• Posted August 23, 2023

To Keep Depression at Bay, Fighting Negative Thoughts Is Key

Millions of Americans who experience major depression will suffer a relapse, but a new study suggests that learning to focus on the positive, rather than the negatives in everyday life, might help reduce those odds.

“What we started to realize is it's not just about how people with depression process negative information but there's something interesting about how they process positive information that might really be important in sustaining their negative mood or depressed mood," said study co-author Lira Yoon, an associate professor of psychology at the University of Maryland, Baltimore County.

Thinking "it might be important to examine both at the same time,” Yoon's team analyzed 44 past studies to better understand how much time those with a history of major depression spend processing negative and positive information. The meta-analysis included more than 2,000 people who had a history of major depressive disorder and more than 2,200 without it.

The studies looked at participants' responses to negative, positive and neutral information, such as photos of people or words that were happy, sad or neither.

The mentally healthy participants tended to respond faster to emotional and non-emotional information, regardless of whether it was positive, negative or neutral. They also had a significant difference in how much time they spent processing positive versus negative information.

Those who had major depressive disorder spent more time on the negative information.

The researchers were particularly interested in how people can disengage from information that is no longer relevant.

“We all get upset when something stressful happens. That's a natural reaction," Yoon said. "But some people can move on or put it aside while they have to do the task at hand, whether it's having conversations with their kids or doing chores or what have you."

Other people are unable to do that. "The thought about the argument they had earlier or some comment that they heard keeps popping back to their mind, which then interrupts the thing that they have to do at the moment,” Yoon explained.

“What our study is showing us is people with past depression, although they are not currently depressed, what they are showing is that they have more difficulty disengaging from irrelevant negative information than they have with the positive irrelevant information,” Yoon said.

Those negative thoughts may take over instead of leaving room to perform what's necessary at the moment, Yoon said.

That in turn may cause more negative emotion, “and if something again stressful happens, that might make them more vulnerable to then experience another episode of depression down the road,” Yoon said.

In 2021, about 21 million U.S. adults had at least one incident of major depression, defined as at least two weeks of depressed mood and loss of interest or pleasure in daily activities. That's about 8% of the U.S. population, according to the U.S. National Institute of Mental Health.

More than half will fall back into a depressive state, often within two years of recovery, the researchers noted.

So, what can someone do to prevent relapse?

Among the most effective treatments for depression are therapy and medication, sometimes in combination. Cognitive behavioral therapy (CBT) is one widely used approach, and among the mainstays of that therapy is cognitive restructuring, said Dr. George Alvarado, a psychiatrist who practices at Northwell Health in New York.

“It's taking scenarios, looking at situations. Could I look at this a different way? Am I interpreting this or misinterpreting it or looking at it through a more negative lens?” Alvarado said.

A lot of therapy is teaching skills someone can use outside of the session, he said.

It can help to make changes at work, in relationships or in lifestyle to improve mood. It's also important to get good sleep, exercise and have a healthy diet.

“Even if someone's in great mental health, if those things went off the rails and you stopped sleeping, were eating junk food all the time, became sedentary, it's going to start to affect your mood,” Alvarado said. “If you have a family history or a personal history of depression or anxiety, if you're not making those changes in terms of lifestyle, it's also going to make it harder.”

Yoon said in addition to existing therapies like CBT, it may be possible to develop a training program to help people with a history of depression to disengage from irrelevant information. That doesn't exist yet.

Different people respond better to different techniques, so it would be good to have an array of tools, she said.

“We still have a way to go, but some of the existing tools like CBT and mindfulness I do think can be useful in helping people better disengage from irrelevant, especially negative information,” Yoon said.

The study findings were published Aug. 21 in the Journal of Psychopathology and Clinical Science.

More information

The U.S. National Institute of Mental Health has more on depression.

SOURCES: Lira Yoon, PhD, associate professor, department of psychology, University of Maryland, Baltimore County, Baltimore; George Alvarado, MD, psychiatrist, Northwell Health, and assistant professor, Zucker School of Medicine at Hofstra/Northwell, Manhasset, N.Y.; Journal of Psychopathology and Clinical Science, Aug. 21, 2023