Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy


Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.

This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)—an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.

Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.

Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.

PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.
Trial registration number

ISRCTN registry ISRCTN74048461, registered 18 may 2015
Keywords: Schizophrenia; Anhedonia; Apathy; Negative symptoms; Psychosocial treatment; Depression


I wonder how much of the improvement was because of the placebo effect. Hopefully not all of it…

I just found that the authors have put all 8 sessions training materials on the internet for everyone to use. Check them out here! (unfortunately - only in French).



The link was in French. I did practice reading it to prepare for my class though, so thanks.


I’m glad they didn’t have interventions like this back in the dark ages when I became schizophrenic. When hospitals were places where you just hung out for awhile and got better -