CogBlog – A Cognitive Psychology Blog

Your friend reveals to you that she suffers from depression. When she hangs out with you and your other friends, she always sees things negatively and seems to bring the whole group down. Why can’t she just think positive? Does she even have a real condition? Everyone gets sad sometimes. You don’t understand why she can’t just cheer up, especially because you always eventually cheer up when you’re sad. You’re confused because there is nothing she needs to be sad about anyways; she has a good life! Besides, it’s all in her head. She just needs to change her mindset. 

Depressed people are all too used to the unhelpful advice to ‘just cheer up.’ The cognitive processes behind depression mean that those suffering from it are simply unable to ‘just cheer up.’ They would cheer up if they were able to.

A multitude of misconceptions surround depression. The stigma surrounding depression often leaves individuals who suffer from it to be perceived as lazy, negative, sad, and dramatic. Depression can be very difficult to understand for those who have not suffered from it. This leads to the perpetuation of misconceptions and a lack of the effective support that depressed individuals need grately. If you’ve ever had thoughts similar to the ones above about someone in your life, while you may have good intentions and want them to get better, you are lacking a basic understanding of depression itself and the cognitive processes behind it. Here’s the thing: Platitudes such as, ‘just think positive!’ ‘snap out of it!’ and ‘you need to cheer up!,’ which are all too commonly used as advice for depressed people, completely miss the mark. Because of the various cognitive processes underlying depression, it is impossible for depressed individuals to fix the issue in the ways that are suggested. It’s not that simple. Believe me, if it was that simple, they would surely be free of their depression by now.

Depression is one of the most prevalent mental illnesses. It is estimated that more than 30 million U.S. adults have had depression in their lifetime, and in general, lifetime prevalence of depression is estimated to be 16.6% (LeMoult & Gotlib, 2019). While many people know that depression can occur because of issues with neurotransmitters, this solely biological explanation is incomplete and inaccurate; depression is caused by a combination of biological factors and cognitive distortions. Most individuals remain unaware of the cognitive processes behind depression, and therefore lack a comprehensive understanding which would allow them to empathize effectively. All too often friends and family have the best intentions in supporting depressed loved-ones, but they are unable to be fully supportive because they do not understand the nature of depression and what causes it. In this post, we are going to take a look at some of the cognitive biases that are linked with depression. Promoting an understanding of these underlying processes will shed light on the complicated nature of depression and how it is deeply entangled in our cognitions. Hopefully, common misconceptions surrounding depression will be called into question, and people will gain insight that will allow them to be better family members, friends, co-workers, etc. 

When someone reveals that they suffer from depression, it is not uncommon for individuals in their lives to bombard them with simple ‘solutions.’ However, depression is much more complex than these pieces of advice imply, as it is rooted in important cognitive processes that affect every aspect of our existence.

Overall, depressed individuals have mood-congruent biases that affect a number of important cognitive processes. Mood-congruent biases are cognitive biases that cause individuals to be preferential to information which matches their mood. In other words, if someone is feeling happy and positive, they would prefer material that matches this mood and is happy and positive in nature as well. In depressed individuals, this bias reveals itself in a number of cognitive processes, such as a memory, attention, and interpretation. As a result, people with depression tend to have negative views of themselves, the world, and their futures. Depressed individuals lack cognitive control over mood-congruent material, and thus, their negative mood causes them to perceive things negatively, which reinforces their negative mood, creating a vicious cycle that is difficult to escape from. In order to better understand this cycle, we will examine mood-congruent biases in a few different cognitive processes. 

Memory

Those with depression are not ‘just sad.’ Depression is just as serious as any other illness. Feeling misunderstood can make depressed individuals reluctant to reach out for the help that they need.

Memory is one of the most important aspects of our lives. Without it, our existences would look very different. Memory affects every aspect of our days, from simple things like remembering what day it is, to more complex things like what the emotion of disappointment feels like. Depressed individuals exhibit a negative bias in memory. This means that they unconsciously prefer to encode and recall memories that are negative in nature. Because memory is clearly so important, it is clear that the effects of a negative bias in memory could create some serious issues, depression being one of them. Encoding is essentially the process of committing information to memory. For more information on the effects of depression on memory, check out this post. 

One way the negative bias of memory affects depressed individuals is by causing them to have a preference for negative material about themselves (Mathews, 1986). In one experiment, the same set of positive and negative words were given to depressed and non-depressed people. Participants were sometimes asked to decide if the word applied to themselves, and other times asked to decide if the word applied to someone else. After this task, they were asked to recall as many words as possible. The results showed that the negative bias in memory was only present in depressed individuals when they were asked to rate themselves. However, when words were rated for other people, the both participants with depression and without exhibited the same positive recall bias (Mathews, 1986). This experiment shows that depressed individuals have particularly negative views about themselves, and these views permeate how they perceive, encode, and remember information. Also, when recalling personal memories, depressed people are slower to recall positive memories and faster to recall negative ones, showing how their minds have been hardwired to perceive themselves and the world around them as negative. 

Additionally, depressed individuals show a negative bias in memory about the future. Research in cognitive psychology has found a connection between how easy it is to retrieve information from memory and our perception of risk involved in future events. In other words, the easier a similar event is recalled from memory, the more likely an individual is to judge a future even as likely to happen. Experiments have shown that depressed individuals are less likely to expect positive future events because they can more easily recall memories of negative events (Mathews, 1986). 

Attention

Mood-congruent biases also affect the cognitive processes involved with attention. A common task used in experiments to study attention via reaction times is the dot-probe task. In this task, words or pictures of faces are used as stimuli and are either neutral or emotional, and participants are asked to find the location of a dot that is behind the stimuli. Reaction time is measured by recording how long it takes participants to detect the dot after the word or the picture is removed. While researchers found that depressed individuals show a greater attentional bias toward sad faces versus faces depicting other emotions, they also found evidence for the negative attentional bias in people with depression when stimuli were presented for a longer duration. The results of this experiment led researchers to conclude that attentional bias in depression is less about individuals being drawn towards negative stimuli, but more about individuals having difficulty disengaging, or removing their attention from negative stimuli. Because depressed individuals tend to engage in negative rumination, these results make a lot of sense as their attention is stuck on the negative stimuli which disrupts the task of locating the dot (LeMoult & Gotlib, 2019). 

Phrases such as ‘just be happy’ or ‘cheer up’ do nothing to help depressed individuals; in fact, it might just reinforce their feeling that no one understands them and the hopelessness that coincides with the perception.

Interpretation and Learning

Mood-congruent biases also cause individuals with depression to interpret, process, and learn information differently than those who are not impacted by the illness. To engage in these processes, it is crucial that we are able to make predictions based on our knowledge, and then update these predictions as new knowledge is encountered. However, individuals with depression not only predict future events to be negative, they have difficulty updating their expectations when positive information is introduced. This is referred to as ‘cognitive immunization,’and when individuals engage in it, they use new disconfirming information in a way that maintains their errored expectation (Kube et al., 2020).  In other words, when a depressed person expects a negative event and then encounters positive information which tells them their expectation is flawed, instead of updating their expectation to be positive, they keep their negative expectation. In this way, depressed individuals are ‘immune’ to positive feedback, and immunity is not a good thing in this case. Because positive feedback is ignored, depressed individuals tend to feel that their negative expectations are confirmed, which causes them to expect more negative events, and thus causes them to enter into a feedback loop of negativity (Kube et al., 2020). Even when positive experiences occur, depressed individuals are unable to update their negative expectations, making the common advice of ‘just think positive’ utterly useless. The quote “what we perceive is not the world as it actually is, but the brain’s best guess of it”(Kube et al., 2020) is particularly salient here. The brains of people with depression make predictions based on their cognitions, and because the cognitions are negatively biased, depressed individuals come to perceive the world as more negative than it actually is. 

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We have established that depression causes and is caused by many different errors in cognition. The question is, can we fix these errors? If so, how? 

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, CBT for short, is an increasingly common method of treatment used to treat individuals with various mental illnesses. CBT has been established as an effective treatment for depression (Flynn & Warren, 2014).  It focuses on

CBT has the power to make individuals more away from their cognitions and how these cognitions contribute to their mental illness. Just giving patients the tools to acknowledge the cognitive processes in question allows them to feel less powerless over their mind. Speaking from experience, cognitive behavioral therapy does, in fact, feel magical at times.

helping patients correct the distorted cognitions that they have about themselves, the world, and the future, as well as on behaviors that may be perpetuating symptoms. Therapists help individuals learn to acknowledge the thoughts and cognitions that underlie how they feel and act, giving them the tools to address the cause of their symptoms. It can be used alone or in combination with medication. For the treatment of mild to moderate depression, CBT was found to be as effective as antidepressant medication, and the combination of CBT and medication increased the likelihood that the patient would adhere to treatment (Flynn & Warren, 2014). Additionally, studies have shown that CBT may also serve as a protective measure against future depressive episodes (Flynn & Warren, 2014). There is great importance to CBT beyond the fact that it is a proven effective treatment for depression and a number of other mental illnesses. CBT goes beyond depression as a solely biological issue caused by issues with neurotransmitters. The effectiveness of CBT supports the idea that cognitive distortions play a major role in depression. 

In cognitive behavioral therapy, therapists help patients to better understand how their mind works, giving them the tools, power, and confidence to help themselves.

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Let’s recap. Depressed individuals are unable to take the all too common advice given to them and ‘just cheer up’ or ‘think positive’; the cognitive processes in their brain simply will not allow them to. Depression causes mood-congruent biases that impact the cognitions involved in their memory, attention, processing of information, and more. In this way, understanding and examining the cognitions behind depression and the problems with them will help to address misconceptions, as these misconceptions are based on a lack of understanding. 

Next time you encounter someone in need of support, particularly if they are depressed, try to avoid phrases that trivialize their experience with mental illness. You may not ever be able to completely understand what they are experiencing. How could you? Their brain and yours have been hard-wired differently, and that is okay. But hopefully, now that you better understand the ways in which their brain differs from yours, you can be there for them in the way they need you to.

References: 

Flynn, H. A., & Warren, R. (2014). Using CBT effectively for treating depression and anxiety. Current Psychiatry, 13(6), 45-53.

Kube, T., Schwarting, R., Rozenkrantz, L., Glombiewski, J. A., & Rief, W. (2020). Distorted cognitive processes in major depression: A predictive processing perspective. Biological psychiatry, 87(5), 388-398.

LeMoult, J., & Gotlib, I. H. (2019). Depression: A cognitive perspective. Clinical Psychology Review, 69, 51-66.

Mathews, A. (1986). Cognitive processes in anxiety and depression: discussion paper. Journal of the Royal Society of Medicine, 79(3), 158-161.