Recovering from severe chronic anhedonia

@AuntGlow and others interested, here are the parts I most resonated with from the article https://yung-sidekick.com/blog/severe-anhedonia-a-somatic-and-behavioral-protocol-for-rebuilding-the-capacity-for-reward

Standard behavioral activation protocols consistently recommend "pleasant activities" for these clients. You've witnessed the resulting frustration and despair. These traditional approaches fail because they assume your clients retain basic pleasure capacity.

I also related a lot to being able to distinguish between the 2 types of anhedonia:

• Motivational anhedonia: Reduced interest or motivation to seek rewarding experiences

• Consummatory anhedonia: Impaired capacity to enjoy rewards when experiencing them

... BA targets motivational aspects through activity scheduling and barrier identification [3], yet leaves consummatory deficits completely unaddressed.

I wonder whether this specific quote might be relevant to many others experience too... @NightFury (My own bolding added)

The standard BA recommendation to engage in "pleasant activities" can intensify suffering for severely anhedonic clients... Severe anhedonia involves impaired reward system functioning beyond reduced motivation... Pleasant activity assignments create a cruel paradox for these clients. Activities prescribed as remedies become evidence of their broken reward system. Each failed pleasure attempt reinforces hopelessness and generates iatrogenic shame—treatment-induced shame that compounds existing suffering. This approach validates clients' fears that nothing will ever feel good again.

I found this part validating:

Rather than aiming directly for pleasure—which clients' nervous systems cannot currently access—initial goals must shift toward regulation.

... Recovery requires first establishing somatic regulation and safety—helping nervous systems achieve neutrality before attempting positive states. Subsequently, rebuilding the dopaminergic "wanting" system through micro-efforts prepares ground for eventual pleasure experiences.

...neutral precedes positive in recovery. Clients frequently feel frustrated when pleasant activities produce no pleasure. Reframing the initial target as achieving neutrality rather than pleasure establishes realistic expectations while explaining how calmer states enhance overall emotional regulation.

I think this part is relevant to explaining the reason that despite doing all the right things I have deteriorated and become burnt-out. I have been pushing myself to do big-effort things without reward; I think I need to step back from big-effort and aim for small-effort so that I am not exhausted from effort, which in itself creates a negative feedback loop for me.

1% effort tasks and movement experiments

I am interested to try the 'Map reward learning' tracking, but know I may find it hard to be motivated to make the effort to track things. This might be somewhere that people here can help me keep motivated/encouraged to do.

I don't think I have much experience (yet) with the application of the pavlovian cue pairing for reward prediction to myself (but to my dogs? Definitely!)

The protocol uses controlled stimulus-reward pairings to rebuild these connections. Identify neutral stimuli—visual cues, sounds, or objects—that can be consistently paired with mildly positive experiences.

I have noticed that when I see pictures of snow-scenes I get a very mild brief fleeting feeling which is neutral-positive. So I can try to leverage that maybe. Like when I saw @Bunniekins 's post today about the "cool bunnies" (bunnies in the snow lol). Thank you @Bunniekins 😍.

... to be continued!

I resonate a lot @AlwaysMyself

I think my psych may be onto it. I’ve been pushing myself with huge to-do lists. Almost impossible to complete. I don’t deserve a reward at the end because it’s just stuff that I need to do. I wouldn’t know what to do to reward myself. She has told me that I need to pat and cuddle my dogs for 5 minutes after completing a couple of tasks. I have to be in the moment with them and feel their love and connection to me. Maybe that’s what she is doing. Trying to get me to enjoy something small and quick and simple. No effort but hasn’t labelled it as enjoyment. Just something to add into my day.

I don’t know if that makes any sense. My head isn’t in a really good place so I’m having trouble organising my thoughts.

That made sense to me @Captain24 😊. I have learned that I slightly benefit (and thus worthwhile) from self-talk that tells me I have done well to do things - even small or "must do" things; anything I don't want to do that I do. And it helps even more if I am able to share that personal achievement (it may not be an achievement for others to do it, but for myself it can be) with a trusted person who understands how hard it is to do things - in my case, that's my mother (or this forum). Last weekend I 'celebrated' unpacking 2 more boxes (from when I moved houses in April... yep so much still in boxes) by choice. I was motivated by trying to find my christmas decorations (which I did not find in the process), but instead of just unpacking onto the floor I actually put everything away as I unpacked it. 😎. Inside I feel nothing positive about this, but cognitively I know it was a good thing to do, so I keep telling myself that i can be proud/glad of doing it to try to have a cognitive-reinforcement, even if I don't have an emotional one lol.

PS @Captain24 I love that cuddling your dogs can be a positive feeling of connection for you 😍. I have 2 dogs myself and sometimes i get a little smile from watching them play together, or from my goofy girl chasing/biting her tail in circles. 🤣

@AlwaysMyself awww AlwaysMyself, sweetheart thinking of you. here are some more "cool bunnies" for you xxx

@AlwaysMyself I can relate.

As part of my care plan, the psychiatrist created for me this week, I need to do more of the things that give me joy...

The problem is...they don't give me joy any more.

For example...

I used to love going to the movies and would probably go once a week. But now, I really find it challenging and want to go home half way through the movie. I don't enjoy it and the fact that I don't enjoy it causes distress. Every single time I go, I leave with the whole..."why am I like this?" Thought process going through my head and that makes me feel worse.

Thanks @Bunniekins 🥰😍.

I had a feeling you might also "get" the "doing but not getting pleasure" situation and the pain of feeling "broken" bexause the supposed treatment doesn't work, @NightFury .

Does it help (with how you feel about yourself "trying" and the lack of positive feedback) to know that you (or even "we"!) are not alone in this, and it is actually a flaw with the treatment being applied to severe cases when its not prepared our physiological responses to be able to succeed at the task?

I hope we can begin to see ourselves not as "broken" because the traditional theory that psychs have pushed onto us as a cure doesn't work, but that perhaps it was their own misunderstanding of our symptoms and neuroscience and how they needed to adapt their practice to where *we* are at individually. 🥰🤗

I get the self-talk thing. @AlwaysMyself.

I have an obsession with writing these lists. They are really massive and really stupid actually. But my house is spotless! But I do allow myself some self-talk to say that I have done well and achieved a lot. I do like to share on here what I have done as I have nowhere else too. My parents aren’t very supportive of my MH and things that I do.

well done on packing away the boxes. I know how hard that is. The way I moved last time was really helpful in not having boxes but at my old house I had a garage full from when I moved before and that was 10 years! This house has no boxes just all the cupboards in all the bedrooms are full!

It’s good that you can recognise it but I get the lack of feeling proud or celebrating it. Like what can I do to celebrate? It’s just tasks.

In the past I allowed myself a self-care day once. I sat and did some Lego, resin and mosaic. Stuff I use to enjoy. I told everyone that I enjoyed the day but it was just stuff to do to keep everyone happy. I had it written on a to-do list of what self-care things to do. I just went about the motions. It was good to share pictures of the things that I did and I did like that I got positive comments which made me think that I did get a good thing done. It was nice that they were noticed and people thought that it was really clever and creative but to me it was just another thing to stick into that cupboard.

Hi @NightFury

The pressure to do things that ‘you enjoy’ is so hard. It feels like I’m failing and I get the distress it causes. It also makes it hard when you maybe feel like doing it but you haven’t been enjoying it so our mind says you won’t. Your mind says ‘this is a waste of time’ it’s like it gets ruined for you.

I had a case manager once say to me not to do my diamond art that I enjoyed while I was not getting any enjoyment out of it. It was so I didn’t ruin it for when I did feel better. It wasn’t something that I forced myself into so I didn’t associate that with trying to find enjoyment. I’m not sure I’m making any sense with that but I’m hoping you get the just if it.

Honestly, I don't know if it helps. @AlwaysMyself it's hard to shift the state of mind from, "it's my fault," to "actually maybe the treatment isn't doing what it's supposed to be doing."

@Captain24 I can relate to the whole, "it's a waste of time," thing. Because that's exactly what I shift into when the disappointment hits because I expected to enjoy the activity.

I spoke to a counsellor yesterday about the fact that I think I need to try and shift the idea that because a medical professional told me that I need to do it, I have to go out and force myself to do the thing. I don't know how to shift it, but I know that I need to shift it. It's that doing what you're told mentality that's been drilled into me since I was a child.

You are making sense!