Helpful Repetitive Thinking in Depression

In a previous blog, I noted that rumination – repeated dwelling on feelings, problems, and difficulties – is an important process maintaining depression. I also discussed the finding that repetitive thinking about upsetting events and unresolved problems is a normal and natural response – and that sometimes it can be helpful. For example, focusing on our difficulties can help us to come to terms with them and to solve problems. These contrasting effects of repetitive thinking led to the key questions of what factors determine whether repetitive thinking is helpful or unhelpful, and how does such thinking go wrong in depression?

These questions have been the primary focus of my research over the last 15 years and we are beginning to get some preliminary answers. This research is summarized in a research paper I published in Psychological Bulletin (2008).

First, it appears that the content and focus of the repetitive thinking is important. If you keep thinking about something positive, it is likely to make you feel better, whereas if you keep dwelling on something negative it will make you feel worse. In a nice meta-analysis of the field, Mor and Winquist (2002) found that attention to negative aspects of the self was strongly related to increased levels of negative mood, whereas attention to positive aspects of the self was related to lower levels of negative mood. The act of repetitively thinking about anything acts as a form of mental rehearsal for the content of inner speech, strengthening and elaborating the mental representations, making them easier to come to mind in future. It also tends to polarize and exaggerate thinking, making it more extreme. So, repetitive focus tends to exacerbate the current state and mood – if you are in a sad mood with negative thoughts, and you dwell on them, the mood will get worse, and the thinking will get more negative. Thus, repetitive thought acts as an amplifier of thoughts and feelings.

Second, the style of the repetitive thinking is equally important. It is possible to focus on negative information in helpful or unhelpful ways.

Imagine that you are faced with an upsetting and saddening event such as the unwanted end of an intimate relationship. The break-down of a relationship will be experienced as negative by nearly everyone and will likely lead one to dwell on its demise. However, there are quite distinct ways of dwelling on it.

One understandable way to dwell on this split is to think about why it happened, what it means, what caused it, and its implications for the future. In this style of processing the break-up, you would be focused on the causes, meanings, and implications of what happened. This way of thinking tends to move away from the specific details and contexts of what happened and to more general abstractions, which capture the key gist of the event and what this event might share with past events and with other situations in the future. Hence, this style of thinking is called abstract processing. Typical questions might include “Why did this happen? What does it mean about me? What does it mean about the future?” An extensive social psychology literature indicates that such “why?” questions tend to make thinking more abstract and to distance individuals from the specifics of situations.

This abstract style of processing negative events is typical of depressive rumination and anxious worry. You can see how if you are feeling down and have low self-esteem, focusing on yourself and thinking about a break-up in this abstract way could be unhelpful, because asking these questions about causes, meanings, and implications is likely to lead to negative self-blaming conclusions, e.g., “It is my fault”. Moreover, because abstract processing tends to broaden out across situations, such thinking will pull in past memories of rejection and loss (e.g., “This keeps happening to me”), and may lead to general conclusions about the future, such as “I will never have a lasting relationship”, all of which worsen mood and exacerbate depression.

In contrast, you could repetitively reflect on the break-up by focusing on exactly how it happened, replaying in detail the events that led up to the split and the final few meetings and conversations with your ex, noting in detail what happened. In this style of processing the break-up, you would be focused on the specific details, the sequence and the circumstance of how the relationship came to an end. This way of thinking focuses on the context (when, where, how, what, who) of what happened and how it happened and stays close to your actual concrete experience of the end of the relationship, rather than thinking about its meaning. Hence, this style of thinking is called concrete processing. Typical questions might include “How did this happen? What did I do? What did my ex do? How did I feel? How did this unfold over time?”

A series of experiments in my lab, replicated in other labs, have found that, when faced with problems or upsetting events, adopting a concrete style of processing is more helpful than an abstract style of processing. For example, when asked to generate solutions to interpersonal difficulties such as an argument with a partner or a disagreement with your boss, we found that prompting currently depressed patients, formerly depressed patients and never depressed controls with either no questions, abstract “Why?” questions, or concrete “How?” questions, influenced the quality of solutions generated. Replicating other findings, patients with depression were worse at solving social problems than recovered depressed patients and non-depressed individuals when left to their own devices. However, when prompted to ask concrete questions, patients with depression were as good at solving problems as the other two groups, suggesting that these “How?” questions ameliorated this difficulty. Further, asking abstract “Why?” questions worsened problem-solving in people who were formerly depressed, suggesting that these questions activated their previous difficulties. We believe that concrete processing is more helpful for problem-solving because it makes an individual aware of the specific circumstances and behaviors that occurred in a situation, suggesting possible alternatives to resolve the situation.

In another study, we found that training students to think about the meanings and implications of emotional events for 30 minutes caused them to feel worse to a subsequent stressful anagram task than students who practiced thinking about the concrete details of emotional events. Thus, relative to concrete processing abstract processing increases the negative emotional response to difficulties. Similar effects have been found when studying how quickly people recover from previous upsetting events, with a concrete style of thinking about past sad or traumatic events proving to be more helpful.

Taken together, this research suggests that repetitive thinking about the self, negative feelings and problems in an abstract style will be particularly problematic, driving depression and anxiety. Further, it suggests that shifting to a more concrete way of thinking about difficulties could be helpful for people with depression. Building on this hypothesis, we have investigated whether training people with depression to become more concrete and specific can itself help to reduce depression. This will be the subject of another blog.

Ed Watkins, Ph.D. is a clinical psychologist.


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