Psychological Medicine

Original Articles

Approach and avoidance learning in patients with major depression and healthy controls: relation to anhedonia

H. W. Chasea1a2 c1, M. J. Franka3, A. Michaela4, E. T. Bullmorea1a5, B. J. Sahakiana1a6 and T. W. Robbinsa1a2

a1 Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK

a2 Department of Experimental Psychology, University of Cambridge, UK

a3 Departments of Cognitive & Linguistic Sciences, Psychology, and Psychiatry and Human Behavior, Brown University, RI, USA

a4 West Suffolk Hospital, Bury St Edmunds, UK

a5 Brain Mapping Unit, University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Cambridge, UK

a6 Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK


Background Central to understanding of the behavioural consequences of depression has been the theory that the disorder is accompanied by an increased sensitivity to negative compared with positive reinforcement (negative bias), whereas other theorists have emphasized a global reduction in sensitivity to reinforcement in depression (blunting).

Method In this study, we used a probabilistic selection task that was designed to examine independently rates of learning to predict both positive and negative reinforcement. Twenty-three depressed out-patients and 23 healthy controls from the local population participated in the study.

Results No evidence for a negative bias was observed on the task, either during acquisition of the task or during generalization of the learned information. Depressed patients responded slower on the task than controls but showed a similar modulation of reaction times (RTs) as controls following reinforcement. Evidence for blunting was observed on the training phase, as reflected in reduced trial-by-trial adjustment during this phase. However, this effect was related specifically to the severity of anhedonia, as measured by the Snaith–Hamilton Pleasure Scale (SHAPS), and was independent of overall depression severity.

Conclusions We argue that the observation of a negative bias or blunting in a group of depressed patients may be dependent on the neuropsychological task and the symptoms of the patients tested. Our results provide insight into how these theories might be further tested.

(Received September 17 2008)

(Revised February 02 2009)

(Accepted May 27 2009)

(Online publication July 17 2009)


c1 Address for correspondence: Dr H. W. Chase, School of Psychology, University Park, University of Nottingham, Nottingham NG7 2RD, UK. (Email: