Longitudinal associations between perceived stress and anhedonia during psychotherapy

Abstract

AbstractBackgroundChronic stress alters reward sensitivity and contributes to the emergence of anhedonia. In clinical samples, the perception of stress is a strong predictor of anhedonia. While there is substantial evidence demonstrating psychotherapy reduces perceived stress, little is known regarding the effects of treatment-related decreases in perceived stress on anhedonia.MethodsThe current study investigated reciprocal relations between perceived stress and anhedonia using a cross-lagged panel model approach in a 15-week clinical trial examining the effects of Behavioral Activation Treatment for Anhedonia (BATA), a novel psychotherapy to treat anhedonia, compared to a Mindfulness-Based Cognitive Therapy (MBCT) comparison intervention (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136).ResultsTreatment completers (n=72) experienced significant reductions in anhedonia (M=-8.94, SD=5.66) on the Snaith-Hamilton Pleasure Scale (t(71)=13.39, p<.0001), and significant reductions in perceived stress (M=-3.71, SD=3.88) on the Perceived Stress Scale (t(71)=8.11, p<.0001) following treatment. Across all treatment-seeking participants (n=87), a longitudinal autoregressive cross-lagged model revealed significant paths showing that higher levels of perceived stress at treatment Week 1 predicted reductions in anhedonia at treatment Week 4.ConclusionsLongitudinal models illustrated that individuals with relatively high perceived stress at the start of treatment were likely to report relatively lower anhedonia a few weeks into treatment. At mid-treatment, individuals with low perceived stress were more likely to report lower anhedonia towards the end of treatment. Early treatment components are thought to reduce perceived stress, allowing for mid-to-late treatment components to exert their direct effects on anhedonia. The findings presented here demonstrate the importance of including stress-reducing components in cognitive-behavioral-based anhedonia treatments.