The triumph of thought over experience

Mental health problems such as depression and anxiety cause tremendous suffering in the modern world. Yet surprisingly little is established about the causes.

We can talk about risk factors – traumatic life events, poverty, social exclusion – and speculate about inherited genes that might dispose someone to carrying the black dog on their shoulders. But the interaction between these inherited dispositions and life experiences is unclear. Why do some people suffer appalling depression with no clear precipitating cause, while others can live through trauma and emerge seemingly unscathed?

A large-scale questionnaire survey published by Public Library of Science (PLOS) One sheds some light, and proposes that a third element may be the key. The questionnaire used a battery of questions designed to find out about people’s social situation, previous adverse life events (notably bullying or abuse), economic situation and family history of mental illness. Then, crucially, they asked questions specifically aimed at uncovering thinking patterns and coping styles. Thinking patterns included excessive rumination over problems, and a tendency to personalise problems or self-blame.

The results showed, as expected, that traumatic life events and close family history of mental health problems were the strongest direct predictors of anxiety or depression. Yet the ‘fit’ of the predictive model was poor, until psychological factors were added into the equation. So someone who had lived through traumatic circumstances and had a tendency to blame themselves for things going wrong had a much higher likelihood of becoming depressed than someone with similar life circumstances, but more helpful thinking patterns. According to the study, thinking patterns and coping styles seem to be the mediators between the direct causes of illness and the illness itself.

That’s exciting, because although we can’t change a predisposition to depression, or shield everyone from traumatic events, we have treatments that can help people improve their coping styles. Cognitive behavioural therapy (CBT) has shown success in treating mental health problems including anxiety, depression and obsessive compulsive behaviour.

As someone with a strong tendency to lie awake and worry, I know the danger of letting rumination and self-blame run away with you. I’ve benefited from cognitive behavioural therapy, and found it to be an excellent resource to short-circuit that type of exhausting, pointless spiral. Teaching people how to think sounds sinister – but my experience of CBT was wholly positive, allowing me to reclaim my brain for more useful and enjoyable tasks.

CBT is often criticised as a sticking plaster, something that treats the symptoms while ignoring the causes. But if the PLOS Online study is correct, a person’s cognitive style may be part of the cause, not simply a reaction to it. And where there is a precipitating cause, the chances of dealing with it when you’re able to think clearly and calmly about the situation are a whole lot better than when you’re lying in bed at 3am, blaming yourself yet again.

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