Abstract
Anhedonia is a risk factor for suicide and poor treatment response in depressed individuals. Most evidence-based psychological therapies target symptoms of heightened negative affect (e.g., negative inferential style) instead of deficits in positive affect (e.g., attenuated reward response) and typically show little benefit for anhedonia. Viewing positive scenes through virtual reality (VR) has been shown to increase positive affect and holds great promise for addressing anhedonic symptoms. In this pilot study, six participants with clinically significant depression completed 13 sessions of exposure to positive scenes in a controlled VR environment. Significant decreases were found in self-reported anhedonia, depression, anxiety, and impairments in functioning from baseline to 1-month follow-up. Negative affect decreased over all 13 sessions, and positive affect increased over sessions 8–13. Results suggest that positive experiences in VR may be a novel avenue for the treatment of anhedonia in depressed individuals.
Highlights
Anhedonia, the diminished capacity to experience joy or pleasure, is a common symptom across psychiatric diagnoses including depression (Fawcett et al, 1990; Morris et al, 2009), social anxiety (Brown et al, 1998; Kashdan, 2007), schizophrenia (Watson and Naragon-Gainey, 2010), and substance use disorder (American Psychiatric Association, 2013; Thomsen et al, 2015)
Depression, Anxiety, and Functional Impairment MASQ-AD [t(17) = −4.875, p < 0.001], Computerized Adaptive Testing-Depression (CAT-DI) [t(17) = −3.892, p = 0.001], Computerized Adaptive Testing (CAT)-ANX [t(17) = −3.843, p = 0.001], and Sheehan Disability Scale (SDS) significantly decreased from baseline to follow-up [t(17) = −6.347, p < 0.001] (Figure 1)
Our results suggest that the virtual reality (VR) protocol significantly reduced symptoms of anhedonia, depression, anxiety and impairments in functioning
Summary
The diminished capacity to experience joy or pleasure, is a common symptom across psychiatric diagnoses including depression (Fawcett et al, 1990; Morris et al, 2009), social anxiety (Brown et al, 1998; Kashdan, 2007), schizophrenia (Watson and Naragon-Gainey, 2010), and substance use disorder (American Psychiatric Association, 2013; Thomsen et al, 2015). Most evidence-based psychological therapies typically target negative affect and have had relatively limited impact upon anhedonia. The mechanisms of this ineffectiveness have been attributed to a number of factors including reversal of motivational state (Winer and Salem, 2016) as well as fear of positive emotion (Vanderlind et al, 2017). Existing literature has suggested that mental imagery might be more effective than a verbal approach in accessing and modifying emotion in therapy (Holmes et al, 2008), and studies combining mental imagery and BA have resulted in greater behavioral
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