Depression takes many things, but one of its most disheartening effects is the loss of pleasure itself: food, hobbies, time with people you love can all feel flat. Clinicians call this anhedonia. A secondary analysis of the COBRA randomised controlled trial, by Alsayednasser and colleagues, looked at how well two standard therapies actually repair it.
The study followed 440 people with major depressive disorder, randomised to receive either Cognitive Behavioural Therapy (CBT) or Behavioural Activation, a therapy focused on re-engaging with meaningful activities. Both treatments led to significant improvements in anhedonia over six months of active treatment, with no meaningful difference between them. At the 12- and 18-month follow-ups, anhedonia had not improved further, and participants remained above healthy population averages. The improvement in anhedonia was also less complete than the improvement in depression symptoms generally. People with more severe anhedonia at the start of treatment tended to show less repair of depression symptoms and fewer depression-free days over the follow-up period.
The findings suggest that CBT and Behavioural Activation are helpful for anhedonia, but only partially so. The authors argue that current therapies may need refinement, or that new approaches may need to be developed, to treat this symptom more fully.
If low mood has lifted but pleasure still feels out of reach, that is worth raising with a psychologist. There may be more that can be done.
What anhedonia is, and how it was measured
Anhedonia is the reduced ability to feel pleasure. In depression research it is often divided conceptually into wanting things, called anticipatory pleasure, and enjoying things in the moment, called consummatory pleasure. This study used the Snaith-Hamilton Pleasure Scale, a self-report questionnaire capturing consummatory pleasure specifically: how much enjoyment someone actually experiences during activities such as eating, socialising or hobbies, rather than how much they look forward to them.
What the study did
This was a secondary analysis of the COBRA trial, a randomised controlled trial in which participants are assigned at random to different treatments so that the groups start out similar on average, making it easier to attribute later differences to the treatment rather than to pre-existing differences between people. A secondary analysis takes data already collected for another purpose and asks a new question of it, here concerning anhedonia rather than depression overall.
440 people with current major depressive disorder were randomised to receive either cognitive behavioural therapy, which targets unhelpful thought patterns and behaviours, or behavioural activation, a more streamlined therapy focused on rebuilding engagement with meaningful, rewarding activities. Anhedonia and depression were measured after six months of acute treatment, and again at 12 and 18 months, to establish whether improvements were maintained or continued.
What it found
Both therapies produced significant improvements in anhedonia during the six months of active treatment, with no significant difference between them. By the six-month mark, however, participants' anhedonia scores remained above healthy population averages, meaning pleasure had not been fully restored. Beyond that point there was no further significant improvement at 12 or 18 months. The gains made during treatment held rather than continuing to grow.
Another finding carries weight. People who began treatment with more severe anhedonia tended to show less repair of their overall depression symptoms and fewer depression-free days across the whole follow-up period, in both treatment groups. When the researchers compared how much anhedonia improved against how much depression overall improved, anhedonia repair was consistently less complete.
Why it matters
These results suggest that two of the most widely used evidence-based therapies for depression only partially treat the loss of pleasure that so often accompanies it, and that neither holds a clear edge over the other for this particular symptom. Because anhedonia severity at the start of treatment was linked to poorer overall recovery, it may serve as a useful early marker of who needs extra or different support, and as a specific target for treatment refinement rather than something expected to resolve automatically alongside other symptoms.
Limits to keep in mind
This was a secondary analysis, so the trial was not originally built to test anhedonia treatments against each other. The abstract does not report the size of the effects, nor explain why anhedonia lags behind other symptoms, nor indicate what would close that gap. It establishes only that current approaches are, in the authors' words, "only partially effective".
If you notice depression easing while joy still feels out of reach, that is worth naming to a therapist. It is a real and recognised pattern, and there may be more that can be done.