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What to Do When Psychotherapy for Depression Fails

Belief updating in depression is examined.

Key points

  • Depressed people often fail to use new positive information to update negative thoughts and views.
  • Failure to update beliefs can maintain biased perceptions of oneself, others, and the world.
  • Belief updating depends on mood, positivity of the new information, and the use of cognitive immunization.
Source: SayaPhotos/Pixabay

Depression is a common mental illness and a leading cause of disability worldwide.

Psychological therapy is often the treatment of choice for depression; however, even evidence-based psychotherapies may not significantly help as many as half the patients.

Part of the reason could be that people with depression have difficulty taking in and integrating information that contradicts their negative beliefs.

Indeed, individuals experiencing depression often resist positive feedback. This means rejecting the idea that they might be, say, more knowledgeable, intelligent, attractive, competent, desirable, successful, kind, or compassionate than they believe.

In some situations, however, depressed individuals are less resistant to disconfirming evidence. When? A recent paper by T. Kube, a post-doctoral researcher at Harvard Medical School, attempts to answer this question.

The author’s findings, published in Clinical Psychology Review, are summarized below.

Depression and exposure to disconfirming evidence

Kube found individuals with depression do not necessarily change their beliefs after receiving positive information (i.e., evidence that disconfirms their beliefs). And this is especially true when:

  • They are in a bad mood.
  • The information presented is seen as either extremely or barely positive at all.
  • It is quite easy to devalue the new information using cognitive immunization strategies.

Cognitive immunization strategies

Cognitive immunization refers to a defensive reinterpretation of evidence that contradicts one’s beliefs.

Specifically, it means making sense of new information in a way that allows one to maintain previous views and expectations.

To illustrate, a patient with depression who wants to maintain the view that she is unlikable may reinterpret other people’s compassion or kindness toward her as pretense, manipulation, mere politeness, etc.

Similarly, a depressed person who receives positive feedback on a test may reason that the test was uncharacteristically easy, he had an easy marker, or he simply got lucky.

Improving psychotherapy for depression

So, given these obstacles, what are some potential strategies for improving psychotherapy for depression?

One, since negative mood appears to have an adverse effect on belief updating, it is important to be in a neutral or good mood before receiving any belief-disconfirming evidence.

Mood-enhancing activities include, among others, engaging in aerobic exercise, listening to music, and spending time with pets.

Two, because it is easy to ignore slightly positive feedback and be suspicious of extremely positive feedback, the information presented must be only moderately positive.

Three, the use of cognitive immunization strategies should be inhibited. Since these strategies are used to devalue disconfirming evidence, the solution is to underline its value and significance instead.

More research is needed to determine how to do this effectively, but to speculate, writing down the positive feedback, being reminded of it regularly, or practicing mindfulness and self-compassion may help.

Indeed, practicing mindfulness can prevent automatic dismissal and facilitate deliberate analysis of the positive evidence. Another way of doing this is by changing the information presentation. For example, in case of written feedback, by changing line spacing or the font style, color, or size.

Source: StockSnap/Pixabay


Cognitive behavioral therapy (CBT) is considered the gold-standard treatment for anxiety disorders and depression.

Patients receiving CBT are usually instructed to carry out behavioral experiments—planned experiential exercises to test negative beliefs. The assumption is that people with depression will update their beliefs when exposed to evidence that contradicts their negative expectations.

But many do not respond to CBT and similar psychotherapies partly because the above assumption is not true all the time. Those with depression may hold on to their negative beliefs by ignoring or devaluing the new evidence.

For example, after an enjoyable interaction with a group of strangers at a party, to think, “They were just pretending to like me.”

To increase the likelihood of belief updating, research shows, depressed individuals need to be in a neutral or positive mood, view the new evidence as “moderately” positive, and be prevented from using defensive cognitive strategies that devalue the positive feedback’s credibility and reliability.

These strategies are a promising way to increase the effectiveness of CBT and other psychotherapies for depression and promote more flexible thinking.

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

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