced, and recalled HR were obtained prior to the task, during the task, and 1 day later, respectively. Anticipatory anhedonia, but not consummatory anhedonia or depression, predicted anticipated HR. In contrast, participants' levels of anticipatory and consummatory anhedonia and depression were not predictive of their experienced and recalled HRs. Depressed individuals showed lower tendency to overpredict their HRs to the task relative to nondepressed individuals. We conclude that clinical reports of anhedonia and depression in a college student population primarily reflect low levels of anticipation of reward, and tendency to accurately estimate their enjoyment of future rewards. If replicated, these results may have important implications for assessing and managing anhedonia associated with depression in clinical settings. © 2009 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Anhedonia, or reduced ability to experience interest and pleasure in response to pleasurable activities, reflects a stable individual difference as well as a transitory state associated with a number of psychological disorders, and particularly with major depression (Loas, 1996). Anhedonia is one of the two essential features of major depression as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association, 1994), and one of the best indicators of the presence of this disorder (Brody et al., 1998). More than two-thirds of all individuals with major depression endorse this symptom (Buchwald and Rudick-Davis, 1993). Severity of anhedonia is positively correlated with severity of depressive symptoms among depressed and nondepressed individuals (Allen et al.,1999; Kaviani et al., 2004; Mathews and Barch, 2006). Despite this consistent pattern of association, few studies have compared the effects of anhedonia and depressive symptoms on hedonic responses (HR, defined as pleasure and interest in response to potentially rewarding stimuli). Theories of depression and anhedonia suggest that anhedonic and/or depressed individuals display an experiential hedonic deficit (Meehl, 1975; Beck et al., 1979; Loas, 1996). Studies offer some support for this assumption, and show that depression and anhedonia are similarly associated with dampened HRs. Relative to nondepressed individuals, individuals with heightened levels of depression show diminished HR to pleasant imagery (Sloan et al., 1997; Allen et al., 1999), and films ⁎ Corresponding author. Tel.: +202 687 3639; fax: +202 687 6050. E-mail address: [email protected] (Y. Chentsova-Dutton). 0165-1781/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2009.06.013
(Rottenberg et al., 2002; Renneberg et al., 2005). Similarly, individuals with heightened levels of anhedonia show diminished HR to pleasant words (Mathews and Barch, 2006), imagery (Fiorito and Simons, 1994), pictures (Fitzgibbons and Simons,1992; Ferguson and Katkin,1996), and films (Kaviani et al., 2004, but also see Berenbaum et al., 1987). Many of these studies relied on complex and/or representational pleasant stimuli (e.g., films). These types of stimuli rely on individuals' ability to attend to them, appraise them or imagine enjoying them. In contrast, a few studies that examined responses to sensory stimuli, such as pleasant tastes, did not show a consistent pattern of association between depression, anhedonia, and HRs. Although some studies show that depression and anhedonia are associated with a reduction in ability to enjoy pleasant tastes (Amsterdam et al., 1987; Berlin et al., 1998), other studies do not replicate this pattern (Berenbaum and Oltmanns, 1992; Germans and Kring, 2000). It is possible that reports of depression and anhedonia are associated with deficits in appraisal, or ability to anticipate or imagine potentially rewarding stimuli, rather than deficits in sensory pleasure. In their daily lives, individuals with depression and anhedonia are likely to encounter both representational (e.g., reading), and sensory sources of pleasure (e.g., eating); thus, it is important to investigate the effects of depression and anhedonia on each. In addition, it is important to make clear distinctions between deficits in anticipated (i.e., anticipating that an activity would be pleasurable), experienced (i.e., actually enjoying an activity), and recalled (i.e., remembering experienced pleasure after a delay) HRs. These types of responses are known to be distinct from each other at physiological, behavioral, and experiential levels (Klein, 1984; Berridge and Robinson,1998; Barbano and Cador, 2007; Gard et al., 2007; also see
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Robinson and Clore, 2002). Clinical disorders may affect the association between these responses (Herbener et al., 2007). Both depression (Bradley et al., 1995; Sanz, 1996; MacLeod and Salaminiou, 2001) and anhedonia (Simons et al., 1982; but see Germans and Kring, 2000) are associated with deficits in anticipation and/or recall of pleasant experiences. Thus, it is important to examine whether depression, anhedonia, or their interaction affect anticipation, experience, and recall of HRs. Finally, most previous studies focused on either depression or anhedonia, but not both. Thus, we do not know whether the effects of depression on HRs are accounted for by anhedonia, or vice versa. Only one study has demonstrated that depression did not account for anhedonia's association with dampened HRs (Mathews and Barch, 2006). This finding requires replication. None of the previous studies examined whether symptoms of depression and anhedonia interact in their effect on hedonic response. The present study builds on the extant literature by examining the contributions of anhedonia, depression, and their interaction to HR. Based on previous research (Mathews and Barch, 2006), and on the fact that measures of anhedonia assess reported deficits in HR more systematically than measures of depression, we hypothesized that anhedonia will affect HR more than depression. Based on previous literature on anticipatory deficits associated with anhedonia (Gard et al., 2007), we hypothesized that anhedonia will affect anticipated HRs more than experienced HRs. In addition, based on previous literature on the effects of depression on anticipation and recall of positive emotional states (MacLeod and Salaminiou, 2001; Beck, 2002; Mennin and Miranda, 2007), we hypothesized that depressed individuals will show less intense positive biases in anticipating and remembering their HRs than nondepressed individuals. To test these hypotheses, we asked participants with different levels of reported depression and anhedonia to rate how much they may enjoy tasting chocolates, to actually taste chocolates, and to recall how enjoyable this task was 1 day after leaving the laboratory. 2. Methods 2.1. Participants Sixty-one college students from a small liberal arts college participated in the study. Participants were recruited through flyers and the psychology subject pool. They were invited to participate in a study on mood and taste perception. Participants were reimbursed $8 or assigned course credits for their time. In order to include participants who experienced depression and anhedonia, advertisements encouraged individuals who “felt blue and were no longer interested in things” as well as individuals without these symptoms to participate. Participants reporting symptoms of depression and higher levels of anhedonia were oversampled from the population of eligible individuals to ensure adequate distribution of depressive symptoms and anhedonia in this sample. Participants were between the ages of 18 and 24 (M = 19.44; S.D.= 1.42). Women comprised threequarters of the sample (46; 75.4%).1 The sample included European American (46, 75.4%), as well as Asian American, Hispanic, and biracial individuals. Two participants reported taking antidepressants. Current smokers and dieters were excluded from the study because these factors can affect taste perception and willingness to taste chocolates. 2.2. Measures 2.2.1. Severity of depressive symptoms To assess severity of depression, participants completed the Beck Depression Inventory (BDI, Beck et al., 1979). About half (31, 50.8%) of the participants were asymptomatic (BDI scores 0-9), with remaining participants reporting mild–moderate (BDI scores 10–18; 22, 36.1%) and moderate–severe (BDI scores 19–28; 8, 13.1%) levels of depressive symptoms. The scale had adequate internal consistency (α = 0.89). Because BDI scores were not normally distributed (Shapiro–Wilk W(60) = 0.95, P b 0.01), we divided the participants into two groups based on a median split of the BDI scores (nondepressed, BDI: 0–9; depressed, BDI: 10–28). Participants also filled out the Diagnostic Inventory for Depression (DID; Zimmerman et al., 2004), a self-report scale that has been shown to have adequate reliability and 1 Preliminary analyses included gender as an additional between-subject factor. Women reported higher levels of HRs than men, multivariate F(1,59) = 5.86, P b 0.05. Because gender did not interact with type of reports, depression or anhedonia, we collapsed across gender in subsequent analyses.
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agreement with structured diagnostic interviews. We divided participants into three groups based on their DID scores: nondepressed (reporting 0–1 DSM-IV symptoms of major depressive episode (MDE), 43%), subsyndromal symptoms of depression (reporting 2–4 DSM-IV symptoms of major depressive episode (MDE) accompanied by significant impairment, 41%), and depressed (reporting 5–8 DSM-IV symptoms of MDE, including depressed mood, anhedonia or both, and accompanied by significant impairment, 16%). There was a significant association between depression status as determined by the BDI and the DID, χ2 (2, N = 61) = 25.96, P b 0.001. These measures demonstrate that participants' reports of depressive symptoms ranged from asymptomatic to clinically significant, thus allowing us to examine the relationship between severity of depressive symptoms and pleasurable responses in this sample. Each measure included two items that captured clinical reports of anhedonia: (1) reported loss of pleasure, and (2) loss of interest. 2.2.2. Anhedonia The 18-item Temporal Experience of Pleasure Scale (TEPS, Gard et al., 2006) was used to measure reports of anticipatory and consummatory experiences of pleasure. The TEPS has high concurrent validity with other measures of anhedonia. It is based on two scales, a 10-item anticipatory pleasure scale (α = 0.76) and an eight-item consummatory (α = 0.64) pleasure scale. Lower scores on these scales indicate higher levels of anhedonia. 2.2.3. Reported intensity of HR Participants provided three reports of their HR: anticipated, experienced, and recalled. For anticipated HR, participants reported their anticipated pleasure in response to six potential study tasks that included chocolate tasting as well as other hypothetical tasks (e.g., solving puzzles). This information was assessed during a brief interview with the experimenter. For experienced HR, participants reported their response to each food sample using rating sheets listing seven taste terms. For recalled HR, participants reported the intensity of their experience in the lab the day before. They indicated how intensely they experienced eight positive and negative emotions during the chocolate-tasting task. Participants used the same nine-point rating scale (0 = “not at all”; 8 = “extremely”) when rating intensity of anticipated, experienced, and recalled HRs. For each report, averages of participants' reports of pleasure and satisfaction were calculated as a measure of HR (α= 0.81 for anticipated response; αs ranging from 0.78 to 0.91 for experienced HRs across chocolate samples; and α= 0.76 for recalled HR). The remaining questionnaire terms were used as fillers. Averages of experienced HRs were calculated for the five chocolate samples. 2.3. Procedure Measures of anhedonia and depression were filled out by participants prior to the study as part of the prescreening packet. Chocolate-tasting task was selected because a pilot questionnaire has revealed that tasting chocolate is one of the most commonly listed sources of sensory pleasure for this population. The task was piloted in the lab and was associated with significant increases in reported pleasure and satisfaction. Upon arrival to the laboratory, participants gave written informed consent, and completed a measure of anticipated HR. After that, participants were presented with seven numerically labeled food samples. Five samples of chocolate (first, third, fourth, fifth, and seventh samples) were small pieces of different brands of milk chocolate, presented in a fixed order. Participants also tasted and rated two samples of bland food (a matzo cracker, second sample, and a rice cake, sixth sample). The participants were asked to savor each sample in their mouths and evaluate it using a rating sheet. They were instructed to eat only a bit of the small sample in order to get sufficient taste without reaching satiety, and drank some water between samples to cleanse their palates. The next day, participants received an e-mail asking them to rate the intensity of their experience in the lab the day before (recalled HR). Upon receiving a response to the follow-up e-mail, the experimenter fully debriefed the participants. In order to examine the extent to which participants were biased in anticipating and recalling their experienced HRs, we calculated anticipatory and recall bias scores. Anticipatory bias score was calculated by subtracting levels of experienced HR from levels of anticipated HR. Recall bias score was calculated by subtracting levels of experienced HR from levels of recalled HR.
3. Results 3.1. Task effectiveness To examine whether the chocolate-tasting task was effective in eliciting HRs, we conducted a repeated-measures analysis of variance (ANOVA) (Food sample [bland foods, chocolate]). Participants' HRs were higher for samples of chocolates than for samples of bland foods, F(1,60) = 129.14, P b 0.01, indicating that the task elicited pleasure and satisfaction, as intended. 3.2. Anticipatory and recalled HRs differ from experienced HRs To examine whether participants' levels of anticipatory, experienced, and recalled HRs differed from each other, we conducted a repeated-
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Table 1 Means, standard deviations, and associations for all variables. Variable
1.
2.
1. DID 2. BDI 3. TEPSa 4. TEPSc 5. Anticipation HR 6. Experienced HR 7. Recalled HR 8. Anticipatory bias 9. Recall bias
– 25.96⁎⁎ 0.37 0.33 0.21 0.26 0.13 0.37 0.12
– 0.19 0.11 0.20 0.03 0.08 0.22 0.07
3.
– 0.40⁎⁎ 0.35⁎⁎ 0.15 0.11 0.25⁎ − 0.02
4.
0.04 0.18 0.26⁎ − 0.11 0.10
5.
– 0.52⁎⁎ 0.01 0.61⁎⁎ − 0.20
6.
– 0.33⁎ − 0.30⁎ − 0.47⁎⁎
7.
– − 0.04 0.68
8.
– 0.20
9.
M(S.D.) 2.77(2.25) 9.98(7.17) 4.55(0.69) 4.84(0.69) 6.21(1.30) 5.04(1.03) 4.66(1.25) 1.14(1.14) − 0.37(1.34)
Notes: Values represent Pearson r for association between continuous variables, eta for association between continuous and categorical variables, and chi-square for association between two categorical variables (DID and BDI). DID = Diagnostic Inventory for Depression; BDI = Beck Depression Inventory score; TEPSa = the Temporal Experience of Pleasure Scale (anticipatory); TEPSc = the Temporal Experience of Pleasure Scale (consummatory); HR = hedonic response. ⁎ P b 0.01. ⁎⁎ P b 0.01.
measure ANOVA (Report [anticipated, experienced, recalled]). This analysis revealed that the three reports of HRs significantly differed from each other, F(2,120) = 41.99, Greenhouse–Geisser adjusted P b 0.01. Although participants enjoyed tasting chocolates in the lab, they anticipated enjoying this task more (M = 6.21; S.D. = 1.30) than they actually did (M = 5.04; S.D. = 1.03), planned within-subject contrast F (1,60) = 62.16, P b 0.01. Furthermore, participants' recalled HRs (M = 4.66; S.D. = 1.25) were lower than both their anticipated (planned within-subject contrast F(1,60) = 57.09, P b 0.01) and actual (planned within-subject contrast F(1,60) = 4.84, P b 0.05) HRs. 3.3. Associations among variables The associations between reported levels of depressive symptoms, anhedonia, and reports of pleasurable experiences are shown in Table 1. Anticipated, experienced, and recalled HRs showed no associations with levels of depressive symptoms as captured by the BDI and the DID. This pattern held when we examined associations of HRs with intensity of clinical symptoms of loss of pleasure and interest from the BDI and the DID (Pearson r's ranging from − 0.23 to 0.06, ns). Thus, endorsement of clinical symptoms of diminished pleasure and interest on depression inventories was not associated with participants' anticipated, experienced, or recalled HRs. Reports of consummatory anhedonia were associated with recalled HRs, but not anticipated or experienced HRs. In contrast, reports of anticipatory anhedonia were associated with anticipated HRs, but not experienced or recalled HRs.
control for the effects of these variables. Main effect variables (depression and anticipatory and consummatory anhedonia) were entered in Step 2 of the equation, and three interaction variables between depression, anticipatory anhedonia, and consummatory anhedonia were entered in Step 3 of the equation. All continuous variables were centered for these analyses. The beta coefficients for each model are listed in Table 2. In the model with anticipated HR as the dependent variable, Step 3 of the model did not result in significant R2 increases. In Step 2, (R2 =0.11, F(3,60)=3.42, Pb 0.05), anticipatory anhedonia emerged as the only significant predictor. In the model with experienced HR as the dependent variable, Steps 2 and 3 of the model did not result in significant increases in explained variance. In Step 1 (R2 =0.28, F(1,60) =23.44, Pb 0.001), anticipated HR emerged as the only significant predictor. Finally, in the model with recalled HR as the dependent variable, Steps 2 and 3 of the model did not result in significant R2 increases. Step 1 was significant (R2 =0.14, F(2,60)=3.54, Pb 0.05). Experienced HR was the only significant predictor of recalled HR (see Table 2).3 In summary, participants' HRs were based in part on their earlier estimates. Their responses to the chocolate task in the lab were predicted by their anticipation of enjoying this task, and, in turn, predicted their memory of how much they enjoyed the task (see Table 2). Interestingly, depression and consummatory anhedonia did not predict anticipated, experienced, or recalled HRs. Anticipatory anhedonia predicted anticipatory HR to the chocolate-tasting task, but not experienced or recalled HR.
3.4. The effects of depression and anhedonia on HRs
3.5. The effects of depression and anhedonia on anticipatory and recall biases
To examine whether the HRs were affected by reported depression and anhedonia, or their interaction, we conducted three hierarchical multiple regressions predicting anticipated, experienced, and recalled HRs from depression status2 (nondepressed = 0; depressed = 1), and reports of anticipatory and consummatory anhedonia (TEPS scales). Because participants made repeated reports of HRs, they could have potentially remembered and reiterated their previous reports. To control for this, previous reports (i.e., reports of anticipated HR for the model predicting experienced HR, and reports of anticipated and experienced HRs for the model predicting recalled HR) were included in the model to examine unique effects of depression and trait anhedonia upon HRs after controlling for participants' previous HRs. For each analysis, previous HRs were entered in Step 1 of the equation (this step was omitted for the model predicting anticipated HR because no previous reports were available for this measure) to
Because anticipated and recalled HRs differed significantly from experienced HRs, we conducted additional hierarchical linear regressions to examine whether depression or anhedonia affected participants' tendency to bias their anticipated and recalled HRs relative to their experienced HRs. Main effect variables (depression and anticipatory and consummatory anhedonia) were entered in Step 1, and three interaction variables between depression, anticipatory anhedonia, and consummatory anhedonia were added in Step 2. Both steps were significant for the model with anticipatory bias as the dependent variable (Step 2: R2 = 0.18, F(6,60) = 3.55, P b 0.01). Anticipatory bias was significantly predicted by consummatory anhedonia, β = −0.68, t = −2.90, P b 0.01, such that higher consummatory anhedonia was associated with higher anticipatory bias or a tendency to overpredict the
2
We repeated these analyses for the DID depression variables. The results were very similar. To reduce redundancy, we are reporting results based on BDI here; the results based on the DID are available upon request.
3 Because retrospective reports of hedonic experiences are affected by peak/end heuristics (Fredrickson, 2000), we repeated the last set of analyses using peak and last ratings of chocolate samples in step 1. Rating of the last sample was a significant predictor of recalled HR; however, steps 2 and 3 of the model remained insignificant.
Y. Chentsova-Dutton, K. Hanley / Psychiatry Research 179 (2010) 176–180 Table 2 Summary of hierarchical regression analyses predicting hedonic responses. Dependent variable (HR) Anticipated
Experienced
Recalled
Predictor variable
B
SE
β
B
SE
β
B
SE
β
Step 1 Anticipated HR Experienced HR
– –
– –
– –
0.43 –
0.09 –
0.54⁎⁎ –
0.05 0.36
0.14 0.18
0.05 0.30⁎
Step 2 Anticipated HR BDI TEPSa TEPSc
– − 0.37 0.70 − 0.24
– 0.32 0.26 0.25
– − 0.14 0.37⁎⁎
– – – –
– – – –
– – – –
– – – –
– – – –
– – – –
− 0.13
Note. BDI = Beck Depression Inventory score; TEPSa = the Temporal Experience of Pleasure Scale (anticipatory); TEPSc = the Temporal Experience of Pleasure Scale (consummatory); HR=hedonic response. ⁎ P b 0.05. ⁎⁎ P b 0.01.
hedonic value of the task. Depression (β = −0.22, t = −1.83, P = 0.07) and anticipatory anhedonia (β = 0.46, t = 1.99, P = 0.05) were marginally significant predictors. Nondepressed individuals and those with lower anticipatory anhedonia tended to show higher anticipatory bias. Moreover, there was a significant interaction between depression and consummatory anhedonia (β = 0.49, t = 2.26, P b 0.05). Regardless of their levels of consummatory anhedonia, depressed individuals reported low levels of anticipatory bias. These findings are consistent with our hypotheses. In contrast, the accuracy of nondepressed individuals' predictions depended on their consummatory anhedonia. High consummatory anhedonia among nondepressed individuals was associated with larger anticipatory bias than low consummatory anhedonia. Contrary to our hypotheses, the model with recall bias as the dependent variable did not yield any significant predictors. 4. Discussion These results add to the literature examining the association between depression, anhedonia, and HRs. Consistent with two earlier studies using sensory tasks (Berenbaum and Oltmanns, 1992, Germans and Kring, 2000; but also see Amsterdam et al., 1987 and Berlin et al., 1998 for contradictory data), the present study demonstrates that individuals' reports of low-to-moderate levels of depression and consummatory anhedonia were not predictive of their HRs to a sensory task. Even those individuals who reported losing interest and pleasure in their usual activities did not show deficits in their sensory HRs. Anticipatory anhedonia, on the other hand, was predictive of intensity of anticipated HR, which in turn affected experienced HR. It is possible that results of prior studies that documented an association between depression, consummatory anhedonia and hedonic deficits in response to sensory tasks (Amsterdam et al., 1987; Berlin et al., 1998) were in part due to low levels of anticipatory anhedonia. Because anticipatory anhedonia may indirectly contribute to experienced HR via its effect on anticipatory HR, it would be important to further investigate whether an intervention targeting individuals' anticipation of pleasure would affect downstream enjoyment of pleasurable experiences. These data stand in contrast to studies linking levels of depression and consummatory anhedonia with dampened HRs to complex elicitors of emotions, such as imagery and films (Fitzgibbons and Simons, 1992; Kaviani et al., 2004; also see Bylsma et al., 2008). It is possible that reports of depression and consummatory anhedonia show stronger association with HRs to stimuli that are complex and representational in nature (e.g., images, stories, and films). Responses to such stimuli require individuals to appraise the stimulus as emotional, imagine being in the presence of an in vivo stimulus, and recruit their beliefs about their ability to experience positive emotions in that situation. Global and retrospective questions assessing levels of depression and consumma-
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tory anhedonia (e.g., “I don't get any real satisfaction out of anything anymore”) also tap a generalized set of beliefs about one's ability to experience positive emotions (see Robinson and Kirkeby, 2005). Hence, the two types of reports may correlate due to a degree of shared reliance on these beliefs. The ability to appraise the complex stimuli and recruit these beliefs may be disrupted in clinical samples. For example, one recent study (Herbener et al., 2007) reported that the association between consummatory anhedonia and experienced HR is stronger for groups of healthy individuals and weaker for clinical samples, a pattern that was not observed in the current study. One factor that can help account for these discrepancies is the fact that the current study is one of the few that used in vivo sensory stimuli. Global and generalized reports of emotions can differ substantially from in-the-moment experiential reports, which are shaped by situational factors (Robinson and Clore, 2002). Thus, measures of depression and consummatory anhedonia may not adequately capture experiential responses to specific in vivo pleasurable stimuli, such as tasting food. Future studies need to assess whether HRs differ systematically across different types of pleasurable experiences. Interestingly, individuals who reported significant symptoms of depression were more accurate than nondepressed individuals in forecasting how enjoyable a future activity may be for them. Although they were more accurate, their forecasts of anticipated rewards may be dysfunctional. An exaggerated belief that one would enjoy going out for dinner with friends may motivate an individual to go through the trouble of getting ready and traveling to the restaurant, thus increasing the chances of enjoying the occasion, even if it may fall short of one's initial expectations. In contrast, generalized beliefs about one's inability to enjoy pleasurable activities may lower depressed individuals' motivation to actively pursue these activities, and prevent them from taking pleasure. These findings illustrate the beneficial effects of pleasant activity homework in cognitive– behavioral therapy for depression (Jacobson et al., 1996). Stimulating individuals with low-to-moderate levels of depression and anhedonia to pursue pleasant activities can expose them to the fact that they can enjoy these activities despite their beliefs to the contrary. Interestingly, for nondepressed individuals, reports of consummatory anhedonia were associated with higher anticipation bias. This finding is novel and requires replication. If replicated, it may reflect the disparity between these individuals' motivation to pursue pleasurable activities and their perceived inability to derive enjoyment from them. This study has several limitations that need to be addressed in future research. First, we did not find that depression or anhedonia affected recall bias or intensity of recalled HRs. This lack of association is in contrast to previous reports that depression is associated with recall biases (Sanz, 1996). We asked participants to recall the task the day after completing it. It is possible that this did not allow sufficient time for deterioration of recall accuracy. Future studies should probe recalled HR after longer time intervals. Second, this study relied on self-reported measures of depression. Future studies need to extend these findings to individuals with clinical diagnoses of major depression. Third, the study conceptualized anticipatory pleasure as anticipation that a task would be pleasurable, rather than taking pleasure in anticipation itself. Additionally, because anticipated HR ratings were made in a face-to-face interview with the experimenter, it is possible that this measure reflected the tendency to underreport HR in interpersonal contexts. Future studies need to: 1) examine whether anhedonia and depression affect individuals' ability to take pleasure in anticipation (e.g., enjoying the feeling of anticipation), and 2) vary the anticipated HR questionnaire format. Finally, this study was limited to investigating HRs to a chocolate-tasting task presented in a laboratory. It is possible that participants may have reacted differently to other types of ecologically valid pleasant tasks, particularly those eliciting social pleasure (e.g., meeting friends). It would be important to examine other types of pleasant tasks in the future. If replicated, the results of this study have implications for our ability to make inferences about individuals' reports of anhedonia and
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depression in clinical and research settings. Reduction of reported anhedonia has become an important aim of many forms of therapy for major depression (Persons, 1989; Schlaepfer et al., 2007). It should not be assumed that all reports of anhedonia reflect experiential hedonic deficits. Recognition that some of these reports may reflect sets of beliefs about one's ability to experience pleasure can be helpful in designing and targeting effective intervention strategies. Acknowledgment This research was supposed in part by Colby College Student Special Funds Award awarded to the second author. The authors would like to thank Ayanna Thomas for her comments on the earlier version of this manuscript. Portions of this paper were presented at the Annual Meeting of the Association for Psychological Science. References Allen, N.B., Trinder, J., Brennan, C., 1999. Affective startle modulation in clinical depression: preliminary findings. Biological Psychiatry 46, 542–550. American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorder (4th ed). American Psychiatric Association Washington, DC. Amsterdam, J.D., Settle, R.G., Doty, R.L., Abelman, E., Winokur, A., 1987. Taste and smell perception in depression. Biological Psychiatry 22, 1477–1481. Barbano, M.F., Cador, M., 2007. Opioids for hedonic experience and dopamine to get ready for it. Psychopharmacology 191, 497–506. Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G., 1979. Cognitive therapy for depression. Guilford, New York. Beck, A.T., 2002. Cognitive models of depression. Clinical Advances in Cognitive Psychotherapy: Theory and Application 14, 29–61. Berenbaum, H., Oltmanns, T.F., 1992. Emotional experience and expression in schizophrenia and depression. Journal of Abnormal Psychology 101, 37–44. Berenbaum, H., Snowhite, R., Oltmanns, T.F., 1987. Anhedonia and emotional responses to affect evoking stimuli. Psychological Medicine 17, 677–684. Berlin, I., Givry-Steiner, L., Lecrubier, Y., Puech, A.J., 1998. Measures of anhedonia and hedonic responses to sucrose in depressive and schizophrenic patients in comparison with healthy subjects. European Psychiatry 13, 303–309. Berridge, K.C., Robinson, T.E., 1998. What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience? Brain Research Reviews 28, 309–369. Bradley, B.P., Mogg, K., Williams, R., 1995. Implicit and explicit memory for emotion— congruent information in clinical depression and anxiety. Behaviour Research and Therapy 33, 755–770. Brody, D.S., Hahn, S.R., Spitzer, R.L., Kroenke, K., Linzer, M., deGruy III, F.V., Williams, J.B.W., 1998. Identifying patients with depression in the primary care setting: a more efficient method. Archives of Internal Medicine 158, 2469–2475. Buchwald, A., Rudick-Davis, D., 1993. The symptoms of major depression. Journal of Abnormal Psychology 102, 197–205. Bylsma, L.M., Morris, B.H., Rottenberg, J., 2008. A meta-analysis of emotional reactivity in major depressive disorder. Clinical Psychology Review 28, 676–691. Ferguson, M.L., Katkin, E.S., 1996. Visceral perception, anhedonia, and emotion. Biological Psychology 42, 131–145. Fiorito, E.R., Simons, R.F., 1994. Emotional imagery and physical anhedonia. Psychophysiology 31, 513–521.
Fitzgibbons, L., Simons, R.F., 1992. Affective response to color-slide stimuli in subjects with physical anhedonia: a three-systems analysis. Psychophysiology 29 (6), 613–620. Fredrickson, B., 2000. Extracting meaning from past affective experiences: the importance of peaks, ends, and specific emotions. Cognition and Emotion 14, 577–606. Gard, D.E., Germans-Gard, M., Kring, A.M., John, O.P., 2006. Anticipatory and consummatory components of the experience of pleasure: a scale development study. Journal of Research in Personality 40, 1086–1102. Gard, D.E., Kring, A.M., Germans Gard, M., Horan, W.P., Green, M.F., 2007. Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophrenia Research 93, 253–260. Germans, M.K., Kring, A.M., 2000. Hedonic deficit in anhedonia: support for the role of approach motivation. Personality and Individual Differences 28, 659–672. Herbener, E.S., Rosen, C., Khine, T., Sweeney, J.A., 2007. Failure of positive but not negative emotional valence to enhance memory in schizophrenia. Journal of Abnormal Psychology 116, 43. Jacobson, N.S., Dobson, K.S., Truax, P.A., Addis, M.E., Koerner, K., Gollan, J.K., Gortner, E., Prince, S.E., 1996. A competent analysis of cognitive–behavioural treatment for depression. Journal of Consulting and Clinical Psychology 64, 295–304. Kaviani, H., Gray, J., Checkley, S., Raven, P., Wilson, G., Kumari, V., 2004. Affective modulation of the startle response in depression: influence of the severity of depression, anhedonia, and anxiety. Journal of Affective Disorders 83, 21–31. Klein, D.F., 1984. Depression and anhedonia. In: Clark, D.C., Fawcett, J. (Eds.), Anhedonia and Affect Deficit States. PMA Publishing, New York, p. 213-134. Loas, G., 1996. Vulnerability to depression: a model centered on anhedonia. Journal of Affective Disorders 41, 39–53. MacLeod, A.K., Salaminiou, E., 2001. Reduced positive future-thinking in depression: cognitive and affective factors. Cognition and Emotion 15, 99–107. Mathews, J.R., Barch, D.M., 2006. Episodic memory for emotional and non-emotional words in individuals with anhedonia. Psychiatry Research 143, 121–133. Meehl, P., 1975. Hedonic capacity: some conjectures. Bulletin of the Menninger Clinic 39, 295–307. Mennin, D.S., Miranda, R., 2007. Depression, generalized anxiety disorder, and certainty in pessimistic predictions about the future. Cognitive Therapy and Research 31 (1), 71–82. Persons, J.B., 1989. Cognitive Therapy in Practice: a Case Formulation Approach. W.W. Norton and Co, New York. Renneberg, B., Heyn, K., Gebhard, R., Bachmann, S., 2005. Facial expression of emotions in borderline personality disorder and depression. Journal of Behavior Therapy and Experimental Psychiatry 36, 183–196. Robinson, M.D., Clore, G.L., 2002. Belief and feeling: evidence for an accessibility model of emotional self-report. Psychological Bulletin 128, 934–960. Robinson, M.D., Kirkeby, B.S., 2005. Happiness as a belief system: individual differences and priming in emotion judgments. Personality and Social Psychology Bulletin 31, 1134–1144. Rottenberg, J., Kasch, K.L., Gross, J.J., Gotlib, I.H., 2002. Sadness and amusement reactivity differentially predict concurrent and prospective functioning in major depressive disorder. Emotion 2, 135–146. Sanz, J., 1996. Memory biases in social anxiety and depression. Cognition and Emotion 10, 87–106. Schlaepfer, T.E., Cohen, M.X., Frick, C., Kosel, M., Brodesser, D., Axmacher, N., Joe, A.Y., Kreft, M., Lenartz, D., Sturm, V., 2007. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology Apr 11. Simons, R.F., Macmillan, F.W., Ireland, F.B., 1982. Anticipatory pleasure deficit in subjects reporting physical anhedonia: slow cortical evidence. Biological Psychology 14, 297–310. Sloan, D.M., Strauss, M.E., Quirk, S.W., Sajatovic, M., 1997. Subjective and expressive emotional responses in depression. Journal of Affective Disorders 46, 135–141. Zimmerman, M., Sheeran, T., Young, D., 2004. The Diagnostic Inventory for Depression: a self-report scale to diagnose DSM-IV major depressive disorder. Journal of Clinical Psychology 60, 87-11.
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Psychiatry Research j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p s yc h r e s
The effects of anhedonia and depression on hedonic responses Yulia Chentsova-Dutton a,⁎, Kaitlin Hanley b a b
Department of Psychology, Georgetown University, 306 White-Gravenor Hall, 3700 O Street, NW, Washington, DC 20057, USA Department of Clinical Psychology, The Pennsylvania State University, 535 Moore Building, University Park, PA 16802, USA
a r t i c l e
i n f o
Article history: Received 17 July 2008 Received in revised form 2 April 2009 Accepted 18 June 2009 Keywords: Depression Anhedonia Hedonic response Anticipation Recall
a b s t r a c t Anhedonia is one of the key symptoms of major depression. The present study examined whether depressive symptoms and trait anhedonia are associated with deficits in anticipated, experienced, or recalled pleasure and satisfaction (hedonic responses, HR). Sixty-one college students tasted chocolate samples in the lab. Participants' anticipated, experienced, and recalled HR were obtained prior to the task, during the task, and 1 day later, respectively. Anticipatory anhedonia, but not consummatory anhedonia or depression, predicted anticipated HR. In contrast, participants' levels of anticipatory and consummatory anhedonia and depression were not predictive of their experienced and recalled HRs. Depressed individuals showed lower tendency to overpredict their HRs to the task relative to nondepressed individuals. We conclude that clinical reports of anhedonia and depression in a college student population primarily reflect low levels of anticipation of reward, and tendency to accurately estimate their enjoyment of future rewards. If replicated, these results may have important implications for assessing and managing anhedonia associated with depression in clinical settings. © 2009 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Anhedonia, or reduced ability to experience interest and pleasure in response to pleasurable activities, reflects a stable individual difference as well as a transitory state associated with a number of psychological disorders, and particularly with major depression (Loas, 1996). Anhedonia is one of the two essential features of major depression as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association, 1994), and one of the best indicators of the presence of this disorder (Brody et al., 1998). More than two-thirds of all individuals with major depression endorse this symptom (Buchwald and Rudick-Davis, 1993). Severity of anhedonia is positively correlated with severity of depressive symptoms among depressed and nondepressed individuals (Allen et al.,1999; Kaviani et al., 2004; Mathews and Barch, 2006). Despite this consistent pattern of association, few studies have compared the effects of anhedonia and depressive symptoms on hedonic responses (HR, defined as pleasure and interest in response to potentially rewarding stimuli). Theories of depression and anhedonia suggest that anhedonic and/or depressed individuals display an experiential hedonic deficit (Meehl, 1975; Beck et al., 1979; Loas, 1996). Studies offer some support for this assumption, and show that depression and anhedonia are similarly associated with dampened HRs. Relative to nondepressed individuals, individuals with heightened levels of depression show diminished HR to pleasant imagery (Sloan et al., 1997; Allen et al., 1999), and films ⁎ Corresponding author. Tel.: +202 687 3639; fax: +202 687 6050. E-mail address: [email protected] (Y. Chentsova-Dutton). 0165-1781/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2009.06.013
(Rottenberg et al., 2002; Renneberg et al., 2005). Similarly, individuals with heightened levels of anhedonia show diminished HR to pleasant words (Mathews and Barch, 2006), imagery (Fiorito and Simons, 1994), pictures (Fitzgibbons and Simons,1992; Ferguson and Katkin,1996), and films (Kaviani et al., 2004, but also see Berenbaum et al., 1987). Many of these studies relied on complex and/or representational pleasant stimuli (e.g., films). These types of stimuli rely on individuals' ability to attend to them, appraise them or imagine enjoying them. In contrast, a few studies that examined responses to sensory stimuli, such as pleasant tastes, did not show a consistent pattern of association between depression, anhedonia, and HRs. Although some studies show that depression and anhedonia are associated with a reduction in ability to enjoy pleasant tastes (Amsterdam et al., 1987; Berlin et al., 1998), other studies do not replicate this pattern (Berenbaum and Oltmanns, 1992; Germans and Kring, 2000). It is possible that reports of depression and anhedonia are associated with deficits in appraisal, or ability to anticipate or imagine potentially rewarding stimuli, rather than deficits in sensory pleasure. In their daily lives, individuals with depression and anhedonia are likely to encounter both representational (e.g., reading), and sensory sources of pleasure (e.g., eating); thus, it is important to investigate the effects of depression and anhedonia on each. In addition, it is important to make clear distinctions between deficits in anticipated (i.e., anticipating that an activity would be pleasurable), experienced (i.e., actually enjoying an activity), and recalled (i.e., remembering experienced pleasure after a delay) HRs. These types of responses are known to be distinct from each other at physiological, behavioral, and experiential levels (Klein, 1984; Berridge and Robinson,1998; Barbano and Cador, 2007; Gard et al., 2007; also see
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Robinson and Clore, 2002). Clinical disorders may affect the association between these responses (Herbener et al., 2007). Both depression (Bradley et al., 1995; Sanz, 1996; MacLeod and Salaminiou, 2001) and anhedonia (Simons et al., 1982; but see Germans and Kring, 2000) are associated with deficits in anticipation and/or recall of pleasant experiences. Thus, it is important to examine whether depression, anhedonia, or their interaction affect anticipation, experience, and recall of HRs. Finally, most previous studies focused on either depression or anhedonia, but not both. Thus, we do not know whether the effects of depression on HRs are accounted for by anhedonia, or vice versa. Only one study has demonstrated that depression did not account for anhedonia's association with dampened HRs (Mathews and Barch, 2006). This finding requires replication. None of the previous studies examined whether symptoms of depression and anhedonia interact in their effect on hedonic response. The present study builds on the extant literature by examining the contributions of anhedonia, depression, and their interaction to HR. Based on previous research (Mathews and Barch, 2006), and on the fact that measures of anhedonia assess reported deficits in HR more systematically than measures of depression, we hypothesized that anhedonia will affect HR more than depression. Based on previous literature on anticipatory deficits associated with anhedonia (Gard et al., 2007), we hypothesized that anhedonia will affect anticipated HRs more than experienced HRs. In addition, based on previous literature on the effects of depression on anticipation and recall of positive emotional states (MacLeod and Salaminiou, 2001; Beck, 2002; Mennin and Miranda, 2007), we hypothesized that depressed individuals will show less intense positive biases in anticipating and remembering their HRs than nondepressed individuals. To test these hypotheses, we asked participants with different levels of reported depression and anhedonia to rate how much they may enjoy tasting chocolates, to actually taste chocolates, and to recall how enjoyable this task was 1 day after leaving the laboratory. 2. Methods 2.1. Participants Sixty-one college students from a small liberal arts college participated in the study. Participants were recruited through flyers and the psychology subject pool. They were invited to participate in a study on mood and taste perception. Participants were reimbursed $8 or assigned course credits for their time. In order to include participants who experienced depression and anhedonia, advertisements encouraged individuals who “felt blue and were no longer interested in things” as well as individuals without these symptoms to participate. Participants reporting symptoms of depression and higher levels of anhedonia were oversampled from the population of eligible individuals to ensure adequate distribution of depressive symptoms and anhedonia in this sample. Participants were between the ages of 18 and 24 (M = 19.44; S.D.= 1.42). Women comprised threequarters of the sample (46; 75.4%).1 The sample included European American (46, 75.4%), as well as Asian American, Hispanic, and biracial individuals. Two participants reported taking antidepressants. Current smokers and dieters were excluded from the study because these factors can affect taste perception and willingness to taste chocolates. 2.2. Measures 2.2.1. Severity of depressive symptoms To assess severity of depression, participants completed the Beck Depression Inventory (BDI, Beck et al., 1979). About half (31, 50.8%) of the participants were asymptomatic (BDI scores 0-9), with remaining participants reporting mild–moderate (BDI scores 10–18; 22, 36.1%) and moderate–severe (BDI scores 19–28; 8, 13.1%) levels of depressive symptoms. The scale had adequate internal consistency (α = 0.89). Because BDI scores were not normally distributed (Shapiro–Wilk W(60) = 0.95, P b 0.01), we divided the participants into two groups based on a median split of the BDI scores (nondepressed, BDI: 0–9; depressed, BDI: 10–28). Participants also filled out the Diagnostic Inventory for Depression (DID; Zimmerman et al., 2004), a self-report scale that has been shown to have adequate reliability and 1 Preliminary analyses included gender as an additional between-subject factor. Women reported higher levels of HRs than men, multivariate F(1,59) = 5.86, P b 0.05. Because gender did not interact with type of reports, depression or anhedonia, we collapsed across gender in subsequent analyses.
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agreement with structured diagnostic interviews. We divided participants into three groups based on their DID scores: nondepressed (reporting 0–1 DSM-IV symptoms of major depressive episode (MDE), 43%), subsyndromal symptoms of depression (reporting 2–4 DSM-IV symptoms of major depressive episode (MDE) accompanied by significant impairment, 41%), and depressed (reporting 5–8 DSM-IV symptoms of MDE, including depressed mood, anhedonia or both, and accompanied by significant impairment, 16%). There was a significant association between depression status as determined by the BDI and the DID, χ2 (2, N = 61) = 25.96, P b 0.001. These measures demonstrate that participants' reports of depressive symptoms ranged from asymptomatic to clinically significant, thus allowing us to examine the relationship between severity of depressive symptoms and pleasurable responses in this sample. Each measure included two items that captured clinical reports of anhedonia: (1) reported loss of pleasure, and (2) loss of interest. 2.2.2. Anhedonia The 18-item Temporal Experience of Pleasure Scale (TEPS, Gard et al., 2006) was used to measure reports of anticipatory and consummatory experiences of pleasure. The TEPS has high concurrent validity with other measures of anhedonia. It is based on two scales, a 10-item anticipatory pleasure scale (α = 0.76) and an eight-item consummatory (α = 0.64) pleasure scale. Lower scores on these scales indicate higher levels of anhedonia. 2.2.3. Reported intensity of HR Participants provided three reports of their HR: anticipated, experienced, and recalled. For anticipated HR, participants reported their anticipated pleasure in response to six potential study tasks that included chocolate tasting as well as other hypothetical tasks (e.g., solving puzzles). This information was assessed during a brief interview with the experimenter. For experienced HR, participants reported their response to each food sample using rating sheets listing seven taste terms. For recalled HR, participants reported the intensity of their experience in the lab the day before. They indicated how intensely they experienced eight positive and negative emotions during the chocolate-tasting task. Participants used the same nine-point rating scale (0 = “not at all”; 8 = “extremely”) when rating intensity of anticipated, experienced, and recalled HRs. For each report, averages of participants' reports of pleasure and satisfaction were calculated as a measure of HR (α= 0.81 for anticipated response; αs ranging from 0.78 to 0.91 for experienced HRs across chocolate samples; and α= 0.76 for recalled HR). The remaining questionnaire terms were used as fillers. Averages of experienced HRs were calculated for the five chocolate samples. 2.3. Procedure Measures of anhedonia and depression were filled out by participants prior to the study as part of the prescreening packet. Chocolate-tasting task was selected because a pilot questionnaire has revealed that tasting chocolate is one of the most commonly listed sources of sensory pleasure for this population. The task was piloted in the lab and was associated with significant increases in reported pleasure and satisfaction. Upon arrival to the laboratory, participants gave written informed consent, and completed a measure of anticipated HR. After that, participants were presented with seven numerically labeled food samples. Five samples of chocolate (first, third, fourth, fifth, and seventh samples) were small pieces of different brands of milk chocolate, presented in a fixed order. Participants also tasted and rated two samples of bland food (a matzo cracker, second sample, and a rice cake, sixth sample). The participants were asked to savor each sample in their mouths and evaluate it using a rating sheet. They were instructed to eat only a bit of the small sample in order to get sufficient taste without reaching satiety, and drank some water between samples to cleanse their palates. The next day, participants received an e-mail asking them to rate the intensity of their experience in the lab the day before (recalled HR). Upon receiving a response to the follow-up e-mail, the experimenter fully debriefed the participants. In order to examine the extent to which participants were biased in anticipating and recalling their experienced HRs, we calculated anticipatory and recall bias scores. Anticipatory bias score was calculated by subtracting levels of experienced HR from levels of anticipated HR. Recall bias score was calculated by subtracting levels of experienced HR from levels of recalled HR.
3. Results 3.1. Task effectiveness To examine whether the chocolate-tasting task was effective in eliciting HRs, we conducted a repeated-measures analysis of variance (ANOVA) (Food sample [bland foods, chocolate]). Participants' HRs were higher for samples of chocolates than for samples of bland foods, F(1,60) = 129.14, P b 0.01, indicating that the task elicited pleasure and satisfaction, as intended. 3.2. Anticipatory and recalled HRs differ from experienced HRs To examine whether participants' levels of anticipatory, experienced, and recalled HRs differed from each other, we conducted a repeated-
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Table 1 Means, standard deviations, and associations for all variables. Variable
1.
2.
1. DID 2. BDI 3. TEPSa 4. TEPSc 5. Anticipation HR 6. Experienced HR 7. Recalled HR 8. Anticipatory bias 9. Recall bias
– 25.96⁎⁎ 0.37 0.33 0.21 0.26 0.13 0.37 0.12
– 0.19 0.11 0.20 0.03 0.08 0.22 0.07
3.
– 0.40⁎⁎ 0.35⁎⁎ 0.15 0.11 0.25⁎ − 0.02
4.
0.04 0.18 0.26⁎ − 0.11 0.10
5.
– 0.52⁎⁎ 0.01 0.61⁎⁎ − 0.20
6.
– 0.33⁎ − 0.30⁎ − 0.47⁎⁎
7.
– − 0.04 0.68
8.
– 0.20
9.
M(S.D.) 2.77(2.25) 9.98(7.17) 4.55(0.69) 4.84(0.69) 6.21(1.30) 5.04(1.03) 4.66(1.25) 1.14(1.14) − 0.37(1.34)
Notes: Values represent Pearson r for association between continuous variables, eta for association between continuous and categorical variables, and chi-square for association between two categorical variables (DID and BDI). DID = Diagnostic Inventory for Depression; BDI = Beck Depression Inventory score; TEPSa = the Temporal Experience of Pleasure Scale (anticipatory); TEPSc = the Temporal Experience of Pleasure Scale (consummatory); HR = hedonic response. ⁎ P b 0.01. ⁎⁎ P b 0.01.
measure ANOVA (Report [anticipated, experienced, recalled]). This analysis revealed that the three reports of HRs significantly differed from each other, F(2,120) = 41.99, Greenhouse–Geisser adjusted P b 0.01. Although participants enjoyed tasting chocolates in the lab, they anticipated enjoying this task more (M = 6.21; S.D. = 1.30) than they actually did (M = 5.04; S.D. = 1.03), planned within-subject contrast F (1,60) = 62.16, P b 0.01. Furthermore, participants' recalled HRs (M = 4.66; S.D. = 1.25) were lower than both their anticipated (planned within-subject contrast F(1,60) = 57.09, P b 0.01) and actual (planned within-subject contrast F(1,60) = 4.84, P b 0.05) HRs. 3.3. Associations among variables The associations between reported levels of depressive symptoms, anhedonia, and reports of pleasurable experiences are shown in Table 1. Anticipated, experienced, and recalled HRs showed no associations with levels of depressive symptoms as captured by the BDI and the DID. This pattern held when we examined associations of HRs with intensity of clinical symptoms of loss of pleasure and interest from the BDI and the DID (Pearson r's ranging from − 0.23 to 0.06, ns). Thus, endorsement of clinical symptoms of diminished pleasure and interest on depression inventories was not associated with participants' anticipated, experienced, or recalled HRs. Reports of consummatory anhedonia were associated with recalled HRs, but not anticipated or experienced HRs. In contrast, reports of anticipatory anhedonia were associated with anticipated HRs, but not experienced or recalled HRs.
control for the effects of these variables. Main effect variables (depression and anticipatory and consummatory anhedonia) were entered in Step 2 of the equation, and three interaction variables between depression, anticipatory anhedonia, and consummatory anhedonia were entered in Step 3 of the equation. All continuous variables were centered for these analyses. The beta coefficients for each model are listed in Table 2. In the model with anticipated HR as the dependent variable, Step 3 of the model did not result in significant R2 increases. In Step 2, (R2 =0.11, F(3,60)=3.42, Pb 0.05), anticipatory anhedonia emerged as the only significant predictor. In the model with experienced HR as the dependent variable, Steps 2 and 3 of the model did not result in significant increases in explained variance. In Step 1 (R2 =0.28, F(1,60) =23.44, Pb 0.001), anticipated HR emerged as the only significant predictor. Finally, in the model with recalled HR as the dependent variable, Steps 2 and 3 of the model did not result in significant R2 increases. Step 1 was significant (R2 =0.14, F(2,60)=3.54, Pb 0.05). Experienced HR was the only significant predictor of recalled HR (see Table 2).3 In summary, participants' HRs were based in part on their earlier estimates. Their responses to the chocolate task in the lab were predicted by their anticipation of enjoying this task, and, in turn, predicted their memory of how much they enjoyed the task (see Table 2). Interestingly, depression and consummatory anhedonia did not predict anticipated, experienced, or recalled HRs. Anticipatory anhedonia predicted anticipatory HR to the chocolate-tasting task, but not experienced or recalled HR.
3.4. The effects of depression and anhedonia on HRs
3.5. The effects of depression and anhedonia on anticipatory and recall biases
To examine whether the HRs were affected by reported depression and anhedonia, or their interaction, we conducted three hierarchical multiple regressions predicting anticipated, experienced, and recalled HRs from depression status2 (nondepressed = 0; depressed = 1), and reports of anticipatory and consummatory anhedonia (TEPS scales). Because participants made repeated reports of HRs, they could have potentially remembered and reiterated their previous reports. To control for this, previous reports (i.e., reports of anticipated HR for the model predicting experienced HR, and reports of anticipated and experienced HRs for the model predicting recalled HR) were included in the model to examine unique effects of depression and trait anhedonia upon HRs after controlling for participants' previous HRs. For each analysis, previous HRs were entered in Step 1 of the equation (this step was omitted for the model predicting anticipated HR because no previous reports were available for this measure) to
Because anticipated and recalled HRs differed significantly from experienced HRs, we conducted additional hierarchical linear regressions to examine whether depression or anhedonia affected participants' tendency to bias their anticipated and recalled HRs relative to their experienced HRs. Main effect variables (depression and anticipatory and consummatory anhedonia) were entered in Step 1, and three interaction variables between depression, anticipatory anhedonia, and consummatory anhedonia were added in Step 2. Both steps were significant for the model with anticipatory bias as the dependent variable (Step 2: R2 = 0.18, F(6,60) = 3.55, P b 0.01). Anticipatory bias was significantly predicted by consummatory anhedonia, β = −0.68, t = −2.90, P b 0.01, such that higher consummatory anhedonia was associated with higher anticipatory bias or a tendency to overpredict the
2
We repeated these analyses for the DID depression variables. The results were very similar. To reduce redundancy, we are reporting results based on BDI here; the results based on the DID are available upon request.
3 Because retrospective reports of hedonic experiences are affected by peak/end heuristics (Fredrickson, 2000), we repeated the last set of analyses using peak and last ratings of chocolate samples in step 1. Rating of the last sample was a significant predictor of recalled HR; however, steps 2 and 3 of the model remained insignificant.
Y. Chentsova-Dutton, K. Hanley / Psychiatry Research 179 (2010) 176–180 Table 2 Summary of hierarchical regression analyses predicting hedonic responses. Dependent variable (HR) Anticipated
Experienced
Recalled
Predictor variable
B
SE
β
B
SE
β
B
SE
β
Step 1 Anticipated HR Experienced HR
– –
– –
– –
0.43 –
0.09 –
0.54⁎⁎ –
0.05 0.36
0.14 0.18
0.05 0.30⁎
Step 2 Anticipated HR BDI TEPSa TEPSc
– − 0.37 0.70 − 0.24
– 0.32 0.26 0.25
– − 0.14 0.37⁎⁎
– – – –
– – – –
– – – –
– – – –
– – – –
– – – –
− 0.13
Note. BDI = Beck Depression Inventory score; TEPSa = the Temporal Experience of Pleasure Scale (anticipatory); TEPSc = the Temporal Experience of Pleasure Scale (consummatory); HR=hedonic response. ⁎ P b 0.05. ⁎⁎ P b 0.01.
hedonic value of the task. Depression (β = −0.22, t = −1.83, P = 0.07) and anticipatory anhedonia (β = 0.46, t = 1.99, P = 0.05) were marginally significant predictors. Nondepressed individuals and those with lower anticipatory anhedonia tended to show higher anticipatory bias. Moreover, there was a significant interaction between depression and consummatory anhedonia (β = 0.49, t = 2.26, P b 0.05). Regardless of their levels of consummatory anhedonia, depressed individuals reported low levels of anticipatory bias. These findings are consistent with our hypotheses. In contrast, the accuracy of nondepressed individuals' predictions depended on their consummatory anhedonia. High consummatory anhedonia among nondepressed individuals was associated with larger anticipatory bias than low consummatory anhedonia. Contrary to our hypotheses, the model with recall bias as the dependent variable did not yield any significant predictors. 4. Discussion These results add to the literature examining the association between depression, anhedonia, and HRs. Consistent with two earlier studies using sensory tasks (Berenbaum and Oltmanns, 1992, Germans and Kring, 2000; but also see Amsterdam et al., 1987 and Berlin et al., 1998 for contradictory data), the present study demonstrates that individuals' reports of low-to-moderate levels of depression and consummatory anhedonia were not predictive of their HRs to a sensory task. Even those individuals who reported losing interest and pleasure in their usual activities did not show deficits in their sensory HRs. Anticipatory anhedonia, on the other hand, was predictive of intensity of anticipated HR, which in turn affected experienced HR. It is possible that results of prior studies that documented an association between depression, consummatory anhedonia and hedonic deficits in response to sensory tasks (Amsterdam et al., 1987; Berlin et al., 1998) were in part due to low levels of anticipatory anhedonia. Because anticipatory anhedonia may indirectly contribute to experienced HR via its effect on anticipatory HR, it would be important to further investigate whether an intervention targeting individuals' anticipation of pleasure would affect downstream enjoyment of pleasurable experiences. These data stand in contrast to studies linking levels of depression and consummatory anhedonia with dampened HRs to complex elicitors of emotions, such as imagery and films (Fitzgibbons and Simons, 1992; Kaviani et al., 2004; also see Bylsma et al., 2008). It is possible that reports of depression and consummatory anhedonia show stronger association with HRs to stimuli that are complex and representational in nature (e.g., images, stories, and films). Responses to such stimuli require individuals to appraise the stimulus as emotional, imagine being in the presence of an in vivo stimulus, and recruit their beliefs about their ability to experience positive emotions in that situation. Global and retrospective questions assessing levels of depression and consumma-
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tory anhedonia (e.g., “I don't get any real satisfaction out of anything anymore”) also tap a generalized set of beliefs about one's ability to experience positive emotions (see Robinson and Kirkeby, 2005). Hence, the two types of reports may correlate due to a degree of shared reliance on these beliefs. The ability to appraise the complex stimuli and recruit these beliefs may be disrupted in clinical samples. For example, one recent study (Herbener et al., 2007) reported that the association between consummatory anhedonia and experienced HR is stronger for groups of healthy individuals and weaker for clinical samples, a pattern that was not observed in the current study. One factor that can help account for these discrepancies is the fact that the current study is one of the few that used in vivo sensory stimuli. Global and generalized reports of emotions can differ substantially from in-the-moment experiential reports, which are shaped by situational factors (Robinson and Clore, 2002). Thus, measures of depression and consummatory anhedonia may not adequately capture experiential responses to specific in vivo pleasurable stimuli, such as tasting food. Future studies need to assess whether HRs differ systematically across different types of pleasurable experiences. Interestingly, individuals who reported significant symptoms of depression were more accurate than nondepressed individuals in forecasting how enjoyable a future activity may be for them. Although they were more accurate, their forecasts of anticipated rewards may be dysfunctional. An exaggerated belief that one would enjoy going out for dinner with friends may motivate an individual to go through the trouble of getting ready and traveling to the restaurant, thus increasing the chances of enjoying the occasion, even if it may fall short of one's initial expectations. In contrast, generalized beliefs about one's inability to enjoy pleasurable activities may lower depressed individuals' motivation to actively pursue these activities, and prevent them from taking pleasure. These findings illustrate the beneficial effects of pleasant activity homework in cognitive– behavioral therapy for depression (Jacobson et al., 1996). Stimulating individuals with low-to-moderate levels of depression and anhedonia to pursue pleasant activities can expose them to the fact that they can enjoy these activities despite their beliefs to the contrary. Interestingly, for nondepressed individuals, reports of consummatory anhedonia were associated with higher anticipation bias. This finding is novel and requires replication. If replicated, it may reflect the disparity between these individuals' motivation to pursue pleasurable activities and their perceived inability to derive enjoyment from them. This study has several limitations that need to be addressed in future research. First, we did not find that depression or anhedonia affected recall bias or intensity of recalled HRs. This lack of association is in contrast to previous reports that depression is associated with recall biases (Sanz, 1996). We asked participants to recall the task the day after completing it. It is possible that this did not allow sufficient time for deterioration of recall accuracy. Future studies should probe recalled HR after longer time intervals. Second, this study relied on self-reported measures of depression. Future studies need to extend these findings to individuals with clinical diagnoses of major depression. Third, the study conceptualized anticipatory pleasure as anticipation that a task would be pleasurable, rather than taking pleasure in anticipation itself. Additionally, because anticipated HR ratings were made in a face-to-face interview with the experimenter, it is possible that this measure reflected the tendency to underreport HR in interpersonal contexts. Future studies need to: 1) examine whether anhedonia and depression affect individuals' ability to take pleasure in anticipation (e.g., enjoying the feeling of anticipation), and 2) vary the anticipated HR questionnaire format. Finally, this study was limited to investigating HRs to a chocolate-tasting task presented in a laboratory. It is possible that participants may have reacted differently to other types of ecologically valid pleasant tasks, particularly those eliciting social pleasure (e.g., meeting friends). It would be important to examine other types of pleasant tasks in the future. If replicated, the results of this study have implications for our ability to make inferences about individuals' reports of anhedonia and
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