In the abstract, it's entirely plausible to me that I somehow need to work to "rewire my gratification circuits". However, nothing has demonstrated even a hint of actually doing that. I've tried multiple approaches to talk therapy, medication, diet/exercise, and self-directed behavioral activation (aka "do stuff"). None of them have noticeably helped; a few have backfired badly.

> I think positive action and experiences are definitely key-part in overriding the negative thinking patterns. Things such as social connections, the feeling of belonging to a group and physical exercise.

Here's the thing: I'm not sure I've genuinely had a positive experience in a long time (maybe decades). I'm not sure I've ever experienced "the feeling of belonging to a group" in an emotional sense. I routinely do things and have interactions that I can intellectually analyze as having been positive accomplishments, but for me there's a disconnect such that this simply fails to add up to a positive experience. As far as I can tell, most approaches to therapy don't even acknowledge this as a possibility, let alone have a method to address it. Those that do acknowledge it tend to have a questionable-to-nonexistent body of scientific evidence and are often phrased with a weird mythical/quasi-religious/metaphorical quality such that I'm often confused as to what advocates or practitioners are even trying to say once they move on from discussion of symptoms.