Targeting Anhedonia in Adolescents: A Single Case Series of a Positive Imagery-Based Early Intervention

Interventions targeting anhedonia in depression demonstrate encouraging results in adults but are lacking for adolescents. Here, we have adapted a brief imagery-based intervention (IMAGINE), which has shown promising results in reducing symptoms of depression in young people, to focus specifically on reducing symptoms of anhedonia (IMAGINE-Positive). We augment positive mental imagery generation with techniques to upregulate positive affect. Eight participants completed the four-session intervention. Data on feasibility and acceptability were collected. Questionnaires of symptomology and cognitive mechanisms (e.g. depression, anhedonia and future imagery vividness) were administered at pre-intervention, post-intervention and 3-month follow-up. The intervention was feasible to deliver and acceptable to participants. There was a large reduction in depression symptom scores from pre- to post-intervention (d = 1.12) and 63% of participants showed reliable improvement (RI), which was maintained at follow-up (d = 2.51, RI = 86%). Although there were only small reductions in anhedonia from pre to post (d = 0.38, RI = 0), there was a large reduction from pre to follow-up (d = 1.28, RI = 29%). There were also large increases in positive future imagery vividness (post, d = − 1.08, RI = 50%; follow-up, d = − 2.02, RI = 29%). Initial evidence suggests that IMAGINE-Positive is feasible and acceptable and may have clinical utility, but future randomised controlled trials are needed to further evaluate efficacy.