Consummatory and anticipatory anhedonia in schizophrenia: Stability, and associations with emotional distress and social function over

six months 1. Introduction Anhedonia, defined as the diminished capacity to experience (1)pleasant emotions, is a (2)clinically (3)significant aspect of schizophrenia (4)most frequently characterized anhedonia as a negative (5)symptom in of the illness. (6)Considered by early (7)theorists to be (8)a (9)central feature of schizophrenia, (10)is characterized(11) (12)behavioral terms(13) by less engagement in (14)pleasurable (15)activities. (18)It (19)has been suggested to be a relatively stable phenomenon (20)over time (16)in persons (17)with schizophrenia and (21) linked with significant (22)impairment in (23)social functioning. One question that has emerged in recent research (24)concerns the expression, experience and (25)measurement of anhedonia in schizophrenia. Exploration in this area has complicated our understanding (26)of this construct. While (27) persons (28)with schizophrenia (29)report (30)lower levels of (31)trait-like hedonic experience (32)as well as (33)score more highly on (34)interview-rated measures of anhedonia compared to (35) (36)controls, (37)they also (38)report experiencing (39)as much pleasant emotion as (40 y 41)controls in response to evocative (42)stimuli(43). This (44)finding (45)broadly described as the emotion paradox has been (46)replicated in studies of (48 y 47)self-reported experiences of pleasure (49)over time and for one-time responses to (50) emotionally evocative stimuli. Differing from (51)self-report measures, experience-sampling methodology (52)has shown relatively normal (53)report of (54)positive emotion in (55) patients. Similarly, Aghevli et al. (2003) have found that while participants (56)with schizophrenia (57)report experiencing similar amounts of emotion to (58)controls in role-plays, (59)they appear (60)significantly less emotionally expressive (61)during those interactions. This pattern of (62)results has led many to conclude that people (63)with schizophrenia have (64)different levels of deficit between (65)trait and state hedonic experience. This (66)emotion paradox (67)has led (68)somewhat directly (69)to the development and (70)expansion of an understanding (71)of anhedonia as

consisting of (72)anticipatory and (73)consummatory components. Working in the (74)field of depression, Klein (1984) (75)initially distinguished between these two, (76)arguing that (77)anticipatory pleasure involves motivated (78) (79)behavior and (80) desire for a future stimulus, while (81)consummatory pleasure describes the positive emotion experienced at (82)satiation. Gard et al. (2006) point out that (83)while often (84)related, (85)motivated behavior and (86)anticipatory pleasure can be differentiated. There are several components that connect (87)anticipatory pleasure to the satiation of the desire (88)for the positive stimulus(89). (90)Anticipatory pleasure involves both the expectation of a positive stimulus in the future(91) as well as(92) pleasure because that the stimulus will soon be experienced. (93)Understood temporally, (94)anticipatory pleasure occurs when first expectation of (95)reward engenders (96)approach motivation and facilitates (97)goal-directed behavior (98)toward a rewarding stimulus. (99)Secondly, expectation of the stimulus (100)itself (101)produces a positive feeling state(102) (103)that (104has been labeled appetitive pleasure. Kring and Caponigro (2010) incorporated these components into a temporal (105)model of (106)anticipation, representation, and successful satiation. According to this (107)model, remembered pleasure maintains the representation of certain stimuli as positive, and allows for the individual to anticipate pleasure. Source: Psychiatry Research