In Recovery we call this a vicious cycle. The vicious cycle of depression intensifies and perpetuates symptoms of the illness. This frame of mind is more than just an unhappy disposition. Depressed people often have difficulty feeling joy, and it is this dogged focus on the unpleasant, the doom and gloom of the world, that in many ways defines depression. Being stuck in repetitive thought patterns is often called rumination, and is a symptom of both anxiety and depression.
Depression is an ailment of mood, where one persistently feels that everything is worthless, and also an illness of motivation, where doing something about the perceived problems with your life is exceptionally difficult and painful. Sometimes I could see clearly what ought to be done, but the intense feeling of lifelessness that pervaded my daily experience made taking action nearly impossible. It wasn't just that I was thinking about negative things all the time, it was like not being able to think about anything else, wanting to think about negative things and having no interest beyond the bleak and the dismal. My mind felt infected, and bent on consuming itself.
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| Dr. Aaron T. Beck |
Dr. Aaron T. Beck introduced the cognitive model of depression over 40 years ago. While Abraham Low's peer support methods that define Recovery meetings predate Beck's work, Beck defined Cognitive Therapy in rigorous scientific terms and popularized the method among therapists. Recent work by Beck and his associates examines the details of rumination, the anatomy of the brain structures associated with rumination, and the behaviors that cause depressed people to get stuck in negative thinking patterns and destructive feedback loops.
The following is a summary of an article titled "Neural mechanisms of the cognitive model of depression" by Beck and his colleagues.
According to Beck’s cognitive model of depression internally stored representations of events, ideas and experiences are activated by internal or external events and then influence how incoming information is processed.
These representations determine how an individual interprets their experiences in a given context. Adverse events that occur early in life might lead to the development of depressive ideas, which are characterized by negative self beliefs. Depressive ideas can be activated by subsequent stressors that reflect underlying values (for example, a job loss may be devastating for someone who equates full time employment with self worth).
Unrealistic values which create a vulnerability for depression, once activated by an event, can change information processing related to ideas about the self, the personal world and the future. This group of concepts is referred to by Beck as the negative cognitive triad. Understanding this triad is the basis of Beck's cognitive therapy method.
Once a depressive episode begins, attention, interpretation and memory are effected. Negative and pessimistic processing of one’s self and context become pervasive, including interpretations, evaluations and appraisals. As a result the individual with depression develops dysfunctional attitudes whereby he or she views themself as defective and day-to-day life as rife with struggle, and assumes that their current difficulties or suffering will continue indefinitely.
The activation of these dysfunctional attitudes increases the likelihood that the depressed person will choose negative situations and filter out positive information. This process increases awareness for depressive elements in the environment and can decrease the positive experiences of a pleasing event, a phenomenon often referred to as a positive blockade. Similarly, there is strong evidence for memory biases in depression. In particular, individuals with depression tend to exhibit preferences for remembering negative experiences over positive ones.
Recent research has suggested that specific impairments in memory and attention are related to inhibitory deficits or, in other words, the inability to disengage from negative stimulation. Several theorists have suggested that inhibitory deficits are manifested clinically as rumination. Depressive rumination, or the tendency to think repetitively about the causes and consequences of negative experiences, has been associated with the onset, deteriorating course, chronicity and duration of depression. Specific biases in attention and memory result from inhibitory deficits, which perpetuates negative thoughts about the self, the world and the future. This process creates a feedback loop within the cognitive system that serves to initiate and maintain an episode of depression.
The inability to allocate attention to appropriate emotional cues is central to the cognitive model. For individuals without mood disturbance, attention is generally biased towards positive situations and events. However, individuals with clinical depression have no selective attention towards angry, happy or neutral input, and instead show a bias for sad stimulation. The inability to disengage from negative events, ideas and activities is thought to exacerbate symptoms of unease and dissatisfaction with the world.
There is evidence that people with depression show increased attention for negative stimuli and decreased attention for positive stimuli compared with non-depressed individuals. In contrast healthy individuals require greater cognitive effort to divert attention away from positive stimuli, while individuals with depression require greater cognitive effort to divert attention away from negative stimuli.
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| http://brainpictures.org/Depression-Brain-Pictures.php |
When individuals with depression process negative input, they show brain activity that is more intense (by up to 70%) and longer lasting (up to three times as long) than in healthy people, even when an emotional task is immediately followed by a nonemotional task. Recent studies indicate that this pattern of response is automatic and exists even if the emotional content of the task is masked to the conscious mind through a subliminal presentation. Depressed individuals will also process negative events faster than those who are not depressed. This change in reactivity in individuals with depression persists even after the adverse stimulation is removed.
It seems that individuals with untreated depression are not only more likely to attend to negative thoughts and experiences than healthy individuals but experience a stronger and longer lasting neural response to these events. The perception of negative information may persist as a result of reduced cognitive control.
Measurable anatomical abnormalities in the prefrontal cortext, which is the part of the brain responsible for executive functions such as working memory, cognitive flexibility, planning, inhibition and abstract reasoning, can be found in some individuals with depression. Research indicates that negative thoughts and experiences have a bigger impact on individuals with depression compared with healthy people. In addition, depressed individuals generally experience a positive blockade, in the sense that they have decreased capacity to process positive emotion and that positive experiences seem to be more difficult to absorb. For example, processing of happy faces involves activation of a particular part of the brain in healthy individuals, but activity in this area decreases measurably as depressive symptoms increase.
Unlike the experience of negative emotion, which is common to mood and anxiety disorders, decreased positive emotion is thought to be a distinctive feature of depression. In healthy individuals, the ability to experience and maintain a positive attitude is closely associated with brain systems that mediate reward and motivation. Decreased response to reward in individuals with depression is consistent with functional MRI results which compare brain activity in healthy individuals with those that are depressed.
In individuals with depression, reduced responses to rewards suggests that rewarding properties associated with an event may not be accurately perceived. As a result, rewarding situations may fail to trigger reinforcement mechanisms, which could impair the ability of individuals with depression to pursue rewarding behaviours.
Biased memory is closely related to biased attention and processing, in that increased awareness for negative stimuli influences the probability that negative information will be encoded and later recalled. This means that the same mechanisms that influence a depressed person in such a way that they pay attention to negative ideas and events will also create an inclination for them to store more negative memories than positive ones. Attempting to recall emotionally charged autobiographical memories yields very different responses in individuals with depression versus healthy individuals. One interpretation is that individuals with depression require greater cognitive effort to recall happy personal memories, whereas recall of negative memories requires less mental effort.
Dysfunctional attitudes play a central part in the cognitive model of depression. Here, the individual forms firm beliefs or representations about themself, their environment or their future that directly relate to their own self worth. Although relatively few studies have examined the networks involved with dysfunctional attitudes, existing research has identified several areas that are associated with these maladaptive beliefs. During negative self-referential tasks, individuals with depression show an intensity of brain activity that is correlated with depression symptom severity.
The amygdala, which is located near the bottom of the cognitive hierarchy, has a primary role in memory, emotional processing and decision making. In depressed individuals the amygdala is more active than in those who are not depressed when they recall negative events, indicating that a stronger than average emotional experience is correlated with depression and negative memories. The prefrontal cortex, which is located near the top of the cognitive hierarchy, is thought to be the key region for internal representation of self. In fMRI studies, this area shows the highest baseline activation when the subject is not actively involved in a task, suggesting that the prefrontal cortex may respond to self-focused stimuli. This area shows a great deal of activity in depressed individuals when they try to focus on positive events, indicating that this activity requires more cognitive effort than average, and is difficult for people suffering from depression.
The neurobiological mechanisms that underlie cognitive biases in depression seem to be influenced by two key processes: 1) low level processes and primitive feelings that tend to initiate negative cognitive bias in depressed individuals and 2) attenuated cognitive control- or a reduction in the ability to manage basic emotions, which allows the bias to persist.
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| http://brainpictures.org/Depression-Brain-Pictures.php |
These processes are observable and measurable in depressed individuals with modern brain imaging techniques. Research done with fMRI scans illustrate the activity of the lower and higher brain functions as depressed individuals respond to events. This research has been used to guide certain treatment paths, both medical, and talk therapy based.
Traditional Cognitive Behavioural Therapy (CBT) is used to target the elements of Beck’s model, particularly dysfunctional attitudes, using direct cognitive interventions such as thought records and guided discovery. Using CBT and other techniques to reduce cognitive biases aims to undermine patients’ perceived accuracy of their negative values and ideas.
While this theory is interesting, and from a scientific perspective tells us details about the mechanisms of rumination and the vicious cycle, and how these phenomena can be observed in the brain, what can we practically do with this? It is helpful for some people to have confirmation of their experience, that their physical feelings of being stuck are externally measurable and in some sense real. Whether we believe that brain structures influence how we think, or that how we think can change the structure of our brain isn't so much the point here, rather it is the case that these phenomena are consistently observed together. These observations validate theories about depression, and help to explain how talk therapies work.
When you feel depressed, there is a measurable failure and biological dysfunction of your brain at work, changing your behaviour and your thoughts can address that dysfunction, although it is difficult. In an interview with a patient (P) in the chapter "Vicious Cycle, Vitalizing Cycle" from MHTWT, Abraham Low, the examiner (E), records the following:
E: How is it, I shall ask, that your thought pulse shows life and vigor during this interview and loses its vitality in other groups?
P:I still think it is the vicious cycle that does that.
E: I told you I am ready to accept the explanation. But it will have to be qualified. There are many types and degrees of vicious cycles. One of them is that of fear, another of anger. These are the most common varieties. If yours were that of fear the vicious cycle would fan it into a panic. If it were that of anger it would be raised to the pitch of rage. I have observed you in the company of other people and you gave no evidence of being rocked by either panic or rage. Your face was smooth, perhaps even blank, and its muscles gave little evidence of lively expression. You sat motionless, staring into space. You give this a different wording when you say that your brain does not think and your speech muscles do not move. They are not lifeless by any means, but you feel that life has gone out of them. The brain feels unable to think, and the muscles unable to act. The more helpless the brain the more limp are the muscles; the more limp the muscles the more helpless is the brain. This is the vicious cycle of helplessness. How is it, I shall ask again, that you are able to shake off this sense of helplessness when you are interviewed here in front of a large crowd?
P: I don't know exactly but the nearest I can think of as an explanation is that I don't feel cramped here as I feel in groups on the outside.
E: That does not explain a great deal. It seems to me I shall have to do the explaining. We spoke of a vicious cycle. That means that some sort of circular movement is set up between the brain cells and the muscles. In this cycle the brain acts on the muscles, and the muscles act on the brain. The two influence one another. The cycle begins its destructive work before you arrive at the particular gathering. For hours and perhaps for days you have anticipated that your brain will be paralyzed and helpless. On the way to the social function which you are to attend the "freezing" process begins and when you reach your destination it has deepened into what you call a blank. The brain feels lifeless and dispatches impulses to the muscles not to stir, not to move. In this manner, the helplessness of the brain communicates itself to the muscles and the vicious cycle is set afoot. I told you that brain and muscles influence one another in this cycle or circular movement. Since they interact or act on one another it ought to be clear to you that if you cause the one to move the other will follow suit.
To state it differently: make the one move and the other will perforce join the movement. You may not be able to get the brain moving. But you certainly can do that with muscles. Command your speech muscles to act, and the brain will instantly realize that its theory of helplessness is a myth, a fiction, an untruth. The more vigorously your muscles will move, the less will the brain be able to believe that it is helpless.
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The movement of the muscles convinced the brain that speaking is possible. And when the brain witnessed the living, vital performance of the muscles it acquired a new vitality itself and lost its lifelessness. The more forceful was the action of the muscles the more vitalized became the brain; the more vital the brain the more forceful the muscles. By commanding your muscles to move you had thus transformed the vicious cycle of helplessness into the vitalizing cycle of self-confidence.
In recent research into the brain activity of depressed individuals we can observe the often reported experience of the preference for negative stimulation, and the lack of response to positive stimulation. As a person who is depressed or is prone to depression this means that you need to be especially aware of why you are choosing to do certain things. It is important to recognize that just because you don't feel the same sense of accomplishment from doing something positive that you used to (like cleaning your room or visiting with you family), that doesn't mean you should give up these positive activities. You also need to be aware that you will have a tendency to focus on the negative events and memories in your life, and these will seem more vivid than positive memories. This isn't reality, it is your illness speaking to you, and it is a change that you can either reinforce by continuing to focus on negative ideas and activities, or with effort undo.
Dealing with depression is difficult. Depression is characterized by the vicious cycle; it is an illness of motivation that has an impact on your memory, your preferences, and your general impressions of the world and how you experience it. These impressions are not permanent changes in your life they are rather the paper tigers of mental illness. Being unwell, depressed individuals will often want to be inactive or spend time resting. Depression, however, is not an illness like the flue, where rest will provide a curative measure. Instead inactivity will intensify depression and lead us further into self destructive predicaments, this is the vicious cycle that keeps people locked in a state of illness.
At Recovery meetings we understand these difficulties and we can help encourage you to have better habits and make active changes to your life. Many of us have suffered through vicious cycles, unproductive ruminations and dealt with our tendencies to complain and endlessly focus on our own troubles. These are problems that can be addressed one at a time, and are part of what we talk about each week. New attendees are always welcome, we can provide tools and support. Join us on Tuesdays at 7:30, at Binkley United Church in Hamilton, or at one of our other meetings.
More Information
Does Depression have a Physical Cause?
The Complaining Habit
Feelings are not Facts
