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Psychic Equivalence: Depression's Secret Weapon

What it is and what you can do about it.

Key points

  • Psychic equivalence is an experience in which what we experience in our minds feels true in the outside world.
  • Depression and stress make us more vulnerable to psychic equivalence.
  • Psychotherapy such as mentalization-based therapy can help.
SIA Art/Pexels
Source: SIA Art/Pexels

I could sense their hatred as I walked down the hallway. Like a sixth sense. I knew I was in an intense depressive episode. I understood the way depression affected my thoughts. Yet, this felt so real, it had to be real. I felt hated. But this time, I caught it. I knew what this was: psychic equivalence. I took a breath, reflected, and brought myself back to reality.

Depression is a master deceiver. It creates a shadow over our perceptions. Depression has a way of shading our view of the world. It creates immense pessimism. Depression can convince you that you are not liked, or not worthy, In cognitive behavioral therapy, this depressive-reality crossover has been called emotional reasoning (Beck, 2020). In this framework, the emotions accompanying depression are said to influence our logic in a habit of thought that ultimately rests in fallacy.

Another perspective on the phenomena comes from mentalization-based theories, a construct called psychic equivalence (Bateman et al., 2023).

Have you ever stood on a diving board at a water park as you feared a shark below? Of course, there would be no reason for a shark to travel from the ocean, somehow breathing air, just to land in that pool you are about to jump in. But, as you jump, that shark sure feels like a real threat. If so, you understand something about psychic equivalence. The shark in your mind becomes a shark in your reality.

Psychic equivalence is an experience in which what is happening inside our mind feels so real as to equate to what is happening in real life. It's a sort of mind-reading practice gone astray wherein our process of relating to self and others is clouded but also takes on a sort of extra certainty.

Mentalization is a process of being able to understand self and others in real time. In mentalization-based treatment, psychic equivalence is considered a "nonmentalizing mode." In other words, it's something that blocks our ability to relate effectively to ourselves and others.

Anyone can encounter psychic equivalence, but we are most vulnerable when under stress. Some people have a greater tendency toward psychic equivalence than others. Psychic equivalence is common in those living with personality disorders such as borderline personality (BPD). Research shows that the phenomenon often also shows up in those living with depression who do not also have BPD (Rifkin-Zybutz et al., 2020).

Unchecked, psychic equivalence can worsen depression, negatively affect relationships, and chip away at one's self-worth. We might act on these beliefs, isolating ourselves from others or lashing out. When most serious, it resembles psychosis, and some have argued that a delusion is, at base, psychic equivalence (Bateman et al., 2023).

If these patterns sound familiar to you, there is hope.

Recognizing and labeling the pattern can be a first step. If you notice this happening most during depression, it can be meaningful to know that while experiencing depression, you may be more vulnerable. Taking space to reflect or to converse with a trusted friend can assist with reality-checking.

If you find psychic equivalence especially troubling to your happiness, sense of self, or relationships, psychotherapy can help. Psychotherapy, particularly mentalization-based approaches, can give you space to understand these patterns and assist you in relating to yourself and others to your fullest. In mentalization therapy, initial sessions focus on the assessment and creation of a mentalizing profile so that you can better understand how you are relating. From here, a therapist (or team) can utilize specific strategies to assist you in bringing the best of your mentalizing capacities back to the surface.

Psychic equivalence can be painful, both in the moment and in the aftermath it can leave on one's relationships. But it can be tamed.

To find a therapist, visit the Psychology Today Therapy Directory.


Bateman, A., Fonagy, P., Campbell, C., Luyten, P., & Debbané, M. (2023). Contents. In: Cambridge Guide to Mentalization-Based Treatment (MBT) (Cambridge Guides to the Psychological Therapies, pp. Vii-Viii). Cambridge: Cambridge University Press.

Beck, J. S. (2020). Cognitive Behavior Therapy (3rd ed.). Guilford Press.

Rifkin-Zybutz, R. P., Moran, P., Nolte, T., Feigenbaum, J., King-Casas, B., Fonagy, P., & Montague, R. P. (2021). Impaired mentalizing in depression and the effects of borderline personality disorder on this relationship. Borderline Personality Disorder and Emotion Dysregulation, 8(1), 1–6.

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