Virtual Reality Could Rewire Reward Circuits to Treat Anhedonia

Anhedonia, the persistent inability to feel pleasure or interest in activities that once brought joy, is one of the most stubborn and disabling symptoms in psychiatry. It cuts across diagnoses, appearing in major depression, anxiety disorders, schizophrenia, PTSD and substance use conditions, and it often lingers even when other symptoms respond to treatment. Now, a new perspective published in Nature Mental Health argues that immersive, interactive virtual reality could become a powerful clinical tool for reigniting the brain’s reward machinery, and it lays out a concrete, neuroscience-driven blueprint for how to design such experiences.

The perspective, authored by Mehmet Kosa of Marshall University, Nora M. Barnes-Horowitz of the University of Colorado Boulder, and Michelle G. Craske of the University of California, Los Angeles, builds on a growing body of evidence that treatments specifically targeting reward sensitivity can meaningfully reduce anhedonia. Rather than treating low mood as a single undifferentiated problem, the authors argue that clinicians should think of anhedonia as a disorder of the reward system, one that can be systematically probed and retrained. Virtual reality, they contend, offers an unprecedented medium for doing exactly that, because it can deliver experiences that are specific, fine-tuned, immersive and personalized in ways that traditional talk therapy or flat-screen interventions cannot match.

The theoretical foundation of the proposal rests on decades of work dissecting how the brain processes reward. Neuroscientists have long distinguished between separable components of reward: ‘liking’, the hedonic pleasure experienced in the moment; ‘wanting’, the motivational drive that pushes an organism to seek out rewards; and learning, the process by which the brain updates its expectations about what is worth pursuing. These components rely on partially distinct neural circuits, and they can be impaired independently of one another. A person with anhedonia may be able to enjoy a pleasurable experience once they are fully engaged in it, yet lack the motivation to begin it, or they may fail to learn from positive outcomes that would normally encourage repetition. This fractionation matters clinically, because a treatment that boosts one component may do nothing for another.

At the heart of the new argument is a deceptively simple computational concept: the reward prediction error. When an outcome turns out better than expected, dopamine neurons in the ventral striatum and midbrain fire in a characteristic burst, signaling a positive prediction error. This signal is not merely a marker of pleasure; it is the engine of reinforcement learning, teaching the brain which actions and contexts are worth repeating. Decades of research, from classic animal studies to modern human neuroimaging, have established that these prediction error signals drive learning, memory encoding, attention and motivation. Crucially, work by Wolfram Schultz and others has shown that the magnitude of the dopamine response scales with the discrepancy between expected and obtained reward, not with the reward itself.

What makes this relevant to anhedonia is a growing literature suggesting that prediction error signaling is blunted in people with the symptom. Studies of reinforcement learning in depression have found flattened responses to unexpected rewards, and related work on internet gaming disorder has documented dampened prediction error signals as well. Meanwhile, computational models of momentary well-being, developed by Robb Rutledge and colleagues, indicate that fleeting happiness depends more on recent prediction errors than on the absolute size of rewards received. In other words, the emotional lift we feel in daily life may be driven less by what we get and more by how much better it was than we anticipated. If anhedonic individuals experience smaller positive prediction errors, the world may feel flat not because nothing good happens, but because nothing good surprises them.

This is where virtual reality enters the picture. The authors propose that carefully engineered VR interactions could be designed specifically to generate positive reward prediction errors, delivering outcomes that reliably and pleasantly exceed expectations. Unlike real life, where reward statistics are messy and uncontrollable, a virtual environment gives designers precise control over timing, probability, magnitude and surprise. A user might reach for a glowing object expecting a modest sparkle and instead trigger a cascading burst of color, sound and narrative payoff. Each such moment, the argument goes, delivers a clean, well-timed dopaminergic teaching signal to a reward system that has grown underresponsive. Over repeated exposures, these signals could gradually recalibrate reward sensitivity, strengthening the learning and motivational components of reward processing that are most impaired in anhedonia.

The second pillar of the proposal is equally ambitious: rather than treating VR as a single undifferentiated pleasure machine, the authors argue that distinct activities within a virtual experience should be mapped onto the distinct phases of reward processing. Anticipatory reward, the ‘wanting’ phase, could be targeted with activities that build expectation and motivation, such as quests, exploration and goal pursuit that require effortful engagement before any payoff arrives. Consummatory reward, the ‘liking’ phase, could be targeted with immersive savoring experiences, rich sensory environments and moments designed purely for in-the-moment enjoyment. Reward learning, meanwhile, could be targeted with probabilistic tasks and feedback structures that require the user to discover, through trial and error, which choices lead to better outcomes. This phase-specific design philosophy mirrors the structure of Positive Affect Treatment, the neuroscience-informed psychotherapy developed by Craske and colleagues, which has shown in multiple randomized controlled trials that directly targeting reward sensitivity can reduce anhedonia, depression and anxiety symptoms.

The evidence base for this approach is still young but encouraging. A pilot study of VR-based reward training for anhedonia demonstrated feasibility, and randomized trials of virtual reality-enhanced behavioral activation for major depressive disorder have shown promising results. Meta-analyses of VR exposure therapy for anxiety disorders have established that immersive technologies can produce clinically meaningful change, and systematic reviews of positive mood induction confirm that virtual environments can reliably elicit positive emotions. Research on presence, the subjective sense of ‘being there’ in a virtual world, suggests that immersion amplifies emotional responses, and studies of interactive media indicate that agency, the feeling that one’s actions matter, adds further emotional impact on top of immersion alone. Interactivity, the authors emphasize, is not a cosmetic feature: it is what allows the user to generate their own prediction errors through action, rather than passively receiving them.

The perspective also confronts the practical and ethical challenges honestly. VR sickness remains a barrier for some users, and validated questionnaires now exist to monitor it. Privacy and security concerns in immersive platforms are real, since these systems can collect intimate behavioral and physiological data. Ethical questions about children and adolescents, and about the risk that highly rewarding virtual experiences could shade into problematic use, particularly given what is known about gaming disorder, must be taken seriously. The authors call for adaptive designs that personalize difficulty and reward statistics to each user, rigorous measurement of presence and side effects, and careful attention to who benefits and who might be harmed.

If the vision succeeds, the implications could extend well beyond anhedonia. Objective measures of reward sensitivity are already being used to track treatment response, and neuroimaging work has linked ventral striatal reward activation to lasting improvements in life satisfaction. A VR platform that reliably elicits positive prediction errors and targets each reward phase could serve simultaneously as a clinical intervention, a research instrument and a personalized medicine tool, allowing clinicians to identify which component of reward processing is impaired in a given patient and to tune the virtual experience accordingly. The authors frame their contribution as a roadmap rather than a finished treatment, but the destination is clear: a future in which the brain’s pleasure circuits, dulled by illness, can be systematically and safely reawakened, one well-timed surprise at a time, inside a headset.

Subject of Research: Using interactive virtual reality to generate reward prediction errors and target anticipatory, consummatory and learning reward phases as a treatment approach for anhedonia.

Article Title: Reward prediction error and reward components in interactive virtual reality for anhedonia

Article References: Kosa, M., Barnes-Horowitz, N. M., & Craske, M. G. (2026). Reward prediction error and reward components in interactive virtual reality for anhedonia. Nature Mental Health. https://doi.org/10.1038/s44220-026-00731-4

Image Credits: AI Generated

DOI: 10.1038/s44220-026-00731-4

Keywords: anhedonia, virtual reality, reward prediction error, dopamine, reward sensitivity, positive affect treatment, reinforcement learning, ventral striatum, behavioral activation, mental health, immersive technology, depression