Background: Anhedonia is a persistent symptom of mental health problems and often emerges early in life. Chronic stress has been shown to predict anhedonia over time, and identifying modifiable processes in this pathway can inform early intervention efforts. Negative cognitive style has been preliminarily suggested to contribute to anhedonia, though their relationship has seldom been tested directly. We examined whether negative cognitive style (global attributions, stable attributions, negative consequentiality, and self-worth implications) mediated the pathway from chronic stress (interpersonal and non-interpersonal) to anhedonia. Methods: We analysed longitudinal data from the Youth Emotion Project of 627 participants, aged 15–17 years at baseline, across 10 annual waves. We used multilevel structural equation modelling to estimate lagged direct and indirect effects at within- and between-person levels. Analyses were repeated adjusting cognitive style for baseline neuroticism. Results: We observed some evidence of between-person mediation. Those reporting greater interpersonal stress compared to others reported a more negative cognitive style, though effects attenuated after adjusting for neuroticism. Several cognitive style components (except global attributions and neuroticism-adjusted self-worth implications) predicted higher anhedonia at the between-person level, whereas stable attributions showed an inverse association. Those reporting greater non-interpersonal stress compared to others reported fewer stable attributions and higher neuroticism-adjusted global attributions. On the within-person level, only higher non-interpersonal stress and stable attributions predicted increases in anhedonia, with no evidence of mediation. Conclusions: Certain aspects of negative cognitive style may confer risk for developing anhedonia, but specificity beyond neuroticism is unclear. Findings underscore the importance of leveraging longitudinal data to disaggregate within- and between-person effects. Future research should incorporate diverse samples, consider measurement windows, and use ecological momentary assessment.

Background:Adolescent mental health care is constrained not only by limited treatment capacity but also by the absence of precise and efficient tools to identify and triage those in need. Measurement-based mental health care relies on standardized assessments to guide identification, treatment selection, and ongoing monitoring of mental disorders. However, conventional assessments present a trade-off: diagnostic interviews lack feasibility at scale, while brief screening tools result in misclassification and suboptimal allocation of limited mental health resources. Computerized adaptive testing addresses this trade-off by dynamically tailoring assessments to individuals, maximizing measurement precision while minimizing assessment burden. Despite these advances, no adaptive assessment for adolescent mental health has been developed or calibrated using African data. Objective:The AfriCAT study aims to develop and internally validate a precision computerized adaptive assessment of adolescent depression and anxiety using nationally representative Kenyan data, with the longer-term goal of supporting measurement-based mental health care across diverse African contexts. Methods:AfriCAT is a mixed methods study integrating psychometric modeling, adaptive simulation, modular clinical decision support networks, participatory workshops, discrete choice experiments (DCEs), and stakeholder interviews. Diagnostic Interview Schedule for Children, version 5 (DISC-5) modules assessing major depressive disorder, generalized anxiety disorder, social phobia, and posttraumatic stress disorder among adolescents aged 10 to 17 years from the Kenya National Adolescent Mental Health Survey (N=5155) will form the item bank. Adaptive engines will be developed using a bifactor multidimensional item response theory framework and a modular neural architecture. Simulation-based internal validation will evaluate precision, efficiency, and diagnostic classification relative to DISC-5 diagnoses. Participatory workshops in Kenya and South Africa, DCEs to quantify adolescent preferences, and stakeholder interviews will inform refinement of adolescent- and provider-facing prototypes. Results:Ethical approval has been obtained from the Human Research Ethics Committee (Medical) at the University of the Witwatersrand and the Aga Khan University Institutional Scientific and Ethics Review Committee. Data preparation and model development are underway. Participatory workshops and DCEs are ongoing. Simulation-based validation and prototype refinement will follow. Conclusions:AfriCAT aims to develop the first adaptive mental health assessment calibrated using nationally representative African adolescent data. By integrating precision psychometrics with participatory co-design, the study seeks to enable more accurate triage and support scalable, measurement-based adolescent mental health care in resource-constrained settings.

Objectives:This study explores the capability of passive digital sensor data from smartphones and smartwatches to predict self-reported ecological momentary assessments (EMA) of affect, motivation, interest, and pleasure in activities in an unseen test sample. Materials and Methods:Data were collected from 245 depressed participants with high-to-low anhedonia (195 train, 50 test) generating 23 812 EMA sessions. Machine learning models were used to assess the ability of behavioral and physiological features, aggregated over windows of 15 minutes to 3 hours, to predict momentary subjective states. Results:For 12 of 15 EMA questions asked, machine learning models exceeded random chance in the fully-held-out test sample, suggesting detectable signals between passive measures and subjective states. Dependent on the sensor type, the optimal aggregation periods ranged from 15 minutes to 3 hours, with generally at least two hours of data being required. Subgroup analyses revealed variations in model performance by demographics, depression severity, and anhedonia severity. Conclusion:This study establishes the feasibility of using passive digital sensing to detect momentary subjective states, providing a baseline for scalable, non-invasive mental health monitoring.

Psychiatric neuroscience typically examines categorical diagnoses and brain systems in isolation. This approach is complicated by comorbidity and within-diagnosis heterogeneity and fails to evaluate whether relationships are unique to, or common across, neural circuits. To address this, we examined associations between reward and threat neural activity and symptoms of General Distress, Fears, and Anhedonia-Apprehension from the tri-level model of depression and anxiety. Data were collected on 339 participants aged 18-19; 272 completed a monetary incentive delay task (MID) assessing reward neural activity and a Pavlovian fear learning task assessing threat neural activity. We used full-information maximum likelihood to handle missing data and thus retained all 339 participants in each analysis. As predicted, heightened Anhedonia-Apprehension was associated with lower orbitofrontal cortex activity during reward receipt in the MID task (b = -.34, se = .147, p = .021). This relationship was specific to Anhedonia-Apprehension relative to other symptom dimensions and to orbitofrontal activity during reward receipt relative to threat-related neural activity. Heightened Anhedonia-Apprehension was also associated with lower ventral striatal activation during reward anticipation in the MID reward task (b = -.53, se = .218, p = .015). Unexpectedly, heightened Anhedonia-Apprehension was also associated with heightened threat neural activity during the extinction phase of the Pavlovian fear learning task (b = .21, se = .066, p = .001). Findings highlight the importance of examining associations between specific brain systems and empirically derived symptom dimensions to better understand mental health problems and develop targeted interventions.

Anxiety disorders are chronic, pervasive, and debilitating; characterised by a persistent or exaggerated response to distal or abstract threats. Impaired threat discrimination (distinguishing safe from threatening stimuli) and impaired threat extinction (learning a once threatening stimulus is now safe), are known risk factors in the development and persistence of anxiety disorders. These effects can be experimentally elicited through fear conditioning. First, repeated trials of paired aversive and neutral stimuli are delivered during a fear acquisition phase, followed by repeated trials with no aversive stimuli in a fear extinction phase. The effects are typically measured through comparison of end-phase data points, or simple descriptive or statistical models. Computational modelling, by contrast, can offer a hypothesis-driven, trial-by-trial mechanistic account of fear conditioning. This unmasks within subject task variance by estimating the rate of threat learning, safety learning, and threat extinction, examining individual differences in the cognitive mechanisms behind anxiety. A normative sample (n = 145) underwent a differential fear conditioning task on a bespoke smartphone app, in addition to completing an anxiety severity measure (GAD-7). Computational models fitted to task data estimated learning rates. Whilst the threat learning rate showed no association, the threat extinction and safety learning rates showed small negative associations with anxiety severity (ρ = –0.22, p = 0.01 & ρ = –0.21, p = 0.01 respectively). These findings are in keeping with prior studies using traditional analytical approaches, and indicate that anxious individuals are not quicker to develop fear of a stimulus, but take more time than their non-anxious counterparts to learn that a stimulus is safe. This study strengthens the evidence for impairments in fear extinction in those with anxiety, and the importance of learning rates as an index of anxiety severity, a previously hidden cognitive mechanism underlying anxiety persistence.

Sensory over-responsivity (SOR) is a heightened reaction to environmental stimuli commonly seen in autism spectrum disorder (ASD) which impacts daily functioning. Parent-reported and observed behavioral assessments are used to study SOR, but show limited associations with each other, possibly because they measure different aspects of SOR or because children inhibit their responses during standardized assessments. Physiological measures provide an objective measure of sensory reactivity, and atypical heart rate (HR) responses to aversive stimuli have been shown to be related to SOR in ASD youth. This study aimed to compare how reported and observed measures of SOR predict HR and to examine if the level of reported behavioral inhibition in ASD youth affects how observed SOR behaviors correlate with physiological reactivity. Participants were 54 typically developing (TD) and 83 ASD youth, ages 8–17, who completed a standardized behavioral assessment of SOR while electrocardiogram recordings were collected. Participants’ parents also reported on their child’s SOR symptoms and behavioral inhibition. ASD youth showed lower inter-beat-intervals (IBI; higher HR) across all auditory and tactile stimuli. For ASD youth, parent-reported SOR interacted with observed SOR to predict HR changes across the stimulation periods, indicating that ASD participants whose parents reported they had high SOR in their daily life, and showed high observed SOR in the lab assessment, exhibited reduced HR deceleration (orienting) after the onset of the stimulus and subsequent increased HR acceleration. Finally, we found that ASD participants who had lower parent-reported behavioral inhibition had a stronger correlation between observed SOR behavior and atypical HR responses. Results support prior findings that increased HR responses to aversive stimuli is related to both ASD and SOR. Furthermore, observed and parent-reported SOR interacted to predict HR, suggesting that a multi-method approach may best capture the extent of SOR for an individual. However, observed SOR measures may be most accurate for ASD youth who are less likely to inhibit their behavioral responses. This study illustrates the importance of integrating multiple measures of sensory reactivity to identify SOR. HR measures of sensory reactivity have the potential to serve as a biomarker of SOR across a diverse range of individuals.

Introduction:Anhedonic depression is a subtype of depression characterized by deficits in reward processing. This subtype of depression is associated with higher suicide risk and longer depressive episodes, underscoring the importance of effective treatments. Anhedonia has also been found to correlate with alterations in activity in several subcortical regions, including the caudate head and nucleus accumbens. Low intensity focused ultrasound pulsation (LIFUP) is an emerging technology that enables non-invasive stimulation of these subcortical regions, which were previously only accessible with surgically-implanted electrodes. Methods:This double-blinded, sham-controlled study aims to investigate the effects of LIFUP to the left caudate head and right nucleus accumbens in participants with anhedonic depression. Participants in this protocol will undergo three sessions of LIFUP over the span of 5-9 days. To investigate LIFUP-related changes, this 7-week protocol collects continuous digital phenotyping data, an array of self-report measures of depression, anhedonia, and other psychopathology, and magnetic resonance imaging (MRI) before and after the LIFUP intervention. Primary self-report outcome measures include Ecological Momentary Assessment, the Positive Valence Systems Scale, and the Patient Health Questionnaire. Primary imaging measures include magnetic resonance spectroscopy and functional MRI during reward-based tasks and at rest. Digital phenotyping data is collected with an Apple Watch and participants' personal iPhones throughout the study, and includes information about sleep, heart rate, and physical activity. Discussion:This study is the first to investigate the effects of LIFUP to the caudate head or nucleus accumbens in depressed subjects. Furthermore, the data collected for this protocol covers a wide array of potentially affected modalities. As a result, this protocol will help to elucidate potential impacts of LIFUP in individuals with anhedonic depression.

In real-world settings, stimulus and outcome associations often depend on situational factors, such as Pavlovian occasion setters (OSs), which disambiguate whether a conditional stimulus (CS) will predict an outcome (unconditional stimulus; US). Whereas previous studies show that OSs are often lower in salience than CSs, no study has examined how low-salience OSs affect learning. In two conditioning experiments, we investigated this from the premise that inconsistently reinforced CSs prompt searching for additional stimuli (OSs) that indicate whether the CS will be followed by the US. Occasion setting learning was assessed using extinction rate-as partial reinforcement slows extinction relative to continuous reinforcement-and self-reported latent learning of stimuli. We hypothesized that a high-salience OS would result in faster extinction rates and occasion setting learning, whereas a low-salience OS would result in slower extinction rates and CS partial reinforcement learning. The results of Experiment 1 were mixed; there was no effect of OS salience on extinction rate, but the results for latent learning supported the hypothesis. We conducted Experiment 2 to specifically test extinction rate, and the results supported our hypothesis. The findings suggest that if a salient OS is found, occasion setting is learned; otherwise, CS partial reinforcement is learned.

Despite the widespread use of cognitive-behavioural therapy (CBT), only about half of patients respond favourably. Understanding whether relevant psychological processes are associated with treatment response could help identify patients at risk of non-response prior to treatment and improve their outcomes by enabling clinicians to tailor interventions accordingly. Fear conditioning tasks are a valuable tool for studying the learning processes associated with anxiety disorders and their treatment. This study examined associations between outcomes from a remote fear conditioning task and responses to internet-based CBT. Anxious adults (n=112) completed a fear conditioning task before receiving internet-based CBT. Participants rated their expectancy of an aversive noise (unconditioned stimulus; US) in response to a reinforced conditional stimulus (CS+) and a nonreinforced conditional stimulus (CS-) during acquisition, followed by extinction where neither stimulus was reinforced. Anxiety symptoms were assessed before each CBT session. Linear regression models indicated no significant association between mean US-expectancy ratings for 'safe' stimuli (acquisition CS- and extinction CS+) and change in anxiety across treatment. These findings contribute to the mixed literature on fear conditioning's role in treatment outcomes, highlighting the need for further research to elucidate the complex interplay between fear conditioning processes and response to CBT in anxiety disorders.

Learning by updating expectancies for aversive events is a proposed mechanism of exposure therapy. Reward processes and positive emotions, such as relief, may be closely tied to this learning process, though this has not been explicitly studied in an exposure therapy setting. Participants were UCLA college students who completed two sessions of exposure to public speaking (16 exposures total) and three public speaking anxiety assessments (baseline, post-assessment, one-week follow-up). Additionally, participants completed rehearsal exercises after exposures and were randomized to one of two rehearsal conditions: positive rehearsal designed to enhance reward processes and positive emotions (n = 42), or neutral rehearsal (n = 42). Self-reported expectancy for the feared outcome (e.g., social rejection) and relief that the expected feared outcome did not occur were measured across exposures using both observed and computational modeling indices. Public speaking anxiety decreased from baseline to follow-up, with no differences between groups. Observed expectancy ratings decreased across exposures at a faster rate for the neutral than the positive rehearsal group, with no group differences in computational modeling of learning rate. Observed relief ratings significantly decreased across exposures for the positive group only, with no group differences in computational modeling of relief rate. Faster expectancy-based learning rate and higher expectancy-based intercept at the first exposure of two exposure sessions predicted lower public speaking anxiety at follow-up. Higher intercept of relief at the first exposure of two exposure sessions, but not relief rate, also predicted lower public speaking anxiety at follow-up. Findings support learning via expectancy updating as an important process in exposure therapy and highlight a need for further study of relief during exposure.

Objective Previous research has found that social anxiety and depression are associated with occupational impairment, including unemployment and decreased productivity. However, longitudinal studies are limited to depression and only examine effects of anxiety cross‐sectionally. Furthermore, prior studies only measured occupational impairment dichotomously as either employed or unemployed. The present secondary data analysis sought to build upon these gaps and investigate bidirectional relationships between hours worked, measured continuously, and symptoms of social anxiety and depression over the course of 48 weeks following a brief intervention for job‐seekers with social anxiety disorder, many of whom reported elevated levels of depression. Employment was operationalized as the average number of hours spent working in a given week. Methods Two cross‐lagged panel models were tested to investigate these relationships in 250 diverse job‐seeking individuals (59.2% female, 40.8% Black or African‐American, and 16.4% Hispanic/Latine). Results In partial support of initial hypotheses, social anxiety and depression symptoms both negatively predicted subsequent hours worked. Hours worked did not predict subsequent social anxiety or depression symptoms. Conclusions This was the first study to investigate relationships among depression, social anxiety, and employment that operationalized employment as a continuous variable. The findings contribute novel information about the longitudinal impact of both social anxiety and depression on hours worked and suggest that symptoms of social anxiety or depression may serve as a barrier to seeking or maintaining employment. Interventions for unemployment should consider incorporating simultaneous treatment of social anxiety and depression.

Aberrant reward processing has been predominantly associated with depressive disorders, with evidence that pre-treatment abnormalities in striatal reward responsiveness relates to treatment outcomes. Emerging research also implicates reward processing differences in anxiety disorders, particularly generalized anxiety disorder (GAD). The current study examined whether pre-treatment reward- and loss- related neural activity predicts symptom improvement with behavioral activation (BA) and exposure therapy (EXP) for GAD. In this randomized clinical trial (ClinicalTrials.gov NCT02807480) conducted from 2016 to 2021, treatment-seeking adults with GAD completed the monetary incentive delay task during functional magnetic resonance imaging pre-treatment, then were randomized to 10-session EXP or BA. The primary outcome measure was the GAD-7. Of 101 participants consented, 69 completed treatment, the 46 completers with quality imaging data were included in analyses (22 EXP, 24 BA; mean 32.7 years, 10.9 % male). A priori region-of-interest analysis revealed that greater left caudate activity during loss receipt predicted greater symptom improvement in EXP, and did not relate to symptom change in BA (F(1, 428)= 5.24, p = 0.023), though this was not significant after correction for multiple comparisons. Whole-brain analysis further identified that greater activity during reward receipt in left frontoparietal regions and anterior insula / ventrolateral prefrontal cortex was associated with better outcomes in BA and worse outcomes in EXP. These findings highlight the role of reward and loss reactivity in GAD treatment. In particular, patients with elevated reactivity to reward salience may benefit most from BA or other reward-focused treatments. Future clinical trials are warranted to further elucidate reward-related predictors of anxiety treatment.