Recent studies of depression
Today I address two recent studies of depression. First, Millgram, Mizrahi Lakan, Joormann, Nahum, Shimony & Tamir (2023) published “Choosing to Avoid the Positive? Emotion regulation strategy choice in depression” in Journal of Psychopathology and Clinical Science. Here’s the edited abstract and impact statement:
Individuals with major depressive disorder (MDD) are more likely than nondepressed individuals to use emotion regulation strategies that decrease pleasant emotions (e.g., distraction from positive stimuli) and increase unpleasant emotions (e.g., negative rumination). If such strategies are actively chosen, these choices may partly reflect weaker motivation for pleasant emotions or stronger motivation for unpleasant emotions. Therefore, this investigation tested, for the first time, whether such strategies are actively chosen, even when alternatives are available. In Study 1, using a behavioral task, MDD participants (N = 38) were more likely than healthy controls (N = 39) to choose to use distraction over positive rumination in response to pleasant stimuli, resulting in reductions in pleasant affect. When instructed to choose the strategy that would make them feel better, however, MDD participants did not differ from controls in their strategy choices. In Study 2, using ecological momentary assessments, MDD participants (N = 58) were more likely than controls (N = 62) to use distraction from pleasant emotions and to use negative rumination in daily life. This pattern of strategy use was predicted by stronger motivation for unpleasant emotions among MDD participants, compared to controls. Stronger motivation for unpleasant emotions in daily life also predicted increases in unpleasant affect and decreases in pleasant affect. Findings suggest that compared to nondepressed individuals, people with MDD are more likely to choose emotion regulation strategies that decrease pleasant emotions. This investigation demonstrates that individuals with MDD may choose such strategies, even when alternatives are available, and that activating motivation to feel better may alter such choices. This pattern of strategy use in MDD is evident both in controlled experimental settings and in daily life and is associated with a relatively weaker motivation to avoid unpleasant emotions.
I love this study because it demonstrates the strategy preference that pretty much guarantees people will stay depressed and suggests that therapists can review a set of emotion regulation strategies and encourage the regular practice of the less preferred alternatives, especially with therapeutic support as they practice. The next study also looks directly at therapy.
Gaines et al. (2023) published “Change in Satisfaction with Social Support as a Common Outcome in Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Depression” in Journal of Psychotherapy Integration. Here’s the edited abstract and impact statement:
As facets of social support can correlate positively with depressive symptoms, it follows that increases in such support are a clinically pertinent proximal outcome in depression-focused therapies. Yet, most research on social support subtypes in psychotherapy has treated them as statically assessed predictors of other therapy outcomes and has largely neglected to examine the degree to which they change over treatment. Addressing this gap, some work has shown that one subtype—patients’ subjective satisfaction with social support (SSS)—improves across interpersonal psychotherapy (IPT) for depression, which is an evidence-based treatment that foundationally targets social support elements. However, it remains uncertain whether SSS improvement is specific to IPT, or whether it also occurs in other evidence-based treatments for which a social support focus is less foundational (e.g., cognitive behavioral therapy [CBT]). Accordingly, we (a) tested the association between lower SSS and depression at pretreatment, (b) explored whether SSS improved across both IPT and CBT, and (c) explored whether such improvement was more pronounced in IPT than CBT. Adult outpatients were randomized to 16 weeks of IPT (n = 39) or CBT (n = 41) and rated SSS and depression at baseline and SSS repeatedly through treatment. As expected, SSS was negatively correlated with depression at baseline, further establishing SSS as a clinically relevant outcome. Additionally, based on multilevel modeling, patients demonstrated significant improvement in SSS across both treatments, but showed no difference between them in the degree of change.
This study reinforces the importance of helping patients with depression experience an increase in their subjective satisfaction with social support (SSS)—one facet of the multidimensional social support construct. Additionally, the preliminary results support the notion that such positive change can occur both significantly and comparably across a course of either interpersonal psychotherapy or cognitive behavioral therapy (two commonly administered and foundationally dissimilar evidence-based treatments for depression). Thus, SSS may be a treatment-common outcome, which—at least when trying to affect change in this extratherapeutic variable—allows for treatment flexibility. Future research should focus on change in other aspects of social support, such as the ability to obtain more support in one’s life.
I think most therapists like having multiple tools available and I like the contrast between interpersonal and cognitive-behavioral therapies. It also seems to me that satisfaction with social support is accompanied by positive emotion; as a result, there may well be ways to utilize these two studies to help patients with depression.