Context-dependent goal-directed control in schizophrenia spectrum disorders: Prioritizing loss avoidance over reward pursuit

While individuals with schizophrenia spectrum disorders show diminished reward pursuit, their ability to avoid negative outcomes appears relatively intact. The neural mechanisms of this dissociation and its relation to negative symptoms remain poorly understood. We hypothesized that in schizophrenia spectrum disorders, cognitive resources are preferentially directed toward avoiding losses rather than pursuing rewards, potentially limiting reward processing and contributing to negative symptoms. A two-step sequential decision task, which distinguishes between goal-directed and habitual strategies under reward and loss conditions, was completed by 50 stable individuals with schizophrenia spectrum disorders and 48 healthy controls during functional magnetic resonance imaging. Healthy participants showed more goal-directed (model-based) control in the reward setting than in the loss context. Individuals with schizophrenia spectrum disorders showed the opposite pattern, engaging model-based control more strongly in the loss context. These behavioral shifts were reflected in a prefrontal network. In anterior cingulate, orbitofrontal, and dorsolateral prefrontal regions, individuals with schizophrenia spectrum disorders showed increased activation during model-based learning in the loss condition. Within this group, loss-related activation in the anterior cingulate region was associated with anhedonia. Our findings suggest that schizophrenia spectrum disorders are associated with a reallocation of cognitive resources from reward pursuit towards loss avoidance. Enhanced loss processing in the anterior cingulate region may help explain the reduced capacity for pleasure seen in individuals with psychotic disorders.