Motivation and Pleasure Deficits Undermine the Benefits of Social Affiliation in Psychosis

Socially relevant affective learning in psychosis: Relations to deficits in motivation and pleasure and cognitive ability

Negative symptoms are common in psychotic disorders and significantly contribute to functional impairment. Deficits in reward processing and memory have been implicated as important factors which contribute to negative symptoms, leading to speculation that deficits in learning and memory of socially relevant information may be particularly important. Previous work has also found poorer learning of positive social behavior associations in psychotic disorders, but limitations have prevented an examination of symptom correlates of this diminished learning. In the present study, we used an updated social affective learning task to examine whether diminished accuracy in learning the affective value of others was related to motivation and pleasure negative symptoms as well as cognitive deficits. Results indicated that participants were able to use both positive and negative behavioral information to generate accurate socially evaluative perceptions. Results also demonstrated that reduced accuracy of learning from positive behavioral information was related to greater motivation and pleasure symptoms and cognitive deficits, including working memory, while reduced accuracy of learning from negative behavioral information was only related to cognitive deficits across multiple domains. When controlling for cognition, motivation and pleasure symptoms were no longer related to positive affective learning, but working memory remained related to learning when controlling for motivation and pleasure symptoms. These findings underscore the role of diminished positive affective learning in negative symptoms and suggest that poorer learning of the positive value of others may be one pathway through which cognitive deficits lead to reduced reward anticipation, defeatist performance beliefs, and negative symptoms.

Blunted Ventral Striatal Reactivity to Social Reward Is Associated with More Severe Motivation and Pleasure Deficits in Psychosis

BACKGROUND AND HYPOTHESIS

Among individuals living with psychotic disorders, social impairment is common, debilitating, and challenging to treat. While the roots of this impairment are undoubtedly complex, converging lines of evidence suggest that social motivation and pleasure (MAP) deficits play a central role. Yet most neuroimaging studies have focused on monetary rewards, precluding decisive inferences.

STUDY DESIGN

Here we leveraged parallel social and monetary incentive delay functional magnetic resonance imaging paradigms to test whether blunted reactivity to social incentives in the ventral striatum-a key component of the distributed neural circuit mediating appetitive motivation and hedonic pleasure-is associated with more severe MAP symptoms in a transdiagnostic adult sample enriched for psychosis. To maximize ecological validity and translational relevance, we capitalized on naturalistic audiovisual clips of an established social partner expressing positive feedback.

STUDY RESULTS

Although both paradigms robustly engaged the ventral striatum, only reactivity to social incentives was associated with clinician-rated MAP deficits. This association remained significant when controlling for other symptoms, binary diagnostic status, or striatal reactivity to monetary incentives. Follow-up analyses suggested that this association predominantly reflects diminished activation during the presentation of social reward.

CONCLUSIONS

These observations provide a neurobiologically grounded framework for conceptualizing the social-anhedonia symptoms and social impairments that characterize many individuals living with psychotic disorders and underscore the need to develop targeted intervention strategies.

Interpersonal consequences of paranoid ideation, negative symptoms and sleep problems in a transdiagnostic sample of individuals with psychosis

Paranoid ideation is a transdiagnostic construct that is associated with social impairment and often occurs in psychotic spectrum disorders. Little research has examined how paranoid ideation is related to social behaviors that underlie social impairment and may ultimately lead to social rejection. It is important to consider that negative symptoms and sleep problems also contribute to social impairment. No research has assessed the unique and combined influence of paranoid ideation, negative symptoms, and sleep problems on social impairment. Therefore, the current study examined how paranoid ideation, negative symptoms, and sleep problems contribute to poorer social skills and social rejection in a transdiagnostic sample of persons with psychosis and community members (N = 112). Assessments included diagnostic and symptom interviews, questionnaires, behavioral ratings of social skill and facial displays of affect, and naive observer reactions utilizing thin-slice methodology. Greater paranoid ideation, negative symptoms, and sleep problems were each related to poorer social skill and more negative reactions from observers. When considered in path analyses, negative symptoms were associated with observer reports of less willingness to interact with participants through poorer social skill. These findings demonstrate the symptom correlates of social rejection and how interpersonal behavior may contribute to social exclusion.