Targeting Positive Affect as a Way to Improve Social Anhedonia in Schizophrenia

The reduced interest in, pleasure from, and motivation for social connection (clinically referred to as social anhedonia) significantly contributes to social dysfunction in schizophrenia. However, social anhedonia in schizophrenia has been challenging to treat. A new wave of psychosocial interventions for anhedonia, referred to as "positive affect interventions", have been validated in depression, but have not been widely applied in schizophrenia.

The goal of this narrative review article is to introduce positive affect interventions as a novel approach to treat social anhedonia in schizophrenia. We provide a narrative review of (1) the current psychosocial interventions for motivational deficits in schizophrenia; (2) the current positive affect intervention strategies for motivational deficits in depression; (3) the reward mechanisms (responsivity, learning, and valuation) that may differentially impact treatment response in schizophrenia vs depression; and (4) adaptations that might be needed to implement positive affect interventions in schizophrenia.

Compared with current psychosocial interventions for motivational deficits in schizophrenia, positive affect interventions have a greater emphasis on increasing positive affect (via reward mechanisms) to increase motivated social behavior. Adaptations of positive affect interventions to treat social anhedonia in schizophrenia might consider challenges with social goal-setting, negative social interactions, and social avoidance.

Psychosocial interventions that target positive affect could ultimately lead to greater improvements in social connection in schizophrenia. Recommendations for next steps to validate positive affect interventions to treat social anhedonia in schizophrenia are discussed.