Rumination and Depression

In a recent edition of TIME, the cover article was titled “The Optimism Bias.” The overall message of the article was that humans are more optimistic than realistic about future events. This is probably an evolutionary adaptation because without optimism, people wouldn’t take the kind of risks that lead to great discovery.

I definitely do not think the same types of optimistic thoughts that the article quotes from the research. But this makes sense considering they found that “while healthy people expect the future to be slightly better than it ends up being, people with severe depression tend to be pessimistically biased: they expect things to be worse than they end up being. People with mild depression are relatively accurate when predicting future events.” Why is being mildly pessimistic (or in reality, realistic), problematic? The article goes on to cite research that shows that the brain also doesn’t learn from experiences when primed to expect bad outcomes, so pessimistic expectations become a self-fulfilling prophecy.

Anyway, the part of the article that I found most interesting is the following:
“How do we find the silver lining in storm clouds?…Our brain… is wired to place high value on the events we encounter and put faith in its own decisions. Making a decision may be a tiring, difficult ordeal, but once you make up your mind…if you are like most people — you view the chosen offer as better than you did before and conclude that the other option was not that great after all. According to social psychologist Leon Festinger, we re-evaluate the options post choice to reduce the tension that arises from making a difficult decision between equally desirable options…This affirmation of our decisions helps us derive heightened pleasure from choices that might actually be neutral. Without this, our lives might well be filled with second-guessing. Have we done the right thing? Should we change our mind? We would find ourselves stuck, overcome by indecision and unable to move forward.”

I pretty much am constantly stuck in second-guessing mode. For example, during my last inpatient stay I had to decide whether or not to follow up my inpatient stay with residential treatment or an intensive outpatient program (IOP).  If my brain functioned like they described, after making the decision to go to IOP I would have re-framed the options in a way that made the residential decision 10x worse. However, the opposite happened! My decision to do IOP was based on carefully weighing pros and cons, and deciding that there were more negatives to residential than IOP. However, once I had decided on IOP, residential suddenly seemed like the better choice – bring on the second guessing and ruminating!

This directly relates to a study the wonderful blogger GreyThinking tweeted about.  The study examined the brain’s response to sadness and relapses in depression and found that:
“Faced with sadness, the relapsing patients showed more activity in a frontal region of the brain, known as the medial prefrontal gyrus. These responses were also linked to higher rumination: the tendency to think obsessively about negative events and occurrences. The patients who did not relapse showed more activity in the rear part of the brain, which is responsible for processing visual information and is linked to greater feelings of acceptance and non-judgement of experience.”

If reframing decisions to help prevent second guessing is one of the ways the brain helps keep people optimistic, it makes sense that people with depression might have a faulty “re-framing” pathway. This leads to rumination and obsessive focus on negative consequences, which is what the research found. So, perhaps therapy focused on decreasing rumination and second guessing will help increase optimism and in turn, decrease depressive symptoms.

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