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Depression

To Overcome Depression, Think Flexibly, Not Positively

New research reviews thinking errors in depression.

Key points

  • Compared to other people, individuals with depression often show fewer positive and more negative interpretation biases.
  • Making negative interpretations is not dysfunctional; what is dysfunctional is a lack of flexibility in information processing.
  • Interpretation biases could result in blunted positive emotions and/or elevated levels of negative emotions.
  • Cognitive bias modification increases interpretation flexibility, thus enhancing emotion regulation ability and also improving mood.
whoismargot/Pixabay
Source: whoismargot/Pixabay

This post summarizes key findings from an article by J. Everaert, published in the October 2021 issue of Current Opinion in Psychology, which discusses research on interpretation biases in depression.

Cognitive Distortions, Interpretation Biases, and Depression

Suppose you're leaving a party, when, suddenly, you notice a guest looking at you and frowning. Why is the person frowning?

Perhaps he's sad that everyone is leaving. Maybe he is experiencing some physical pain and distress. Then again, the guest might be angry at a thing you said or did at the party.

Making sense of ambiguities is an important part of life. After all, many individuals in our lives—e.g., coworkers, friends, classmates, spouses, children, parents—sometimes speak or behave in ways open to interpretation.

How one interprets these ambiguities is influenced by a variety of factors, including personality traits and mental health conditions. For instance, many individuals with anxiety and depression are prone to cognitive distortions or thinking errors.

Common cognitive distortions include:

  • Arbitrary inference: Jumping to conclusions (e.g., because a friend did not call you as promised, he/she must hate you).
  • Catastrophizing: Assigning a high likelihood to the worst-case scenario (e.g., a breakup means you will die alone).
  • “Should” statements: Having unreasonable expectations (e.g., a good teacher should never make mistakes).
  • Personalizing: Self-blame for a negative outcome not fully under one’s control (e.g., you blame yourself for your parents’ divorce).
  • Black-and-white thinking: Viewing experiences as either all good or all bad (e.g., since you made a spelling error in the love letter you sent, the love letter is worthless).
  • Labeling: Labeling oneself based on a behavior (e.g., because you lost the game, you’re a loser and a failure).

Cognitive distortions are challenged in therapy using techniques like cognitive restructuring, a typical component of cognitive behavioral therapy (CBT).

How Do Depressed People Interpret Ambiguity?

Compared to others, people with depression often make fewer positive interpretation biases (e.g., failing to interpret a smile as a sign of romantic interest) but more frequent negative interpretation biases (e.g., interpreting a frown as a sure sign of disapproval and rejection).

The mechanisms behind the interpretation biases in depression likely involve higher-order cognitive processes, which naturally rely on more basic cognitive processes like attention, working memory (i.e. short-term memory), and long-term memory.

Beck’s schema theory suggests depressed people hold negative self-referential beliefs (e.g., “I am a failure”) in their memories. These negative schemas guide what depressed people attend to, how they interpret ambiguous information, and what they recall. And these reinforce the maladaptive schemas. For instance, depressed people are more likely to interpret a problem as a sign of personal weakness and use it to confirm their negative views of themselves.

Before continuing, some clarifications: Paying attention to potential negative consequences of actions or making negative interpretations are not always dysfunctional and maladaptive. In some situations, pessimism is adaptive, whereas being overly optimistic is maladaptive. In fact, negative thinking could be beneficial when the goal is preparing for contingencies.

What is dysfunctional is less the negative interpretation and more the lack of flexibility in revising the negative interpretation when one should (e.g., when provided with disconfirming evidence).

How Do Interpretation Biases Lead to Depression?

Negative inflexible interpretations of ambiguity may lead to depression through their effects on emotion regulation. Negative interpretation biases could result in blunted positive emotions and/or elevated levels of sadness and other negative emotions like fear and anger.

Interpretation biases impact relationships too. They contribute to interpersonal problems, hostile and quarrelsome behaviors, and reduced social engagement. Why?

Perhaps because cognitive distortions and interpretation biases lead one to interpret comments or behaviors negatively, and as a result, respond in a manner not conducive to socialization (e.g., becoming critical of a person or refusing to get close to them). These responses elicit negative reactions in others, undermine relationships, and thus worsen depression.

Engin_Akyurt/Pixabay
Source: Engin_Akyurt/Pixabay

Treatment for Depression and Interpretation Biases in Depression

To summarize, people with depression often interpret ambiguous situations in a negative, personal, and inflexible manner. For instance, when a depressed person who has donned a new hairstyle is told, “You look different,” he or she might interpret the statement as, “I am ugly,” or “I can’t do anything right.”

These interpretations “make sense” to the person with negative self-representations (e.g., as undesirable, unattractive, incompetent, worthless). The biased and inflexible interpretations (e.g., of the comment regarding the hairstyle) reinforce these negative views of the self, thus exacerbating depression.

As noted earlier, it is not wrong to pay attention to negative cues or consider negative interpretations of events. The problem lies with inflexible, automatic, and black-and-white thinking. With failing to modify one’s beliefs after obtaining evidence inconsistent with the interpretation.

For example, to believe failing a course means one is incompetent or stupid, and continue to believe so even after learning of the high percentage of students who fail courses, suggests an interpretation bias.

Not surprisingly, the most effective treatments for depression not only provide experiences that challenge dysfunctional and maladaptive beliefs but also promote flexibility in attention, and especially, information processing.

The goal of treatment is to help depressed patients:

  1. Pay attention to both positive and negative information (e.g., notice positive information that disagrees with their negative core beliefs).
  2. Flexibly integrate positive information into negative beliefs they hold, so as to develop a richer and more accurate understanding of themselves and their world.

The good news is modifying interpretation biases can improve depression. Indeed, an investigation of people with depression and generalized anxiety disorder found cognitive bias modification for interpretation (CBM-I) induced a more positive interpretation bias and resulted in reduced worry, depression, and rumination. (Rumination refers to repetitive thoughts that are focused, often passively, on one’s mood and its symptoms, causes, implications, etc.).

Cognitive bias modification promotes flexible and efficient information processing, opening the door to new possibilities for sustainable happiness and well-being.

LinkedIn image: Prostock-studio/Shutterstock

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