Department of Psychiatry and the Mary land Psychiatric Research Center, Unive rsity of Mary land School of Medicine, Baltimore, USA.
Am J Psychiatry. 2012 Apr;169(4):364-73. doi: 10.1176/appi.ajp.2011.11030447.
Previous research provides evidence for discrepancies in various types of emotional self-report in individuals with schizophrenia; patients and healthy subjects report similar levels of positive emotion when reporting current feelings, yet patients report lower levels of positive emotion when reporting on noncurrent feelings. Such apparent discrepancies, which have come to be termed the "emotion paradox" in schizophrenia, have complicated our understanding of what anhedonia actually reflects in this patient population. The authors sought to resolve this paradox.
The authors reviewed the empirical literature on anhedonia and emotional experience in schizophrenia through the lens of the accessibility model of emotional self-report, a well-validated model of emotional self-report developed in the affective science literature that clarifies the sources of emotion knowledge that individuals access when providing different types of self-report. The authors used this model to propose a resolution to the "emotion paradox" and to provide a new psychological conceptualization of anhedonia.
Data are presented in support of this new perspective on anhedonia and to demonstrate how cognitive impairments may influence reports of noncurrent feelings in schizophrenia.
The authors conclude that anhedonia should no longer be considered an experiential deficit or a diminished "capacity" for pleasure in patients with schizophrenia. Rather, anhedonia reflects a set of beliefs related to low pleasure that surface when patients are asked to report their noncurrent feelings. Encoding and retrieval processes may serve to maintain these beliefs despite contrary real-world pleasurable experiences. Implications for assessment and treatment are discussed in relation to this new conceptualization of anhedonia.
先前的研究为精神分裂症个体在各种类型的情感自我报告中存在差异提供了证据；患者和健康受试者在报告当前感受时报告了相似水平的积极情绪，但在报告非当前感受时报告的积极情绪水平较低。这种明显的差异，在精神分裂症中被称为“情绪悖论”，使我们对快感缺失在这一患者群体中实际反映的情况更加难以理解。作者试图解决这一悖论。
作者通过情感自我报告的可及性模型来审查快感缺失和精神分裂症中的情感体验的实证文献，这是情感科学文献中提出的一种经过充分验证的情感自我报告模型，该模型阐明了个体在提供不同类型的自我报告时所获取的情感知识的来源。作者使用该模型来提出解决“情绪悖论”的方法，并提供快感缺失的新的心理学概念化。
提出了支持这种新的快感缺失观点的数据，并展示了认知障碍如何影响精神分裂症患者的非当前感受报告。
作者得出结论，快感缺失不应再被视为精神分裂症患者的体验缺陷或愉悦“能力”降低。相反，快感缺失反映了一组与低愉悦相关的信念，这些信念在患者被要求报告他们的非当前感受时浮现出来。尽管存在相反的现实愉悦体验，但编码和检索过程可能有助于维持这些信念。本文讨论了与快感缺失这种新的概念化相关的评估和治疗的意义。
