Why Some Depressed People Don't Get Better

Published in the Journal of Psychopathology and Clinical Science, a recent study investigated emotion regulation strategies used by depressed patients.

The data showed that compared to non-depressed individuals, depressed people are just as skilled in emotion management and yet “more likely to choose emotion regulation strategies that decrease pleasant emotions.”

Conducted by Millgram and colleagues—from Harvard University, Yale University, and The Hebrew University of Jerusalem—this research is described below.

Investigating Emotion Regulation in Depression

Study 1

Sample: 38 participants with depression and 39 controls.

Methods: Participants were first taught how to use the emotion regulation techniques of distraction and rumination. They then applied these techniques to pleasant or unpleasant events from the past six months.

Results: Depressed people were more likely to spontaneously choose the strategy of distraction when the recalled event was positive. This often led to reduced positive emotions.

When instructed to pick the technique that would likely make them feel happier, however, their choices resembled those of mentally healthy participants.

Thus, it appears that the reason individuals with depression initially chose an inferior mood management strategy was not a lack of knowledge but possibly a lack of motivation.

Study 2

Sample: 58 participants with depression and 62 without.

Methods: The study used ecological momentary assessments for 10 days (four surveys per day). The surveys included questions about mood, use of distraction and rumination, and motivation for pleasant and unpleasant emotions (i.e., whether participants wanted to feel happy).

Results: In agreement with the findings from the previous investigation, depressed participants were more likely than controls to distract themselves when experiencing pleasant emotions in daily life.

As for motivation, participants in both groups preferred experiencing positive emotions (e.g., happiness and calmness). Nevertheless, compared to the healthy group, the group with depression was more willing to experience negative emotions (e.g., sadness, anxiety, and grief).

This stronger willingness to experience negative emotions, the data suggested, “predicted the use of more distraction from pleasant emotions, more negative rumination, increases in unpleasant affect and decreases in pleasant affect.”

Ability vs. Willingness to Feel Better

An important research question is why depressed people use emotion-regulation strategies that do not help them experience more happiness. Though no consensus has been reached, perhaps the answer depends on the person and the nature of their mental illness. Having said that, here is a list of potential reasons:

• Feeling undeserving of happiness
• Fear of happiness (e.g., due to fear of loss or losing control)
• Having a goal other than to feel better
• The challenge of identifying the best regulation strategy in the middle of intense negative emotions
• The belief that emotional control is impossible
• The familiarity of negative moods
• The perception of negative emotions as more self-consistent than positive ones
• Ineffective strategies learned or reinforced by depressed family and friends

Additional research is needed to evaluate the contribution of these causes.

Takeaway

Depressed people appear to have the necessary knowledge and skills to self-regulate and cope with intense emotions, yet they use non-optimal emotion regulation strategies, possibly due to motivational reasons.

This suggests that a person with depression could benefit from bringing greater awareness to how they usually respond to different emotions—and why. For instance, by asking:

• How do I usually cope with potentially unpleasant feelings, such as sadness, anxiety, anger, and grief?
• Do I enjoy feeling good (e.g., happy, calm, relaxed, excited)? If not, why not?
• Do personal or environmental factors prevent me from using optimal emotion regulation strategies?

If you find it difficult to answer these questions accurately and honestly, therapy may help. To find a therapist, visit the Psychology Today Therapy Directory.

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