Emotional Flatlining: How to Deal with Anhedonia in Rehab

Anhedonia is a common side effect when recovering from addiction and can be a dangerous precursor for relapse if it in not clearly understood.

This article will review the six different holistic ways Tree House Recovery uses to decrease the symptoms of anhedonia for our client during addiction treatment. Because understanding anhedonia can also help reduce the risks of relapse, this article will also cover why people in addiction recovery experience it, the symptoms of anhedonia and how long the symptoms typically last.

Six Holistic Ways to Treat Anhedonia

1: Aerobic Activity

Activities that raise heart rate and create adrenaline. Running, jogging and high intensity workout that raise the heart rate. It is all about get your heart pumping. As your heart starts pumping faster, you’ll start breathing more quickly, and the dead feeling of anhedonia will slowly fall away.

What’s happening is that physical activity activates your sympathetic nervous system, the body’s prompt to switch into high-gear, and a stress response is born. The stress response creates adrenaline which amps up your entire body and counteracts anhedonia’s numbed feeling of emptiness.

2:  Strength Training

For those in recovery, anhedonia is a common side effect of PAWS (post-acute withdrawal syndrome). Because drugs change the chemistry of the brain, after you stop it has to change back, and while this happens the brain can’t function properly.

Anhedonia occurs because, during PAWS, the brain has a shortage of the pleasure hormone dopamine — so it’s hard for the person to feel pleasure. Strength training exercise keep your heart rate up and puts tension on your muscles creates a protein called BDNF (Brain-Derived Neurotropic Factor).

BDNF has a number of functions: [1] [2]

  • It repairs damage in the brain just like other proteins repair damage to muscles after exercise (aka how muscles grow).
  • It grows more connections in the brain.
  • It creates more BDNF receptors so that more brain regions receive these benefits in the future.
  • It creates dopamine.

Essentially, PAWs occurs because the brain is damaged and one effect of this is anhedonia. Working out helps repair this damage more quickly, and also creates dopamine which relieves anhedonia symptoms. At Tree House we have developed a custom built exercise program called ESM Fitness Therapy to bring the symptoms of paws in check reducing the impact of anhedonia.

3: Nutrition

Eating the right foods is an important factor. Anhedonia is a lot like depression because it results from low dopamine levels in the brain. But certain foods increase dopamine production which helps relieve anhedonia.

  • An amino called Tyrosine, found in food, can be synthesized into dopamine. Another amino acid called phenylalanine can be synthesized into Tyrosine. These are both found in protein-rich foods. Eat turkey, beef, dairy, soy, and legumes [3].
  • Saturated Fats decrease dopamine production. Limit things high in saturated fat such as animal fat, butter, full-fat dairy, palm oil, and coconut oil [3].
  • Eat Velvet Beans. They contain L-dopa which stimulates dopamine production [3]. BUT in high amounts these can be toxic. Follow the product guidelines on the packaging.
  • Take Vitamins like iron, niacin, folate and vitamin B6. Your body uses these to create dopamine. If you are lacking in any of them, your dopamine supply suffers and anhedonia lasts longer [3].

4: Meditation

Meditation is the act of focusing on breathing or immediate surroundings as a way to calm the mind, release stress, and relax the body. It can be used to treat the symptoms of anhedonia as well.

Meditation decreases depression symptoms by lowering the amount of the stress hormone cortisol. Several brain scan studies have correlated high cortisol levels with symptoms of major depression disorder (like anhedonia) [4]. Although it serves as part of the fight or flight response, continually high levels of cortisol shrink parts of the brain responsible for emotional processing. A by-product is lower serotonin (the chemical in most anti-depressants) and dopamine. But studies have also shown a correlation with frequent meditators and a decrease in cortisol, which allows the brain to regrow and to create and process serotonin and dopamine — which decreases anhedonia symptoms.

Meditation Increases Quality of Life. Feeling numb and empty every day can make someone feel worthless and like nothing matters. Frequent meditation was tested on patients with late-stage cancer and heavy radiation treatments. Results indicated that participants in yoga and chemotherapy had a much higher quality of life compared to those who only received chemotherapy [5] [6]. Patients reported better moods, less fatigue, and an improvement in the effects of chemotherapy. At Tree House we have developed a custom-built Yoga program called EP Yoga Therapy design to help you develop emotional mastery by tapping into your parasympathetic nervous system. Through practicing breathwork, you will be able to “put the brakes on” your flight or fight response to lifes stresses.

5. Meaningful Social Interactions with People.

It’s not enough to be around people, you have to feel close to them or connected. Often this means sharing trust and vulnerability with one another.

Deeply bonding with others creates dopamine [7]. According to Dr. Lisa Feldman Barrett, Professor of Psychology at Northeastern University “strong social relationships have the potential to improve your outcome if you have a disease, such as depression, where dopamine is compromised.” And because someone with anhedonia has a large shortage of dopamine, meaningful socialization is one more way to find relief. Tree House has created a social platform to help people in early recovery break free from the isolation of addiction and rebuild strong bonds with peers during our morning ABI therapy sessions. This is a team-based approach that helps people build leadership and collaboration skills with Navy SEAL style beach training in boats. Ultimately helps men build fellowship through the adversity of working towards a common goal.

Physical Touch can decrease anhedonia symptoms by creating oxytocin. Physical connection with other humans like hugs, holding, or even intercourse produces the neurotransmitter oxytocin [8] [9] [10] [11]. Although it is frequently called the “love hormone” oxytocin also decreases cortisol levels. And since high cortisol levels produce symptoms of depression and anhedonia, lowering cortisol levels will also decrease those symptoms.

6. Talk-Therapy

Even with the best food, excessive exercise, a host of deep friendships, and frequent meditation — the brain is not going to heal in a day or a week. Anhedonia is the result of dopamine deficits because the brain has a compromised ability to send and receive it. And unfortunately, even with all the hacks above, it takes time to reverse that. In the meantime, talk therapy can help someone learn coping skills that help them deal with anhedonia.

Therapy can also employ an intervention called activation therapy. In activation therapy, each week patients try one new thing as a short term commitment, just to try it. In the therapy session, patients practice a “savoring” reflection where they recount what they liked about the activity using only their five senses. If applicable they also describe any feelings of pride, enjoyment, or accomplishment [12].

By asking people to reflect and recall things that were pleasing to their senses, activation therapy is essentially trying to jumpstart/reboot (or re-activate) the connections in the brain’s reward center. Since the reward center is responsible for sending and receiving dopamine, when activation therapy is successful it increases dopamine levels as well as the brain’s potential to receive more dopamine and create more pleasure. To learn more about what makes the 1 on 1 sessions at Tree House differnt click HERE.

What Causes Emotional Flatlining in Rehab?

Addiction, like mood disorders, affects dopamine in the rewards system. Every time someone with addiction uses narcotics, it creates high levels of dopamine.

Eventually, the brain becomes used to these high levels of dopamine and stops producing dopamine on its own. When narcotics are withdrawn, the person is left with a very high tolerance for dopamine and a limited ability to produce it. As a result, their brain can no longer create dopamine in response to pleasure, and what it does produce has little effect due to the high dopamine tolerance.

In addition to the dopamine deficit, another part of anhedonia is psychological. Life in active addiction has a lot of adrenaline. When this person enters recovery, they go from a life of constant adrenaline to almost none.

How Long Does Anhedonia Last in Sobriety?

Milestones such as 3, 6, and 12 months of sobriety are when symptoms like anhedonia noticeably improve. Like most symptoms of PAWs, anhedonia comes in waves. For some people episodes of anhedonia fade after a few hours or days. For others, they can last weeks. But with time, anhedonia symptoms don’t last as long and don’t happen as often.

Symptoms of Anhedonia:

  • Avoiding social situations with friends.
  • Avoiding romantic relationships or pulling away from current relationships.
  • Feeling or thinking more negative about yourself or other people. Including saying negative things to yourself.
  • Feeling fewer emotions like joy, sympathy, empathy, and having more blank/unemotional facial expressions.
  • Uncomfortable around other people. Including friends, coworkers, or acquaintances.
  • Putting on fake emotions. For example, pretending you’re happy around others.
  • Decreased or missing sex drive.
  • No interest in physical or emotional intimacy.
  • Reoccuring physical problems, such as being sick often, aches, pains, or headaches.

Tree House Recovery is a rehab facility based on the latest addiction science. We reverse the effects of addiction, help our patients understand and prevent future relapses, and then leave our clients in the best mental and physical shape of their lives. For more info, see our reviews and success rates.

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