Reduced anhedonia following internet-based cognitive-behavioral therapy for depression is mediated by enhanced reward circuit activation

Shir Hanuka, Elizabeth A. Olson, Roee Admon, Christian A. Webb, William D.S. Killgore, Scott L. Rauch, Isabelle M. Rosso, Diego A. Pizzagalli

Research output: Contribution to journalArticlepeer-review


Background Major depressive disorder (MDD) is a highly prevalent psychiatric condition, yet many patients do not receive adequate treatment. Novel and highly scalable interventions such as internet-based cognitive-behavioral-therapy (iCBT) may help to address this treatment gap. Anhedonia, a hallmark symptom of MDD that refers to diminished interest and ability to experience pleasure, has been associated with reduced reactivity in a neural reward circuit that includes medial prefrontal and striatal brain regions. Whether iCBT can reduce anhedonia severity in MDD patients, and whether these therapeutic effects are accompanied by enhanced reward circuit reactivity has yet to be examined. Methods Fifty-two MDD patients were randomly assigned to either 10-week iCBT (n = 26) or monitored attention control (MAC, n = 26) programs. All patients completed pre- and post-treatment assessments of anhedonia (Snaith-Hamilton Pleasure Scale; SHAPS) and reward circuit reactivity [monetary incentive delay (MID) task during functional magnetic resonance imaging (fMRI)]. Healthy control participants (n = 42) also underwent two fMRI scans while completing the MID task 10 weeks apart. Results Both iCBT and MAC groups exhibited a reduction in anhedonia severity post-treatment. Nevertheless, only the iCBT group exhibited enhanced nucleus accumbens (Nacc) and subgenual anterior cingulate cortex (sgACC) activation and functional connectivity from pre- to post-treatment in response to reward feedback. Enhanced Nacc and sgACC activations were associated with reduced anhedonia severity following iCBT treatment, with enhanced Nacc activation also mediating the reduction in anhedonia severity post-treatment. Conclusions These findings suggest that increased reward circuit reactivity may contribute to a reduction in anhedonia severity following iCBT treatment for depression.

Original languageEnglish
Pages (from-to)4345-4354
Number of pages10
JournalPsychological Medicine
Issue number10
StatePublished - 17 Jul 2023

Bibliographical note

Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press.


  • Anhedonia
  • fMRI
  • internet-based cognitive-behavioral therapy (iCBT)
  • major depressive disorder (MDD)
  • monetary incentive delay (MID)
  • reward circuit

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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