Exploring the Link Between a Prior Belief for Active Avoidance and Apathy, Anhedonia, and Depression: A Network Analysis

Background: Learned helplessness has been suggested as a mechanism through which anhedonia in depression is developed. It has been theorized that this stems from a generalized pessimistic prior belief about the probability of success when attempting to actively avoid negative outcomes, thereby resulting in apathy and reduced motivation. However, how such a prior belief may relate to depression and apathy is unknown. Here, we leveraged a novel method based on cognitive tasks and Bayesian modeling to extract a reliable generalized prior belief expressing the probability with which negative outcomes are expected to be actively avoidable. Methods: We quantified this prior belief in 521 nonclinical participants. Then we used Bayesian network analysis to explore how the prior’s mean was related to total scores of the Patient Health Questionnaire-9 (PHQ-9) depression scale, specific items of the PHQ-9, and 6 subscales measuring apathy, motivation, anhedonia, and emotional reactivity. Results: We found that the mean of the prior belief was positively related to the tendency to get motivated to initiate and maintain goal-directed actions as measured with the Apathy Motivation Index (AMI) and not hedonic capacity as measured by the Snaith-Hamilton Pleasure Scale. Moreover, the same reverse-coded behavioral apathy subscale in the AMI was related to the total score of the PHQ-9 independently of hedonic capacity. Finally, the prior belief itself was not directly linked to depressive symptoms or PHQ-9 total scores. Conclusions: These results indicate that our behavioral measure of helplessness is indirectly related to depressive symptoms through behavioral activation and independently of hedonic capacity.