Unpacking the Anhedonia Paradox Across the Psychosis Continuum: The Role of the Positivity Offset

Conceptual models of negative symptoms evolved to explain how seemingly intact hedonic capacity fails to translate to motivated behavior in SZ; however, Cacioppo’s Evaluative Space Model indicates that hedonic deficits are apparent in the form of a reduced positivity offset (i.e., experiencing lower levels of positive relative to negative emotion when affective input is absent). Prior evidence indicates that the positivity offset is reduced across the psychosis continuum and associated with negative symptoms, suggesting it may contribute to the disjunction between hedonic and volitional responding in SZ, as well as differences in hedonic capacity along the psychosis continuum. The current study examined the positivity offset during a laboratory-based emotional experience task in two samples: (1) individuals with SZ (n = 98) and healthy controls (CN: n = 84); (2) individuals at clinical high-risk (CHR) for psychosis (n = 45) and CN (n = 51). Results indicated that SZ is best characterized by intact hedonic capacity, as well as a reduced positivity offset that is associated with more severe anhedonia and avolition. CHR demonstrated an intact positivity offset that was not associated with anhedonia or avolition. Findings add to current conceptual models of negative symptoms by demonstrating distinct emotional abnormalities that may underlie anhedonia at different phases of psychotic illness.