Blunted experience of pleasure, unsystematic subjective value representation, and disrupted goal-directed behaviors: an ecological momentary assessment study across mood and psychotic disorders

BACKGROUND: Motivational deficits are a core clinical feature across mood and psychotic disorders, although distinct mechanisms may contribute to similar symptom presentations. We aimed to understand diagnostic groups differences in daily reports of consummatory and anticipatory pleasure, physical and mental effort exertion, and goal-directed behaviors. Additionally, we explored how subjective value computation during decision-making in lab settings mapped onto real-world motivated behaviors. STUDY DESIGN: Participants from five diagnostic groups-healthy control (n = 81), schizophrenia-spectrum disorder (n = 56), current major depression (n = 58), remitted major depression (n = 48), and bipolar I disorder (n = 53)-completed ecological momentary assessment measures for two weeks. Additionally, we used a person-centered modeling approach to examine subjective value representation during two laboratory-based effort-cost decision-making paradigms. We examined the association between decision-making, subjective pleasure and effort ratings, and motivated behaviors. STUDY RESULTS: We observed lower consummatory and anticipatory pleasure ratings in current major depression, which was mediated by self-reported motivational impairments. Individuals with psychosis or bipolar disorder were less likely to engage in goal-directed behaviors, and all patient groups reported increased subjective effort sensitivity in daily living. Moreover, systematic subjective value representation during effort-cost decision-making was associated with, yet did not fully account for, differences in goal-directed behaviors across disorders. CONCLUSIONS: These findings point toward both common features and heterogeneities in motivated behaviors, hedonic experiences, and effort sensitivity across diagnostic boundaries. Meanwhile, individual differences in effort-cost decision-making only partially contributed to real-world motivational deficits, suggesting a need for future research to parse out transdiagnostic affective and cognitive mechanisms underlying motivational deficits.