Longitudinal associations between perceived stress and anhedonia during psychotherapy

Abstract

Background: Chronic stress alters reward sensitivity and contributes to the emergence of anhedonia. In clinical samples, the perception of stress is a strong predictor of anhedonia. While there is substantial evidence demonstrating psychotherapy reduces perceived stress, little is known regarding the effects of treatment-related decreases in perceived stress on anhedonia.

Methods: The current study investigated reciprocal relations between perceived stress and anhedonia using a cross-lagged panel model approach in a 15-week clinical trial examining the effects of Behavioral Activation Treatment for Anhedonia (BATA), a novel psychotherapy to treat anhedonia, compared to a Mindfulness-Based Cognitive Therapy (MBCT) comparison intervention (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136).

Results: Treatment completers (n = 72) experienced significant reductions in anhedonia (M = -8.94, SD = 5.66) on the Snaith-Hamilton Pleasure Scale (t(71) = 13.39, p < .0001), and significant reductions in perceived stress (M = -3.71, SD = 3.88) on the Perceived Stress Scale (t(71) = 8.11, p < .0001) following treatment. Across all treatment-seeking participants (n = 87), a longitudinal autoregressive cross-lagged model revealed significant paths showing that higher levels of perceived stress at treatment Week 1 predicted reductions in anhedonia at treatment Week 4; lower levels of perceived stress at Week 8 predicted reductions in anhedonia at Week 12. Anhedonia did not significantly predict perceived stress at any stage of treatment.

Conclusions: This study showed specific timing and directional effects of perceived stress on anhedonia during psychotherapy treatment. Individuals with relatively high perceived stress at the start of treatment were more likely to report relatively lower anhedonia a few weeks into treatment. At mid-treatment, individuals with low perceived stress were more likely to report lower anhedonia towards the end of treatment. These results demonstrate that early treatment components reduce perceived stress, thus allowing for downstream changes in hedonic functioning during mid-late treatment. The findings presented here suggest it will be critically important for future clinical trials evaluating novel interventions for anhedonia to measure stress levels repeatedly, as an important mechanism of change.

Trial name: Development of a Novel Transdiagnostic Intervention for Anhedonia - R61 Phase. TRIAL URL: https://clinicaltrials.gov/ct2/show/NCT02874534.

Trial registration number: NCT02874534.

Keywords: Anhedonia; Longitudinal analysis; Perceived stress; Psychotherapy; Transdiagnostic.

Fig 1.. Autoregressive cross-lagged panel model of anhedonia and perceived stress over 15 weeks of psychotherapy treatment.

Time-invariant covariates are age, sex, and treatment group, which were regressed on treatment (Tx) week 15 observed variables. Gamma coefficients represent the directional paths from exogenous to endogenous variables. Beta coefficients represent the directional paths between endogenous variables. Zeta coefficients represent the error variance terms for endogenous variables. Phi coefficients represent the covariances between exogenous variables. Psi coefficients represent the covariances between error variances linked to endogenous variables.

Fig 2.. Treatment-related decline in perceived stress was associated with treatment-related decline in anhedonia severity.

Multiple regression line for the association between change scores for perceived stress, measured by the Perceived Stress Scale (PSS), and change scores for anhedonia, measured by the Snaith-Hamilton Pleasure Scale (SHAPS). Change scores represent post-treatment minus pre-treatment scores. Covariates for age, sex, and treatment-group were included.

Fig 3.. Estimated autoregressive cross-lagged model (CLPM) of anhedonia and perceived stress across psychotherapy treatment.

One-headed dash lines represent auto-regressive paths; one-headed solid lines represent cross-lag paths; two-headed solid lines represent concurrent associations among variables at the same week in treatment. For ease of interpretation, error variance terms and covariates of age, sex, and treatment group are not included in the visualization. Values presented are standardized path coefficients.**p< 0.001, *p<.05, ^p<.10.