The Multidimensional Experience of Anhedonia in Young People with Elevated Depression and Social Anxiety: A Qualitative Study

Anhedonia, defined as a “markedly diminished interest or pleasure in all, or almost all, activities” (American Psychiatric Association, 2013), is a key symptom observed in depression (American Psychiatric Association, 2013) and social anxiety (Kashdan, 2007). Anhedonia has been shown to predict negative outcomes such as elevated suicidality and poorer treatment response, yet it remains under-researched and under-addressed in interventions (Craske et al., 2024). Depression and social anxiety both emerge early in life, with peak onset at 19.5 years and 14.5 years, respectively (Solmi et al., 2022). Furthermore, anhedonia presents in approximately 10-15% of young people, with or without psychiatric difficulties (Pornpattananangkul et al. 2019; Stringaris et al. 2015; Prabhakar, Nielson, & Stringaris, 2022). These statistics, coupled with the negative outcomes associated with anhedonia, underscore the importance of better understanding anhedonia in young people. Qualitative studies are a valuable method to explore the phenomenology of anhedonia. However, only one known qualitative study has investigated anhedonia in young people (Watson et al., 2019), focused on how young people experience anhedonia in the context of depression. This study did not explore aspects of anhedonia that the current study aims to study. In addition to exploring young people’ daily experiences of anhedonia, we aim to better understand the dimensions of anhedonia, referring to underlying components of anhedonia related to reward functioning. We also aim to better understand anhedonia in different domains, i.e., the contexts of types of stimuli for which anhedonia is experienced. We focus on these based on critical gaps in the literature. Anhedonia has largely been studied as a unitary construct representing a general loss of interest and pleasure. However, this approach does not account for its different dimensions (Ho & Sommers, 2014). Anhedonia is intrinsically related to impaired reward functioning, and impairments may relate to reward anticipation, reward consumption, or reward learning (Strauss & Gold, 2012). Therefore, we can differentiate the following dimensions: anticipatory anhedonia, consummatory anhedonia, and reward learning anhedonia. Furthermore, anhedonia may occur in different domains, and we can distinguish between social anhedonia and physical anhedonia (Chapman et al., 1976). The social domain of anhedonia may be particularly important to understand in young people, as adolescence constitutes heightened sensitivity to negative interpersonal interactions (Larson & Ham, 1993; Crone & Dahl, 2012), and chronic stress has repeatedly been shown to predict anhedonia (Pizzagalli, 2014), especially when stressors are interpersonal (Losiewicz et al., 2023). This study aims to better understand the phenomenology of these dimensions and domains in young people experiencing elevated social anxiety and/or depression. Hence, the aims of this qualitative study are: (1) to understand the day-to-day experience of anhedonia in young people with elevated depression and/or social anxiety; (2) to explore the phenomenology of different dimensions of anhedonia (anticipatory, consummatory, reward learning); and (3) to explore experiences of anhedonia within different domains (social, physical), with a focus on understanding interactions with young people’s social context. We will interview approximately 20 young people aged 16-24 years, with elevated anhedonia and elevated depression and/or social anxiety, about our research questions. We will then conduct a thematic analysis of the interview transcripts. The findings of this study have the potential to inform further investigations into anhedonia, to improve identification through the development of multidimensional measures of anhedonia (which is presently lacking; Khazanov, Ruscio, & Forbes, 2019), and to optimise early interventions (as different strategies may be required to optimally target each dimension) focused on anhedonia that may reduce the risk of developing depression and/or social anxiety.