One of the paradoxes that emerged from the findings on emotional experience in schizophrenia is a discrepancy between laboratory studies and clinical ratings. Specifically, many people with schizophrenia receive a clinical rating of anhedonia, indicating that they have diminished experience of positive emotion. Yet in the presence of emotionally pleasant things, such as films, pictures, tastes, or just day-to-day life, people with schizophrenia report experiencing as much pleasure as do people without schizophrenia. Drawing upon research on the reward system in humans and animals, Kring (1999)
argued for the importance of considering the temporal course of pleasure to distinguish anticipatory from in-the-moment pleasure. When people with schizophrenia are presented with pleasurable stimuli either in a lab or in daily life, they can and do derive pleasure from these experiences. However, evidence now supports the contention that people with schizophrenia appear less likely to anticipate that future events will be pleasurable, are less likely to experience pleasure in anticipation of things to come, and thus may be less likely to seek out pleasurable experiences (Gard, Kring, Germans Gard, Horan, & Green, 2007
). Other behavioral and fMRI studies also find that people with schizophrenia have difficulties in what we call anticipatory pleasure
. This term encompasses both the anticipation of future pleasurable experiences as well as the experience of pleasure in anticipation of future events.
The ability to anticipate whether something in the future will be pleasurable requires complex cognitive skills, such as imagination, reflection, drawing upon past experiences, and maintaining an image or emotional state. Thus, the latest wave of research on emotion in schizophrenia explicitly integrates emotion and cognition, or feeling and thinking. What do we mean by cognition? Broadly, cognition refers to a set of mental or thought processes, such as attending, thinking, remembering, perceiving, and deciding. In , we point to several emotion–cognition interactions that come into play in the temporal experience of pleasure. For example, consider the problem of what to have for dinner. You consider pizza, which may then lead you to summon a past experience of eating pizza from the neighborhood pizzeria (activating a representation and holding this in working memory), which prompts you to predict that the pizza will be very enjoyable; indeed you experience pleasure now, knowing you will soon be eating tasty pizza (i.e., anticipatory pleasure). These processes will support your motivational system such that you will order and pick up the pizza (approach motivation and behavior), and once you eat it, you will experience in-the-moment or consummatory pleasure. You will savor (maintain) the pleasure from the pizza, and this experience will be encoded into memory. Thus, the next time you contemplate dinner, this memory may be called upon to kick-start the process all over again.
Fig. 1 A model of the temporal experience of pleasure. A pleasurable experience may involve activating a cognitive representation of a past, related experience that will then trigger a process of predicting or anticipating what the new experience will feel like (more ...)
Cognitive and affective neuroscience research with healthy people has clearly demonstrated that the brain is not simply divided into regions specific to our psychological concepts, such as cognition and emotion. Instead, overlapping brain regions support thinking and feeling in interesting and complex ways (e.g., Barrett, 2009
). Understanding cognition–emotion interactions is also at the forefront of research on mental illness (Taylor & Liberzon, 2007
Cognitive neuroscience findings in healthy people suggest that our ability to forecast relies on our ability to remember the past (e.g., Schacter, Addis, & Buckner, 2007
), with a core network of brain regions, including areas of the medial prefrontal and medial temporal cortex, supporting both abilities. Thus, when we imagine what it will be like to have a tasty dinner with friends, we likely draw on our past experiences with dinners and friends to help imagine this future experience. Maintaining and processing emotional experiences as they occur no doubt facilitates the development of memories for these experiences, and evidence from psychophysiological and fMRI studies finds that people with schizophrenia appear to have difficulty holding on to these experiences (Horan, Wynn, Kring, Simons, & Green, 2010
; Kring, Germans Gard, & Gard, 2010; Ursu et al., in press
Only a few studies to date have examined whether people with schizophrenia can retrieve memories of their emotional experiences, and even fewer have examined the relationship between memory and anticipation. One study found that people with schizophrenia were able to recall their feelings about positive films and foods 4 hours later (Horan, Green, Kring, & Neuchterlein, 2006
). However, the majority of the work in this area focuses on recalling emotional stimuli (which is distinguishable from remembering feelings). For example, one study found that people with schizophrenia had difficulty recalling positive emotional stimuli 24 hours later (Herberner, Rosen, Khine, & Sweeney, 2007). Research with healthy people has found that emotionally arousing events and stimuli are remembered better than neutral ones. However, individuals with schizophrenia may not exhibit this enhancement for remembering emotional stimuli (Hall, Harris, McKirdy, Johnstone, & Lawrie, 2007
A study that investigated the link between memory and anticipation in schizophrenia found that people with schizophrenia recalled fewer specific memories and generated fewer specific anticipated future events than did people without the disorder (D’Argembeau, Raffard, & van der Linden, 2008
). It will be particularly important to explicitly examine the linkage between envisioning the future and remembering the past, particularly for emotional events among people with schizophrenia, both at the behavioral and neural levels.
Other investigators have begun to examine how cognitive control, which refers to a broad array of processes including direction of attention to relevant information, maintenance of contextual information to guide behavior, and monitoring of novel information for its relevance to current goals, can influence emotional experience. For example, Dichter, Bellion, Casp, and Belger (2009)
examined how, among people with and without schizophrenia, attention and emotion interact. The daily-life analog to this type of experiment might be paying attention to road signs on your way to a destination despite a screaming toddler in the backseat of your car. Findings indicated that healthy individuals activated different brain regions to facilitate attention to the demands of a task (e.g., more dorsal regions of the prefrontal cortex) while at the same time inhibiting attention to emotionally distracting information (e.g., more ventral areas of the prefrontal cortex), whereas people with schizophrenia did not. Ursu et al. (in press)
found that people with and without schizophrenia exhibited comparable activations in the ventromedial prefrontal cortex while viewing emotionally evocative pictures. However, healthy controls continued to show activation in the dorsolateral and ventromedial prefrontal cortex during a 12-second delay between picture viewing and reporting emotional experience, presumably reflecting the active maintenance and control of their feelings, whereas people with schizophrenia did not show this persistent activation.