Multi-modal assessment of reward functioning in adolescent anhedonia.

BACKGROUND: Anhedonia is a core symptom of depression that predicts worse treatment outcomes. Dysfunction in neural reward circuits is thought to contribute to anhedonia. However, whether laboratory-based assessments of anhedonia and reward-related neural function translate to adolescents' subjective affective experiences in real-world contexts remains unclear. METHODS: We recruited a sample of adolescents (n = 82; ages 12-18; mean = 15.83) who varied in anhedonia and measured the relationships among clinician-rated and self-reported anhedonia, behaviorally assessed reward learning ability, neural response to monetary reward and loss (as assessed with functional magnetic resonance imaging), and repeated ecological momentary assessment (EMA) of positive affect (PA) and negative affect (NA) in daily life. RESULTS: Anhedonia was associated with lower mean PA and higher mean NA across the 5-day EMA period. Anhedonia was not related to impaired behavioral reward learning, but low PA was associated with reduced nucleus accumbens response during reward anticipation and reduced medial prefrontal cortex (mPFC) response during reward outcome. Greater mean NA was associated with increased mPFC response to loss outcome. CONCLUSIONS: Traditional laboratory-based measures of anhedonia were associated with lower subjective PA and higher subjective NA in youths' daily lives. Lower subjective PA and higher subjective NA were associated with decreased reward-related striatal functioning. Higher NA was also related to increased mPFC activity to loss. Collectively, these findings demonstrate that laboratory-based measures of anhedonia translate to real-world contexts and that subjective ratings of PA and NA may be associated with neural response to reward and loss.

Reported Personality Traits and Histories of Childhood Maltreatment in Borderline Personality Disorder and Bipolar 2 Disorder: A Comparative Study.

This study compared borderline personality disorder (BPD) and bipolar 2 disorder (BP 2 disorder) with respect to reported childhood trauma and Five-Factor personality traits using the Childhood Trauma Questionnaire (CTQ) and the NEO Five-Factor Inventory (NEO-FFI). Participants were 50 men and women, aged 18-45, with DSM-5-diagnosed BPD and 50 men and women in the same age group with DSM-5-diagnosed BP 2 disorder. Participants could not meet criteria for both BPD and BP 2 disorder. Borderline participants had significantly higher scores on the neuroticism subscale and significantly lower scores on the agreeableness subscale of the NEO-FFI. After correction for multiple comparisons, there were no between-group differences on CTQ scores. Study results suggest that BPD and BP 2 disorder differ primarily with respect to underlying temperament/genetic architecture and that environmental factors have only a limited role in the differential etiologies of the two disorders.

Personalized prescriptions of therapeutic skills from patient characteristics: An ecological momentary assessment approach.

OBJECTIVE: Rather than relying on a single psychotherapeutic orientation, most clinicians draw from a range of therapeutic approaches to treat their clients. To date, no data-driven approach exists for personalized predictions of which skill domain would be most therapeutically beneficial for a given patient. The present study combined ecological momentary assessment (EMA) and machine learning to test a data-driven approach for predicting patient-specific skill-outcome associations. METHOD: Fifty (Mage = 37 years old, 54% female, 84% White) adults received training in behavioral therapy (BT) and dialectical behavior therapy (DBT) skills within a behavioral health partial hospital program (PHP). Following discharge, patients received four EMA surveys per day for 2 weeks (total observations = 2,036) assessing the use of therapeutic skills and positive/negative affect (PA/NA). Clinical and demographic characteristics were submitted to elastic net regularization to predict, via cross-validation, patient-specific associations between the use of BT versus DBT skills and level of PA/NA. RESULTS: Cross-validated accuracy was 81% (sensitivity = 93% and specificity = 63%) in predicting whether a patient would exhibit a stronger association between the use of BT versus DBT skills and PA level. Predictors of positive DBT skills-PA associations included higher levels of nonsuicidal self-injury (NSSI) and sleep disturbance, whereas predictors of positive BT skills-PA relations included higher emotional lability and anxiety disorder comorbidity, and lower psychomotor retardation/agitation and worthlessness/guilt. Corresponding models with NA yielded no predictors. CONCLUSIONS: Findings from this initial proof-of-concept study highlight the potential of data-driven approaches to inform personalized prescriptions of which skill domains may be most therapeutically beneficial for a given patient. (PsycInfo Database Record (c) 2022 APA, all rights reserved).