How to Stop Buying the Negative Thoughts of Depression
Change your relationship with depression through mindful presence.
Posted Mar 18, 2020
Millions of men and women experience clinical depression every year. Being depressed is a miserable experience, as I know not just from my clinical work but from personal experience. It’s hard to feel fully alive when you're down all the time and struggling to find enjoyment in any activity. Poor sleep, low energy, mental fog, and other symptoms add to the pain.
While there are effective forms of treatment for depression, many people don’t find them helpful, or get only limited relief. For example, in the STAR*D trial, one of the largest depression treatment studies to date, only about one-third of depressed participants were depression-free after 12-14 weeks of treatment with a selective serotonin reuptake inhibitor (SSRI). That was a better outcome than placebo, but it left two out of three individuals with significant symptoms of ongoing depression.
Effective forms of psychotherapy like cognitive behavioral therapy (CBT) lead to similar outcomes, with many individuals improving but large numbers continuing to struggle with symptoms. Combining medication and psychotherapy, while marginally better, is not the magic bullet of depression treatment. For example, in the STAR*D study about half of depressed participants were still depressed even after 12 weeks of medication plus 12 weeks of cognitive therapy.
Mindfulness-Based Cognitive Therapy
These limitations have led to the search for other potentially helpful treatments. I recently spoke with psychiatrist Dr. Stuart Eisendrath about one such treatment called mindfulness-based cognitive therapy (MBCT). As the name suggests, it combines the best-tested psychotherapy for depression with practices in mindful awareness, which involves focusing on the present and letting go of resistance to reality.
Most forms of psychotherapy focus on trying to get rid of symptoms; traditional cognitive therapy, for example, teaches a person to recognize and challenge the negative automatic thoughts that are common in depression. So if your mind tells you, “You’re such an idiot—you’re always screwing things up,” your therapist would work with you to identify those thoughts and consider the evidence for and against them. Together you would aim to develop more useful and fact-based ways of thinking.
MBCT offers a different approach in which you would work to change how you relate to depressive thoughts. Eisendrath used this helpful metaphor to explain: “If you’re walking down the main street of a small town, you may see a number of store fronts, with various depressive thoughts on display,” he said. “Typically in depression you would go into the store and buy those thoughts, and then go back out and start walking down the street having those thoughts with you.”
Cognitive therapy would also involve going into the store and directly engaging with the thoughts. You might point out to the shop owner that the thoughts on display are misleading, accuse them of false advertising, and demand that they change the thoughts. Perhaps the shop owner would nod understandingly, agree with your points, and then refuse to change the display.
In contrast, a mindful response to the thoughts involves seeing them through the window without going into the store. “You notice the depressive thoughts in the store,” said Eisendrath, “and you don’t get rid of observing those thoughts. But you don’t go in and buy them, and you don’t have to carry them with you as you go down the street.”
This approach can be very helpful for those who struggle to change their negative ways of thinking, which in my experience is a large percentage of people with depression. Even when they know rationally that their thoughts are unrealistically negative and that they’re being too hard on themselves, the thoughts stubbornly persist. And paradoxically, debating with your negative thoughts can make them seem more important, like a problem that has to be solved before you can move on and be in your life.
A mindful response to depressive thoughts allows you to let go of the struggle with them, and to simply coexist alongside the thoughts. “You’re able to continue walking down the street,” said Eisendrath, “and you can still go where you want in life”—even with the negative automatic thoughts.
Mindful Responses to Depression Symptoms
There are countless techniques for responding mindfully to depressed ways of thinking. What all of them have in common is bringing our attention to what’s happening right now, and adopting an attitude of acceptance. Simply being in this moment “helps diminish depression because you’re not laying on that negative story about the future,” said Eisendrath. “You’re just focusing on the present.” Here are some practices for changing your relationship with depressive thoughts:
- Be in the Body: Connecting with the body is one of the most effective ways of letting go of resistance and bringing your attention into the present. Eisendrath recommended asking yourself questions like, “What do I notice as I’m depressed right in this moment? A tension in the shoulders or chest? A headache?” Rather than making these sensations a problem, be curious about your experience—what's happening in my body right now?
- Breathe: Like the body, the breath is always with you. Practice breathing with your thoughts, emotions, and physical sensations. As the body opens to the breath, let your spirit open to your experience just as it is.
- Focus on Your Senses: When you find yourself stuck in negative patterns of thought, come to your senses—carefully note something you see, something you hear, and a touch sensation you’re aware of. The aim isn’t to force the negative thinking to stop, but to change the channel, widening your attention beyond the narrow spotlight of distressing thoughts.
- Do What’s Important: Depression often fosters a focus on how we’re feeling, why we feel that way, and how we can get rid of bad feelings. Doing something important to you can be a very mindful way to break depression’s preoccupation with itself. Instead of focusing on how you’re feeling, ask yourself what needs to be done. Taking out the trash? Doing the dishes? Writing that email you’ve been putting off? Let the action be as big or as small as you can manage—maybe for now it’s simply brushing your teeth. Seeing ourselves move through depression is one of the most effective ways to change our relationship with difficult thoughts and emotions.
The full conversation with Dr. Stuart Eisendrath is available here: How to Improve Depression Treatment With Mindfulness Practice.
Eisendrath, S. J. (2019). When antidepressants aren't enough: Harnessing the power of mindfulness to alleviate depression. Novato, CA: New World Library.
Warden, D., Rush, A. J., Trivedi, M. H., Fava, M., & Wisniewski, S. R. (2007). The STAR* D Project results: A comprehensive review of findings. Current Psychiatry Reports, 9, 449-459.