A parallel-arm, randomized trial of Behavioral Activation Therapy for anhedonia versus mindfulness-based cognitive therapy for adults with anhedonia

Paul M Cernasov; Erin C Walsh; Gabriela A Nagy; Jessica L Kinard; Lisalynn Kelley; Rachel D Phillips; Angela Pisoni; Joseph Diehl; Kevin Haworth; Jessica West; Louise Freeman; Courtney Pfister; McRae Scott; Stacey B Daughters; Susan Gaylord; Gabriel S Dichter; Moria J Smoski

doi:10.1016/j.brat.2024.104620

A parallel-arm, randomized trial of Behavioral Activation Therapy for anhedonia versus mindfulness-based cognitive therapy for adults with anhedonia

Behav Res Ther. 2024 Nov:182:104620. doi: 10.1016/j.brat.2024.104620. Epub 2024 Aug 23.

Authors

Paul M Cernasov¹, Erin C Walsh², Gabriela A Nagy³, Jessica L Kinard⁴, Lisalynn Kelley⁵, Rachel D Phillips⁶, Angela Pisoni⁷, Joseph Diehl⁷, Kevin Haworth⁵, Jessica West⁵, Louise Freeman⁶, Courtney Pfister⁶, McRae Scott⁶, Stacey B Daughters⁶, Susan Gaylord⁸, Gabriel S Dichter⁹, Moria J Smoski¹⁰

Affiliations

¹ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: paul.cernasov@unc.edu.
² Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
³ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Duke University School of Nursing, Durham, NC, USA.
⁴ Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
⁶ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
⁸ Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
⁹ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
¹⁰ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.

PMID: 39213738
PMCID: PMC11519751 (available on 2025-11-01)
DOI: 10.1016/j.brat.2024.104620

Abstract

Background: Anhedonia, deficits in motivation and pleasure, is a transdiagnostic symptom of psychopathology and negative prognostic marker.

Methods: In this randomized, parallel-arm clinical trial, a novel intervention, Behavioral Activation Treatment for Anhedonia (BATA), was compared to an individually administered Mindfulness-Based Cognitive Therapy (MBCT) in a transdiagnostic cohort of adults with clinically significant anhedonia (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Participants received 8-15 individual psychotherapy sessions, once weekly, with either BATA (n = 61) or MBCT (n = 55) and completed repeated self-report assessment of anhedonia and other internalizing symptoms.

Results: Indicators of treatment feasibility were similar across conditions, though MBCT showed a trend towards greater attrition rates than BATA, with an adjusted odd's ratio of 2.04 [0.88, 4.73]. Treatment effects on the primary clinical endpoint of anhedonia symptoms did not significantly differ, with a 14-week estimated difference on the Snaith Hamilton Pleasure Scale (SHAPS) of -0.20 [-2.25, 1.84] points in BATA compared to MBCT (z = 0.19, p = 0.845, d = 0.05). The expected 14-week change in SHAPS scores across conditions was -7.18 [-8.22, -6.15] points (z = 13.6, p < 0.001, d = 1.69). There were no significant differences in the proportion of participants demonstrating reliable and clinically significant improvements in SHAPS scores, or in the magnitude of internalizing symptom reductions.

Limitations: Limitations included a modest sample size, lack of longer-term follow up data, and non-preregistered analytic plan.

Discussion: There was no evidence to support superior clinical efficacy of BATA over MBCT in a transdiagnostic cohort of adults with elevated anhedonia. Both interventions reduced anhedonia symptoms to a comparable magnitude of other existing treatments.

Keywords: Anhedonia; Behavioral activation; Mindfulness; SHAPS.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adult
Anhedonia*
Behavior Therapy / methods
Cognitive Behavioral Therapy* / methods
Female
Humans
Male
Middle Aged
Mindfulness* / methods
Treatment Outcome
Young Adult

Associated data

ClinicalTrials.gov/NCT02874534
ClinicalTrials.gov/NCT04036136

Abstract

Publication types

MeSH terms

Associated data

Grants and funding