Facing Your Depression

“Laugh, and the world laughs with you; weep, and weep alone.” So wrote the poet Ella Wheeler Cox. Emotions are contagious, and most people intuitively seek out the positive while avoiding the negative. The exception, however, is those who are suffering from depression. The depressed misread emotional facial cues, finding gloom and doom where others see contentment.

We’re generally pretty good at reading the emotional expressions of others as portrayed on their faces, at least when it comes to the basic emotions, like happiness, sadness, and anger. We read the emotions of those we’re interacting with and regulate our own mood in response. After all, we can’t cooperate effectively with others if our emotions are out of sync. Crying at a party will likely get you shunned, as will laughing at a funeral. You’ve got to express the right emotion for the occasion.

Facial expressions of emotion are innate, but we do have some ability to fake or suppress them. Even though you’re feeling down, you may decide to put on a happy face at a party just to get along. And since others then respond to your positive expression, you might start feeling better as well. Likewise, you may need to put on a sad face at a funeral to fit in, even though you feel no loss or grief.

Our innate ability to read emotional expressions on the faces of others breaks down, however, as we fall into depression. The depressed can still read obviously happy or sad faces, but a problem arises when others display ambiguous feelings. This can occur either because the other person is trying to suppress their emotional expression, or because they aren’t sure how they feel at the moment.

When facial expressions of emotion are ambiguous, people tend to project their own feelings onto them. Happy people read ambiguous expressions as happy ones. And those in a low mood interpret them as sadness. Thus we fall into a cycle—either vicious or virtuous—depending on whether we’re depressed or not.

It’s hard to tell exactly where a vicious cycle begins—do we see others as sad because we’re sad, or do we feel sad because we see sadness in others? British psychologist Ian Penton-Voak and his colleagues think they have an answer to that question. These researchers study the perception of emotional expressions, and they’ve found some interesting patterns.

It’s already established that depressed people tend to interpret ambiguous emotional expressions as negative. What’s also well-known is that after a course of drug therapy with an SSRI like Prozac, depressed patients report a lift in their mood. They also shift their negative bias in interpreting facial expressions of emotion to a more positive one. In other words, ambiguous expressions that they interpreted as “sad” before treatment they now read as “happy” after treatment. But which comes first, the improved mood or the positive bias in face perception? Or do they occur together?

It generally takes a couple of weeks before patients report an improvement in mood after starting a regimen of antidepressants. Penton-Voak and his colleagues took advantage of this time lag to test their hypothesis that a positive bias in facial perception precedes an improvement in mood. Their results support this hypothesis. In other words, patients show a positive shift in the interpretation of ambiguous facial expressions even before they report an improvement in their mood. The researchers found that sometimes patients shifted to a positive bias in face perception after just a single dose of an SSRI—while they were still in the throes of depression!

There are lots of problems with drug-based approaches to treating depression. First, the drugs don’t always work. Doctors often need to try out several different prescriptions before they find one that’s effective for a particular patient. Second, even when the drugs do work, they frequently come with a host of negative side effects. Finally, some people object to a chemical solution for what they perceive as a psychological problem—and if they have a personal or family history of substance abuse, this attitude is quite understandable and reasonable.

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Given these issues with drug therapy, Penton-Voak and colleagues wondered if they could bypass the drugs altogether and work directly with patients on changing their patterns of face perception. In a procedure called cognitive bias modification, depressed patients view pictures of faces on a computer screen and rate each as “happy” or “sad.” The computer then gives them feedback. When the patients rate ambiguous faces as “sad,” the program lets them know other people rated these faces as “happy.” After just four sessions, the patients show a clear positive shift in their perception of emotional expressions. More importantly, though, two weeks after the training was complete, these patients reported an improvement in mood. This evidence clearly suggests that changing the way you view other people’s facial expressions can lead to an improvement in your mood.

Source: Penton-Voak, I. S., Munafò, M. R., & Looi, C. Y. (2017). Biased facial-emotion perception in mental health disordes: A possible target for psychological intervention? Current Directions in Psychological Science, 26, 294-301.

The researchers admit that cognitive bias modification is still in the experimental stage, and more research is needed before the technique can be offered to the general public. If the procedure is found to be reliable, it could become an important tool for treating depression, either to enhance the effects of drug and talk therapy, or even as a replacement for them. Cognitive bias modification would certainly be far more cost effective than any current treatment. And what’s more, the procedure could be put on an app you could download onto your mobile device.

Cell phone psychotherapy is still off in the future. But perhaps some people suffering from depression could benefit from a “self-help” version of cognitive bias modification. If you’re feeling low, you can help yourself by being mindful of the biases in your thinking that are dragging you into a vicious cycle. Instead of trusting your intuitions, question whether that sour-puss face you see in another person isn’t really just a reflection of your own sour mood. And while you’re at it, put a smile on your face even though you don’t feel like it. If you do, you’ll see a lot more people smiling back at you. And that in itself is a real mood-booster.