Depression
The Reward-System Protocol
For people stuck in low motivation, blunted feeling, or the dimmer-switch sense that joy and interest aren't quite reaching anymore. The reward-system Prism protocol trains the brain network behind pleasure and motivation — helping you live better with depression.
Why the Reward System?
The ventral striatum is part of the brain's reward system — the circuitry that responds to anticipation, pleasure, motivation, and the experience of joy. In depression, especially with prominent anhedonia (the inability to feel pleasure or care about activities you used to love), this network is often underactive. Patients often describe it as: “I know I should enjoy this, but I can't feel it.”
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The reward-system Prism protocol trains you to up-regulate that signal — to actively engage the brain circuitry behind motivation and joy, and rebuild access to feelings depression has dimmed.
What This Protocol Is Used For At Our Practice
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Major depressive disorder, especially with prominent anhedonia symptoms
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Treatment-resistant depression — when medications and therapy haven't fully helped
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As a complement to your ongoing psychiatric care (medication, therapy, or both)
What the Research Shows
A 2025 multicenter pilot study followed 34 adults with major depressive disorder and prominent anhedonia (SHAPS-C ≥25) through 10 sessions of the reward-system Prism protocol:
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78% had a clinically meaningful improvement in depression severity (HDRS reduction ≥4 points)
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76.5% had meaningful improvement in anhedonia (SHAPS-C reduction ≥50%)
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32% achieved remission (HDRS ≤7)
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85% patient satisfaction
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Large effect sizes for both depression (1.22) and anhedonia (0.92)​
No serious or treatment-requiring adverse events. A 15-session course is recommended for the most robust and sustained outcomes.²
What Treatment Looks Like
10–15 sessions over 5–8 weeks (twice weekly, about 30 to 45 minutes each). You wear a soft EEG cap and engage with a simple animated scene — often a dog who wants their owner to come outside — that responds in real time to activity in your reward system. You bring the mental work: recalling experiences that brought you joy, satisfaction, or motivation, things you used to look forward to. Prism shows you, moment by moment, which of those mental strategies actually activates your brain's pleasure and motivation circuitry.
References:
² Amital, D., Gross, R., Goldental, N., Fruchter, E., Yaron-Wachtel, H., Tendler, A., Stern, Y., Deutsch, L., Voigt, J. D., Hendler, T., Harmelech, T., Singer, N., & Sharon, H. (2025). Reward system EEG–fMRI pattern neurofeedback for major depressive disorder with anhedonia: A multicenter pilot study. Brain Sciences, 15(5), 476. https://doi.org/10.3390/brainsci15050476