How Psychologists Treat The Kind Of Thinking That Leads To Depression

Rumination sucks. But researchers know how to stop it.

Image courtesy of Unsplash.

When human brains have nothing else to do, they think. Even if you’ve meditated for 3,000 hours, you’ll still get thoughts popping into your head every ten seconds or so. When people are put into brain scanners and don’t have a task to do, their brains inevitably start reflecting or planning. Narrating to ourselves what has happened or could happen is such a central part of the human experience that neuroscientists have come to call it the brain’s default mode.

Moment by moment, we’re piecing together our life stories. While there is some disagreement, the scientific community generally sees this as a good thing. But there’s one particular form that researchers say can be particularly destructive. Not all stories we tell ourselves are helpful; some are self limiting, and you find yourself running a half marathon to learn that you’re capable of being athletic.

“We live through our stories rather than living with our stories,” says Jim Carmody, PhD, a professor of preventative medicine at the University of Massachusetts medical school and a lifelong meditation practitioner. While no one’s ever seen a thought “standing in the living room,” Carmody says that people tend to take their thoughts to be real and objectively true. But in contrast to lamps, chairs, computers and the like, thoughts aren’t objects out in the world; they’re mental events. Still, without some sort of training, we spend our lives so immersed in our opinions about people, places and things — including ourselves — that we mistake the stories we tell about reality for reality itself. It’s a form of what social psychologists call “naive realism”: that your experience of something is the final word on that thing, that if somebody made you mad, it’s because they’re a bad person, or if you just got dumped, that must mean you’re unloveable.

These self-narratives get especially self-limiting — or even self-destructive — in the form of pathological rumination, a mental process that’s a key player in depression and anxiety disorders. Kevin Ochsner, the director of Columbia University’s Social Cognitive and Affective Neuroscience Lab, tells Thrive Global that rehashing negative experiences is likely just a part of the way humans are built: your brain tags difficult times as significant experiences, and they get replayed in your memory — one of the main ways the brain stores anything for later retrieval.

Rumination is “an unproductive way of cycling through those things repeatedly without ever gaining any insight into what those events mean in the bigger picture,” Ochsner says. The problem is when we don’t gain any psychological distance from these events and fail to gain greater perspective about them: if you’re just refreshing an argument with your partner in your head like webpage on your browser, you’re not really getting anywhere. This pattern of rehearsal becomes more damaging when paired with the self-narratives that can spiral into depression, where “every event becomes a referendum on your negative self-worth,” Ochsner says. There’s enough ambiguity in life that if you’re looking for a negative interpretation of events, you’re going to find it: if your new coworker can’t make it to lunch, it must be because you’re so unlikeable. Then, if this pattern continues, you ruminate on that collegial slight every time you see them. There’s a claustrophobic inflexibility to the pattern: It’s a “cycle of reliving without reframing,” Ochsner says.

Rumination has been found again and again to be a strong mediator for anxiety and a huge risk factor for depression, including in a 137-person study that tracked people for 2.5 years. People who ruminate frequently are less forgiving of themselves, abuse alcohol more, take more risks driving, and are at greater risk of suicidal ideation.

With rumination being an on-ramp to depression and anxiety disorders, it’s not just a personal concern, but a global public health issue. About one in 21 people worldwide will experience major depression in their lives, estimates indicate, and one in 13 are experiencing an anxiety disorder. According to the Lancet’s authoritative Global Burden of Disease Study, major depressive and anxiety disorders are the third and ninth leading causes of disability worldwide. The World Health Organization estimates that depression and anxiety cost the global economy $1 trillion every year — and these conditions aren’t limited to the West, but are prevalent in Africa and Asia as well.

Still, it’s hard to even realize all this narrativizing is happening without some sort of training. “The cognitive process, the story becomes integrated into our initial experience of the world,” Carmody says. Even as infants, we’re trying to make sense of the world, and by the time language comes online, the self-narrative process has already been interwoven with our sensory experience, even before episodic memory starts forming. Self-narrative develops right along with language use, and that’s all interwoven with sensory experience.

Not having a voice in your head commenting on everything “is like going back to the Big Bang,” he says. “It’s so implicitly embedded in our experience of the world that we don’t see it.” And there’s a million years of evolutionary pressure telling you to do so: the forebear that didn’t worry about storing enough food for winter or what went wrong on the last hunt didn’t become your forebear. “This is what attention does,” he says. It’s a needs-based mental function: in addition to noticing opportunities, it highlights threats.

In a way, lots of the leading treatments for negative self talk, anxiety, depression and other mental disorders are methods for establishing a new relationship with your predisposition to finding threats, analyzing weaknesses and telling stories about yourself that all those years of evolution handed down to us. Both meditation and cognitive behavioral therapy train you in treating your thoughts with a lighter touch — to, as the Zen maxim says, not believe everything you think. Carmody, the UMass professor, has been meditating for decades, and he likes to say that when you bring awareness to your thoughts, they begin to take on “their natural translucency.” Meditation has been shown to reduce rumination in general populations as well as in people with depression, and CBT helps with everything from depression to generalized anxiety to panic disorders. The combination of the two may be especially effective: mindfulness-based cognitive therapy has been shown to significantly reduce relapse in people who have recovered from depression, at a rate that’s at least as effective as antidepressant medication.

With CBT, those self narratives are challenged through “reappraisal,” whether by yourself, with a computer, a therapist, or in a group. This works by rethinking a given situation — examining what people’s intentions might have been, how you might be interpreting whether your ideas about what happened are truly accurate — and with that rethinking, adjusting your emotional reaction. Ochsner says that a big reason for why CBT works so well for people heavy on rumination is that they’ve spent so much time interrogating their own thoughts. With reappraisal, you’re taking that same skill in internal investigations and turning it into something that breaks down barriers, rather than creating them. Like Batman, you’re using abilities trained in darkness for the good of humanity.

A handful of mental processes are used in reappraisal: working memory, or your ability to hold multiple objects in mind, like the digits of a phone number; cognitive control, or the ability to focus on some sensations and ignore others; and theory of mind, or your ability to sense what others (and even yourself!) feel in a given situation. When these processes work in concert, you can revise your assumptions, and see situations in new, possibly life-giving light. It happens spontaneously, too, as our aphorisms suggest: when we’re finding silver linings or making lemonade out of lemons, we’re reappraising. You probably want to wait until the strong emotions have subsided, however, Ochsner says, as dramatic experiences tend to limit activity in the frontal lobe, the brain region where lots of the conceptual work of reappraisal gets done.

The key first step is to realize that the events in your life didn’t just objectively happen — all emotions have some degree of interpretation, in the way that, Ochsner says, “all of reality is subjective.” This is an insight embedded in the world’s cultural traditions: in Hindu philosophy, it’s postulated that humans experience “maya,” an illusion born of interpretation. In his landmark brain-imaging study of the neurological mechanics of reappraisal, Ochsner quotes Shakespeare’s Hamlet, who observed that ‘‘there is nothing either good or bad, but thinking makes it so.” It’s about getting beyond that naive realism, where you assume that how you think something went down is the ultimate truth of the matter.

Carmody, the UMass professor, says that beginning to see your thoughts is a lot like the parable of explaining water to fish: if you’ve spent your entire life immersed in them, it’s hard to see that they’re even there. But with techniques like mindfulness and CBT, it’s easier to see the narratives that structure your life and how you may spend more time than you’d like ruminatively rehearsing them. That way, instead of unconsciously living through your stories, you can choose to live alongside them.

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