Illuminating a joyless life: qualitative, transdiagnostic exploration of anhedonia

BACKGROUND: Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions. AIMS: The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective. METHOD: Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes. RESULTS: Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia. CONCLUSIONS: The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.