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Reduced anhedonia following internet-based cognitive-behavioral therapy for depression is mediated by enhanced reward circuit activation

Published online by Cambridge University Press:  17 June 2022

Shir Hanuka ,
Elizabeth A. Olson ,
Roee Admon Open the ORCID record for Roee Admon [Opens in a new window] ,
Christian A. Webb ,
William D. S. Killgore ,
Scott L. Rauch ,
Isabelle M. Rosso  and
Diego A. Pizzagalli
Shir Hanuka
Affiliation:
School of Psychological Sciences, University of Haifa, Haifa, Israel
Elizabeth A. Olson
Affiliation:
Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
Roee Admon
Affiliation:
School of Psychological Sciences, University of Haifa, Haifa, Israel The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
Christian A. Webb
Affiliation:
Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
William D. S. Killgore
Affiliation:
Department of Psychiatry, University of Arizona, Tucson, AZ, USA
Scott L. Rauch
Affiliation:
Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
Isabelle M. Rosso
Affiliation:
Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
Diego A. Pizzagalli*
Affiliation:
Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Diego A. Pizzagalli, E-mail: dap@mclean.harvard.edu
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Abstract

Background

Major depressive disorder (MDD) is a highly prevalent psychiatric condition, yet many patients do not receive adequate treatment. Novel and highly scalable interventions such as internet-based cognitive-behavioral-therapy (iCBT) may help to address this treatment gap. Anhedonia, a hallmark symptom of MDD that refers to diminished interest and ability to experience pleasure, has been associated with reduced reactivity in a neural reward circuit that includes medial prefrontal and striatal brain regions. Whether iCBT can reduce anhedonia severity in MDD patients, and whether these therapeutic effects are accompanied by enhanced reward circuit reactivity has yet to be examined.

Methods

Fifty-two MDD patients were randomly assigned to either 10-week iCBT (n = 26) or monitored attention control (MAC, n = 26) programs. All patients completed pre- and post-treatment assessments of anhedonia (Snaith–Hamilton Pleasure Scale; SHAPS) and reward circuit reactivity [monetary incentive delay (MID) task during functional magnetic resonance imaging (fMRI)]. Healthy control participants (n = 42) also underwent two fMRI scans while completing the MID task 10 weeks apart.

Results

Both iCBT and MAC groups exhibited a reduction in anhedonia severity post-treatment. Nevertheless, only the iCBT group exhibited enhanced nucleus accumbens (Nacc) and subgenual anterior cingulate cortex (sgACC) activation and functional connectivity from pre- to post-treatment in response to reward feedback. Enhanced Nacc and sgACC activations were associated with reduced anhedonia severity following iCBT treatment, with enhanced Nacc activation also mediating the reduction in anhedonia severity post-treatment.

Conclusions

These findings suggest that increased reward circuit reactivity may contribute to a reduction in anhedonia severity following iCBT treatment for depression.

Keywords

AnhedoniafMRIinternet-based cognitive-behavioral therapy (iCBT)major depressive disorder (MDD)monetary incentive delay (MID)reward circuit
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 10 , July 2023 , pp. 4345 - 4354
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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Footnotes

*

Denotes equal first author contribution

†

Denotes equal last author contribution

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