By: Dr. W. Scott West, Chief Medical Officer, Nashville NeuroCare Therapy
When you’re struggling with depression, even the smallest, most basic tasks can feel impossible. Things you once enjoyed can lose their appeal. This is called anhedonia, and it’s one of the two hallmark symptoms of a Major Depressive episode. The APA defines it as “the inability to enjoy experiences or activities that normally would be pleasurable,” and it can relate to other disorders like schizophrenia in addition to depression.
When things you used to be able to predict would bring you joy, pleasure, or comfort fail to do so, our internal reward systems become confused. You might do the same action that was once reliably pleasurable— embark on a favorite activity, hang out with friends, eat delicious food— and instead of pleasure, there’s . . . nothing.
Pleasure, pain, and motivation are intrinsically linked. We are motivated to do something if we can rely on it to bring us pleasure or alleviate pain.
For example, let’s say you’re hungry:
- Hunger feels unpleasant.
- You go to the pantry and grab a snack.
- You eat the snack.
- The snack is tasty (pleasure) and alleviates your hunger (pain relief).
- From this experience, you learn that going to the pantry results in pleasure and pain relief.
- The next time you’re hungry, you’ll be motivated to go to the pantry and get a snack so you can experience the same pleasure and pain relief.
Let’s say, however, you receive no pleasure from either the taste or the sensation of hunger satiation. If that’s the case, you’d have little to no incentive to seek out the pantry snacks. Things that you could once count on to bring you pleasure stop being enticing or motivating at all.
This can become a vicious cycle. Coping strategies and activities that once helped you regulate and improve your mood no longer seem to work, so you might stop trying them altogether. This works with pain relief and survival, as well. Activities you need to do to survive and avoid pain— like showing up to work, taking care of your body and home, and even feeding yourself— can also feel impossible with anhedonia.
Some studies even suggest that the essence of anhedonia as experienced by those with major depression and schizophrenia is often more of an “‘avolition’ or more specific impairment of incentive motivation” rather than a literal loss of sensory pleasures (NCBI). This might explain how people often know what they should do to make themselves feel better, but no matter how bad their mood, they can’t seem to force themselves to practice their coping strategies.
Regardless of the shapes anhedonia can take, it can be challenging for those not experiencing it to understand what this could feel like to not experience pleasure from things we enjoy or to not be able to activate on things we know will make us feel good.
So, how can someone experiencing anhedonia break the cycle and begin to experience pleasure again? Or, at the very least, find the motivation to get out of bed in the morning?
The ideal solution is going to the source of anhedonia and seeking treatment for depression. However, as we just described, finding the motivation to get help can feel overwhelming with anhedonia. How can someone work up the motivation to make the phone call, schedule the consultation, show up, do the intake paperwork . . . and all the other steps necessary to meet with a mental health professional?
Tiny habits are a great strategy to make large tasks or changes so much more manageable than they seem at first glance. Stephen Guise, the author of Mini Habits: Smaller Habits, Bigger Results, is a proponent for what he calls “too-small-to-fail habits.” These are actions so small, so simple, that anyone can do them without fail.
For example, if you are trying to exercise more, you might set the goal to do one pushup a day. Just one. Or, if you’re trying to read more, read just one page of a book. While you have no expectation or commitment to do any more pushups or read more of your book, chances are you might do another. Or 12 more. Or 20. Any extra you do, however, is a bonus. Simply showing up and doing the one, tiny, and, most importantly, achievable thing is success in itself.
There are many reasons this tactic works for most people. For one, it helps you build confidence in your own ability to change your life. When stuck in the cycle of anhedonia, it can be easy to believe that nothing you do makes a difference. But, when you make and stick to one tiny habit, you prove to yourself that you can do the things you say you’ll do, even if it’s just one pushup.
Also, so often, when we set goals, we bite off more than we can chew. We shoot too high under the assumption that even if we miss our goal, we’ll have done something. Unfortunately, this ends up being an unsustainable approach for most people. Rather than interpreting the effort itself as success, humans often get discouraged that we didn’t reach our intended target and stop trying altogether. However, suppose you flip it, and you intentionally shoot for much (or much, much) less than you can realistically accomplish. In that case, chances are you’ll certainly meet if not exceed your own expectations. And, when it comes to time to grow your goals, you can do so in small, slow increments that are proportionally achievable.
Research on habit formation tells us that “‘habits’ are defined as actions that are triggered automatically in response to contextual cues that have been associated with their performance” (NCBI). For instance, you might wash your hands (action) after using the bathroom (contextual cue). The cue then spurs the action, which is then followed by a reward. This reward might be a natural consequence of the action, such as endorphins from exercise or dopamine from a delicious snack, or it might be something external that you offer yourself for completing your action, like a gold star.
With anhedonia, rewards don’t always hit as hard, so sometimes, the reward is the intellectual knowledge that you are building a good life for yourself and will be able to enjoy one day when your anhedonia lifts.
You can use the science of miniature habits to support your journey towards the treatment of your depression. Maybe one day, your only goal is to tell a friend (action), then you treat yourself with your favorite snack (reward). Then, maybe the next week, you and your friend call a therapist (action) and then watch your favorite movie together (reward). Breaking up all the steps to getting help can make it feel more achievable. Of course, it’s important to set up a contextual cue to remind you to do your action. Maybe you do it first thing in the morning when your alarm goes off or at night when you climb into bed. Maybe you set an alarm at lunch to remind you to do your one tiny thing.
The good news— and your impending reward— is that depression is absolutely treatable. You don’t have to live in the gray fog of anhedonia forever. At Nashville NeuroCare Therapy, we specialize in treating depression with TMS Therapy, or transcranial magnetic stimulation therapy.
In depressed brains, centers that regulate mood and behavior are often underactive. Using gentle, magnetic stimulation, we activate these underdeveloped centers in the brain. The stimulation from the magnetic-pulse technology encourages the brain to build and strengthen neural pathways so your brain can start regulating your mood and behavior all on its own and without the aid of medication. This offers long-lasting, self-sustaining relief without any adverse side effects commonly associated with medications. TMS Therapy is the APA’s professional recommendation to try if antidepressants haven’t been offering you relief from your depression. TMS Therapy could be the treatment option you’ve been missing.
Schedule a consultation with our office for today, then reward yourself. As we well know, reaching out can be the hardest step. You deserve it.
