Karolinska Institutet Psychology Speaker Series: Michelle G. Craske

Reward sensitivity as a treatment target for depression and anxiety

Threat and reward sensitivity are fundamental processes that become dysregulated in the context of vulnerability to, or expression of, anxiety and depression. Treatments have traditionally targeted reductions in threat sensitivity with limited effects upon reward mechanisms. Investigation of reward sensitivity is essential for our understanding of psychopathology and for targeted treatment approaches. I will present two related lines of my research on this topic.  First, I will present our latest findings regarding neural, behavioral and subjective features of reward hyposensitivity (specifically in domains of reward anticipation-motivation, response to reward attainment, and reward learning) that correlate with and predict anxiety, depression and anhedonia. These findings led us to develop a treatment that specifically targets reward hyposensitivity, termed Positive Affect Treatment, which we have shown to be more effective than standard cognitive behavioral therapy for anxious and depressed individuals. I will present our most recent replication study in anxious, depressed and extremely low positive affect individuals, where the symptomatic outcomes occur in parallel with changes in target measures of reward anticipation-motivation and attainment to a greater degree than occurs with standard cognitive behavioral therapy. I will also present findings from virtual reality technologies for delivering aspects of Positive Affect Treatment. Second, building upon the work of others who have demonstrated the role of reward-related relief mechanisms in extinction learning, I will present our latest evidence regarding neural, behavioral and subjective correlates of anhedonia in the context of fear conditioning and related paradigms. Further, I will present evidence for anhedonia to interfere with exposure therapy (as a clinical proxy of extinction). I will conclude with a treatment model that incorporates reward targets to augment inhibitory retrieval models of exposure and our latest findings with neuro-reinforcement for “unconscious exposure”.