Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
Department of Psychology, University of Toledo, Ohio, USA.
Br J Clin Psychol. 2022 Jun;61(2):255-280. doi: 10.1111/bjc.12335. Epub 2021 Oct 9.
Anhedonia, or reward system dysfunction, is associated with poorer treatment outcomes among depressed individuals. The role of anhedonia in treatment engagement, however, has not yet been explored. We review research on components of reward functioning impaired in depression, including effort valuation, reward anticipation, initial responsiveness, reward learning, reward probability, and reward delay, highlighting potential barriers to treatment engagement associated with these components. We then propose interventions to improve treatment initiation and continuation by addressing deficits in each component of reward functioning, focusing on modifications of existing evidence-based interventions to meet the needs of individuals with heightened anhedonia. We describe potential settings for these interventions and times at which they can be delivered during the process of referring individuals to mental health treatment, conducting intakes or assessments, and providing treatment. Additionally, we note the advantages of using screening processes already in place in primary care, workplace, school, and online settings to identify individuals with heightened anhedonia who may benefit from these interventions. We conclude with suggestions for future research on the impact of anhedonia on treatment engagement and the efficacy of interventions to address it. PRACTITIONER POINTS: Many depressed individuals who might benefit from treatment do not initiate it or discontinue early. One barrier to treatment engagement may be anhedonia, a core symptom of depression characterized by loss of interest or pleasure in usual activities. We describe brief interventions to improve treatment engagement in individuals with anhedonia that can be implemented during the referral process or early in treatment. We argue that interventions aiming to improve treatment engagement in depressed individuals that target anhedonia may be particularly effective.
快感缺失,或奖赏系统功能障碍,与抑郁个体的治疗效果较差有关。然而,快感缺失在治疗参与中的作用尚未得到探索。我们回顾了与抑郁中受损的奖赏功能成分相关的研究,包括努力评估、奖赏预期、初始反应性、奖赏学习、奖赏概率和奖赏延迟,突出了与这些成分相关的治疗参与潜在障碍。然后,我们提出通过解决奖赏功能每个成分的缺陷来改善治疗启动和延续的干预措施,重点是对现有基于证据的干预措施进行修改,以满足那些快感缺失程度较高的个体的需求。我们描述了这些干预措施的潜在环境以及在向心理健康治疗机构转介、进行评估或提供治疗的过程中可以实施这些干预措施的时间。此外,我们还注意到利用初级保健、工作场所、学校和在线环境中已经存在的筛选流程来识别那些可能受益于这些干预措施的快感缺失程度较高的个体的优势。最后,我们对快感缺失对治疗参与的影响以及解决该问题的干预措施的功效的未来研究提出了建议。
临床医生要点:许多可能受益于治疗的抑郁患者没有开始治疗或早期停止治疗。治疗参与的一个障碍可能是快感缺失,这是抑郁的核心症状之一,表现为对通常活动失去兴趣或乐趣。我们描述了一些简短的干预措施,可以改善有快感缺失的个体的治疗参与度,这些干预措施可以在转介过程中或早期治疗中实施。我们认为,针对抑郁个体的治疗参与度的干预措施,如果以改善快感缺失为目标,可能会特别有效。
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