Across two studies using complementary methods, schizophrenia patients reported as much pleasure in the moment as controls in their daily lives and on a measure of trait consummatory pleasure. However, schizophrenia patients predicted that future daily life events would be less pleasurable, and they reported experiencing less pleasure in anticipation of future events compared to healthy controls. Further supporting the distinction between anticipatory and consummatory pleasure, clinical ratings of anhedonia were related to anticipatory, but not consummatory pleasure. In addition, ratings of functional outcome spanning family and social functioning were related to patients’ reports of anticipatory, but not consummatory pleasure.
These findings help provide clarity to the discrepancy between experimental studies of emotion and schizophrenia (where no clear pleasure deficits have been found) and self-report and interview studies (where pleasure deficits have been found). Schizophrenia patients may have a deficit in anticipating that things will be pleasurable, but once an enjoyable stimulus is before them, they can and do experience pleasure. This distinction may help uncover some of the mechanisms behind social and emotional functioning deficits in schizophrenia, and it may also lead to more targeted treatments of anhedonia. In Study 2, we found evidence for a linkage between the experience of anticipatory pleasure and family and social network functional outcomes. A deficit in the ability to experience anticipatory pleasure may contribute to interpersonal or social isolation, limited social engagement, and other impoverished environments, though such causal suggestions are clearly beyond the data presented here. Future studies should look more specifically to social anticipatory pleasure to clarify these relationships.
Given the connection between dopamine and anticipatory pleasure, it is possible that the observed anticipatory pleasure deficit in schizophrenia reflects a consequence of medication more than an aspect of the illness. However, other investigations have observed anhedonia among unmedicated patients, using both self-report measures (e.g., Arnfred & Chen, 2004
; Gruzelier & Davis, 1995
) and clinical ratings (Zhang, Peet, Ramchand, Shah, & Reynolds, 2001
), and among first episode patients, many of whom were not taking medication (e.g., Malla et al., 2002
). A recent fMRI investigation (Juckel, Schlagenhauf, Koslowski, Wustenberg et al., 2006
) also found evidence for an anticipatory deficit among unmedicated patients as indexed by less activation than healthy controls in brain regions associated with reward anticipation (ventral striatum, including nucleus accumbens; cf Knutson et al., 2001
) during presentation of reward cues. Furthermore, this reduced activation was associated with more severe negative symptoms, including anhedonia. In a second study using the same reward anticipation task, reduced activation in ventral striatum was found only among patients taking typical neuroleptics (Juckel, Schlagenhauf, Koslowski, Filonov et al., 2006
). Most of the patients in Study 2 were taking atypical antipsychotics. In future studies it would be useful to study at risk groups or unmedicated individuals in the schizophrenia spectrum.
Although schizophrenia patients represent emotion in the same two-dimensional structure (valence, arousal) as healthy controls (e.g., Kring, Barrett, & Gard, 2003
), demand characteristics may have influenced reports of pleasure. However, there is no reason to believe that demand characteristics would operate more strongly for consummatory pleasure than anticipatory pleasure, or for patients more than controls. Nonetheless, it will be important for future studies to assess anticipatory and consummatory pleasure with additional behavioral and physiological measures.
The anticipatory/consummatory pleasure distinction has been discussed in the depression literature (e.g., Klein, 1984
), and cognitive therapy for depression has targeted anticipatory pleasure (e.g., Burns, 1999
). Though it remains to be seen if this type of intervention would be beneficial in schizophrenia, such investigations are now underway (e.g., Beck & Rector, 2005
; Turkington, Dudley, Warman, & Beck, 2004