Reinforcement sensitivity, depression and anxiety: A meta-analysis and meta-analytic structural equation model

Benjamin A. Katz*, Kathryn Matanky, Gidi Aviram, Iftah Yovel

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

40 Scopus citations


Reinforcement Sensitivity Theory (RST) posits that individual differences in reward and punishment processing predict differences in cognition, behavior, and psychopathology. We performed a quantitative review of the relationships between reinforcement sensitivity, depression and anxiety, in two separate sets of analyses. First, we reviewed 204 studies that reported either correlations between reinforcement sensitivity and self-reported symptom severity or differences in reinforcement sensitivity between diagnosed and healthy participants, yielding 483 effect sizes. Both depression (Hedges’ g =.99) and anxiety (g = 1.21) were found to be high on punishment sensitivity. Reward sensitivity negatively predicted only depressive disorders (g = −.21). More severe clinical states (e.g., acute vs remission) predicted larger effect sizes for depression but not anxiety. Next, we reviewed an additional 39 studies that reported correlations between reinforcement sensitivity and both depression and anxiety, yielding 156 effect sizes. We then performed meta-analytic structural equation modeling to simultaneously estimate all covariances and control for comorbidity. Again we found punishment sensitivity to predict depression (β =.37) and anxiety (β =.35), with reward sensitivity only predicting depression (β = −.07). The transdiagnostic role of punishment sensitivity and the discriminatory role of reward sensitivity support a hierarchical approach to RST and psychopathology.

Original languageAmerican English
Article number101842
JournalClinical Psychology Review
StatePublished - Apr 2020

Bibliographical note

Funding Information:
This research was partially supported by the Israel Science Foundation grant 886/18 awarded to IY. Author BAK was involved in all parts of the current research. Author KM assisted in literature searches, coding of data and editing of the manuscript. Author GA contributed to writing of the manuscript. Author IY supervised study design, analysis and writing of the manuscript. All authors have approved the final manuscript. The authors have no conflicts of interest to report. The authors thank Avraham N. Kluger for his input regarding the formulation and analysis of this project and Deborah Schwartz for her assistance in editing the manuscript. We also thank the researchers who took time to provide unpublished data and additional information that improved the quality and scope of these analyses.

Publisher Copyright:
© 2020


  • Anxiety
  • Depression
  • Meta-analytic structural equation modeling
  • Reinforcement Sensitivity Theory
  • Reward processing


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