We've learned how depression takes hold. Now how do we target these cognitive habits to help ourselves?
In this conversation, we explore the complexities of depression, discussing ineffective strategies and highlighting effective methods for managing depressive symptoms. We dip back into the research for a few helpful (not helpful) pointers before relaying practical tips based on the implications of what we've covered and flattening the steep climb out of the depression pits.
keywords
depression, mental health, cognitive control, rumination, emotional regulation, mindfulness, self-compassion, therapy, coping strategies, attention
Today we’re here to ask: What can we take away from all the depressing research we’ve worked through? And what are more effective ways to deal with depression?
Right off the bat, lets start with now knowing why so many things DON’T work when you’re depressed… and why some surprising things do.
- Meditation? Difficult. A mind wandering without the ability to “let the thoughts pass” means latching on to those negative thoughts and watering them, instead.
- Journaling? Words are going to be negatively slanted under depression. So writing it out can make perceptions and perspectives more damaging than helpful.
- Feeling your feelings – what we’re all told we need to do? Doesn’t work out well when they don’t rise and fall, but instead sustain themselves. Instead, feeling emotions can be torturous and neverending.
- Talk therapy and commiseration? Again, are limited by the negative slantings of words and the negative memories they bring up. Trying to discuss depression can just lead to… deeper depression.
- Reading? Same. Each word can have a valance to it. Your mind may not even pick up positive ones, while it’s triggered into unpleasant thoughts by negative ones. And when it’s not being fully engaged because it’s missing half of the contents? This gives thoughts a chance to, once again, wander, back into damning territories.
And what weirdly DOES help when you’re depressed (we know now, for research-backed reasons)?
- Spontaneous feeling without thinking. Perceptual memories aren’t biased by depression. Explicit thoughts are. So the ability to think and feel in sensation, rather than narrative, helps emotions become “settled” without engaging in negative, long-lasting, spirals.
- For this? Nature is a great mediator. One of the reasons it helps fight off depression? There’s removal from the chatty human world and therefore opportunity to observe, sensorily, what’s happening inside and outside of yourself. “touch the moss and listen to the wind” instead of “trying to verbally make sense of your experience.”
- Art. If you can dip under your wordy thoughts and work with more abstract inner events, you avoid some of the complications of semantic torture that come with depression. Memory processing and self expression can take place without stoking rumination.
- Also. Sex. If you can turn off the narrative and to-do listing, and instead be in the body, sensing… (not easy things to do when depressed)… you can find positive affect, embodiment, and novel thoughts that are FUN to have, rather than the depression routine.
- And, resting also helps. Yes, constant activity will temporarily provide some reprieve. But the activity will end and the mind will return back to its default mode network behaviors of trying to ascertain why you suck and in what ways. So ACTUAL resting and neutral reflection – not self-distracting with a phone while laying down – can help preserve energy, to then apply it to problem solving and reappraisal.
And also, none of “beating depression” is as easy as anything I just said.
So, let’s hit up the research for some additional clues, and end with five empirically evidenced suggestions to help ourselves.
Going back to:
Cognition and Depression: Current Status and Future Directions
Ian H. Gotlib, Jutta Joormann
Annu Rev Clin Psychol. 2010
What DOESN’T work, according to them? Just “choosing to be happy” or “think of happier times.”
… three important mechanisms have been implicated as potential links between biased attentional/memory processes and emotion dysregulation in depression: biased inhibitory processes and deficits in working memory (Joormann 2005); ruminative responses to negative mood states and negative life events (Nolen-Hoeksema 2000); and the inability to use positive and rewarding stimuli to regulate negative mood (Joormann & Siemer 2004, Joormann et al. 2007a).
If we can’t identity positive events and stimuli, all the treats in the world won’t help. And either will recollections of “better times.”
They say
Memories themselves can be potent in regulating emotions. For example, recent studies have demonstrated that memories of unpleasant events fade more quickly than do memories of pleasant events and that this differential fading is associated with happiness (Walker et al. 2003). Further, recalling positive autobiographical memories can repair an induced negative mood state (Joormann & Siemer 2004), and remembering positive events and forgetting negative events has been found to be associated with increased well-being over the lifespan (Charles et al. 2003).
Thus, selective recall not only can affect other emotion-regulation strategies (e.g., situation attention or selection), it is also an effective strategy for directly changing emotions and mood states. Indeed, investigators have documented that mood-incongruent recall is often used as a mood repair strategy in response to a negative mood induction (e.g., Rusting & DeHart 2000).
Problem being…
Studies investigating the use and effectiveness of mood-regulation strategies in depression suggest that, in contrast to non-depressed persons, depressed individuals are unable to use positive autobiographical memories to regulate induced negative mood states.
Meaning, depression makes positive memories inaccessible or ineffective. In my experience, they become something to grieve – reminders of better times that are no longer here – and often encourage negative self-reflection in an attempt to place the blame somewhere.
Unquestionably, though, if attention isn’t controlled, memory and emotion can’t be either. We can’t will ourselves to feel different than what we’re focusing on and creating associated emotional states around.
So, that means controlling attention has to be a part of effective depression recovery.
They tell us:
The bulk of evidence points to depression-associated deficits in the control of attention rather than to limited processing capacity. When depressed participants’ attention is well controlled by the demands of the task and they have no opportunity to ruminate, no depressive deficits are found.
If we could simply keep our minds out of the gutters with full, constant, mental activation, we might be able to free ourselves from the negative networks and interpretive biases that spark rumination and lead to depression.
Which, I’m sure, many have tried to do. Which, probably explains why staying busy is short-term relieving, but the devastation returns as soon as an activity isn’t thoroughly engaging. Why panic attacks, morose moods, and brain-active insomnia come at night, as the mind finally gets a chance to re-engage in its self-referential ruminations.
Which, as we keep saying, come at an opportunity cost.
They tell us:
Research also indicates that rumination enhances the operation of cognitive biases. Thus, dysphoric participants who were induced to ruminate endorsed more negative interpretations of hypothetical situations, generated less effective problem-solving strategies (Lyubomirsky & Nolen-Hoeksema 1995), and exhibited increased recall of negative autobiographical memories (Lyubomirsky et al. 1998).
We can only pay attention to one thing at a time. If thoughts are tied up in negative recall and reflection, individuals aren’t going to be finding SOLUTIONS for their problems. They will only stare into the gap between desired and actual.
What we need is the ability to switch focus, which could even PREVENT the onset of depression before rumination entered the picture. But doing so requires the cognitive control that’s disrupted by both rumination and depression.
Singer & Dobson (2007) found that remitted depressed patients who were instructed to ruminate during a negative mood induction had higher levels of depressed mood than did participants who were instructed to use distraction.
Focusing attention requires individuals to inhibit task-irrelevant thoughts. Thus, the findings reviewed here support the affective interference hypothesis and the proposition that depressed individuals are characterized by reduced cognitive control.
Interventions focused on directly modifying cognitive biases and on increasing cognitive control hold considerable promise for improving the effectiveness of the treatment of depression.
Just to bring this point all the way home.
Rumination as a Mechanism Linking Stressful Life Events to Symptoms of Depression and Anxiety: Longitudinal Evidence in Early Adolescents and Adults
Louisa C. Michl, Katie A. McLaughlin, Kathrine Shepherd, Susan Nolen-Hoeksema
J Abnorm Psychol. 2013
They tell us:
In addition, experimentally inducing rumination in distressed individuals prolongs both depressed and anxious mood compared with inducing distraction.
And
Rumination on discrepancies following negative events may persist if it focuses on the causes and/or consequences of those events or on the distress/negative affect associated with stressful events, rather than on actions aimed to resolve the discrepancies.
So, the goal?
Increase cognitive control, increase attentional switching, increase access to problem solving and more positively valanced internal events, which allows attention to remain elsewhere – away from the negative self-rumination trap that leads to cog dep.
And, lastly, we have to make sure we go about this in a mind-informed manner, considering the ironies of attempting to manhandle our brains.
They say:
Efforts to suppress thoughts about negative events may also increase ruminative thinking
Which might make you think about Wegner’s theory of ironic cognitive control from earlier this year.
It told us that if individuals try to rid themselves of negative, depressing, thoughts and feelings… what they’ll actually end up doing is creating a hyper-focus on the presence or absence of those internal events.
At which point, if any negativity is detected, they consider themselves failures, eliciting a negative state, and creating the very condition that they were trying to avoid. Which then feeds back into even greater counteractive attempts to regulate negative thought and emotion.
Yet another reason that remission is more challenging than “just trying harder.”
But, since the literature still hasn’t produced a comprehensive method for overcoming the cognitive challenges… Let’s take everything we know and pull out some pointers of what and what not to do to help ourselves.
- We’ve learned that a state of NS arousal isn’t going to help. If we’re stressed or fearful the amygdala is going to be more active, causing the ruminatory circuit to also be more active. Distraction feels like it assists with depression, but continual activity can help drive up autonomic responses, which will also degrade attentional control. So, though it feels contradictory to overcoming depression, slowing down and then engaging in nervous system regulation behaviors is a good place to start.
- Preventing mental exhaustion is very important. Expending resources where it’s not necessary may provide temporary relief (short term distraction) but once the brain is zonked, it will return to negative cycling again (long term depression). Brainstorming effective and targeted solutions to ongoing life problems is a priority. Attempting to engage in continual learning or mental output will eat up the energy required for problem solving, and depression will return when the brain is tired out, without means to help itself.
- We also want to be mindful of engaging in uninspiring activities. When we’re not fully engaged, but trapped in a required time or activity prison – like, sitting at a desk for 8 hours, appearing to be busy – the mind will wander, the DMN will be more active, and suffering will increase as ruminations over negative feelings do. If you’re able to inspire yourself to engage in behaviors and tasks that you fully enjoy or fully demand your attention, you can get some reprieve from sadness and negative recollecting. And you can practice switching your attention, so that it becomes easier even when extremely-uplifting or demanding tasks aren’t available.
- What we don’t want to do? Is to have any amount of continued engagement with people who reject you or situations that can be interpreted as rejecting. If social stress increases rumination intensely by sparking self-reappraisal, doubt, and scorn… maybe the worst thing we can do for our depression is to be in ambiguous or unaccepting social surroundings. They will perpetually move cognitive activities in the wrong direction.
- We also don’t want to? Sit in our depression dens or maintain routines that have been experienced under depressive conditions. With these negative neural networks and self-schemas primed and waiting for daily activation? Even minute details of the environment can be causing a mind to re-engage the same thoughts, feelings, and memories, continually. Seeing the same four walls, smelling the same laundry detergent, taking the same route to work, and every color, texture, shape, and sound in between… can be maintaining activation of all-encompassing cognitive webs in the brain.
- Self-forgiveness and confidence are everything.
To shorten those points up:
Don’t run from depression. Even though going slow can feel like “wallowing,” you don’t want an overactive nervous system from hyping yourself up with coffee and overfilling your days. Instead, try to regulate it, with a mixture of physical activity and then physical relaxation, breathing, embodiment exercises, and neuroceptive control.
Prioritize plans for resolving your depression with behavioral changes, rather than running your brain into the ground and having no energy left for your own problems. Distraction helps, but only until you aren’t distracted anymore.
As much as possible, don’t force yourself into tasks that bore you. The ability for your mind to wander while only half-engaged will let it crawl right off a cliff.
Get away from difficult and ambiguous people, they’ll trigger RSD, rumination, and depression.
Change as much as you can. Get into new scenery. Recognize that even completely inert stimulation objects and events can be maintaining a negative mental state.