Feeling, including for people associated with sadness, may be key to recovering from depression

summary: Suppressing or withholding physical sensations related to emotions such as sadness can hinder recovery from depressive symptoms and may cause a relapse into depression.

source: University of Toronto

The physical sensations that accompany sadness can feel as undesirable as they are intense — chest constriction, watery eyes, a raw throat, to name a few.

But Norman Farb, associate professor of psychology at the University of Toronto Mississauga, and Zindel Segal, Distinguished Professor of Mood Disorders Psychology at T. Scarborough University, have discovered that keeping sensation alive in the face of stress is critical to a healthy-running, especially for those who have recovered from Depression.

In the largest neuroimaging study to date of psychotherapy to prevent relapse and recurrence of depression, researchers linked prior depression to a greater tendency to turn off sensory processing when faced with emotional stress.

They also found that blocking sensation was associated with an increased risk of depressive relapse.

“We don’t like feeling bad things,[but]we don’t really think about the implications of balancing our short-term relief with our long-term health,” Farb says.

“Our research explains why action is so important to maintain feeling. It lays the foundation for seeing that emotional stress actually robs us of feeling – and to release stress, one must counteract this inhibitory effect.”

The study was recently published in the journal NeuroImage: Clinical, co-written by Farb and Segal, along with Ph.D. Student Philip DeSormo, in the Graduate Department of Clinical Psychological Sciences at T. Scarborough University, and Professor Adam Anderson of Cornell University.

The study included 166 participants who recovered from depression but were at risk of a future episode. They were divided into two groups. Over an eight-week period, one group underwent cognitive therapy focusing on well-being, while the other group underwent mindfulness-based cognitive therapy.

Between cognitive therapy sessions, the brain activity of 85 participants was also measured by fMRI while watching four consecutive clips of television programs that would not normally produce an emotional stimulus as a baseline—for example, a lifestyle-related show on HGTV—such as Plus Clips from an emotionally charged film such as 1983’s Terms of Endearment.

Over the next two years, the researchers followed up with the participants every two months.

Farb says he and his colleagues discovered something remarkable while studying brain scans of those who had relapsed: They had a greater tendency to “stop working.”

When exposed to emotionally charged videos, the parts of the brain that control sensations shut down more often than those who did not relapse. The researchers also found that those who reported high feelings of sadness during movie clips were not necessarily more likely to relapse.

They also found that blocking sensation was associated with an increased risk of depressive relapse. The image is in the public domain

“What really determined their levels of depression was the extent to which that sadness was associated with sensory cessation,” Farb says.

He adds that when our brains block sensory information during a negative mood, we’re left with only our thoughts to make sense of what’s going on. All too often, these thoughts fail to provide a broader view of what is going on—the blocking of bodily sensations traps people in an “echo chamber” for their negative opinions.

“Our thoughts are there to make things clear so that you can stick to them over time, and that’s okay as long as they’re constantly being renewed — but the thing that brings them up are new sensations,” Farb explains.

The researchers say their findings help explain why negative everyday situations — such as being criticized in a work meeting or your spouse gored — cause a relapse in someone who has recovered from depression.

Such seemingly minor events can trigger deeper feelings of inadequacy and worthlessness in those with a history of depression, Segal says.

“This negative mood is associated with thoughts about oneself and is easily perpetuated over time, and a person can feel bad,” Segal says, adding that such thoughts often produce physical sensations.

“If a person suppresses these bodily sensations, their thoughts will turn into more and more depressive reactions.”

Farb adds that the study could help clinical researchers create new assessments about sensory inhibition as a risk marker for depression. It could also contribute to the development of targeted therapies that help people recovering from depression become better at noticing their feelings throughout the day, which in turn could help them counteract negative moods that can shut down sensation and “lock in” depressive thinking.

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This shows the head and mind of a man and a woman

“We don’t have to wait for a person to really start spinning, as it takes a lot of resources, time, and effort to get them out,” Farb says.

“You can start noticing if the person is starting to fit into the profile of someone who is truly sensory avoidance. We can address it then, before the person stops coming to work or looking after their children.”

About this research on depression news

author: Kristi Strauss
source: University of Toronto
Contact: Kristi Strauss – University of Toronto
picture: The image is in the public domain

original search: open access.
Stable and treatment-responsive brain biomarkers for relapsing depression after psychotherapy: Evidence from a randomized control trial by Norman AS Farb et al. NeuroImage: Clinical


a summary

Stable and treatment-responsive brain biomarkers for poor relapse of depression after preventive psychotherapy: evidence from a randomized controlled trial.

background

The neural reactivity of disturbed mood induction refers to the tendency of distress to enhance cognitive interaction and sensory avoidance. Correlating these responses with predictors of illness after recovery from major depressive disorder informs our understanding of depression vulnerabilities and provides engagement targets for preventive interventions.

Techniques

A prospective functional magnetic resonance imaging neuroimaging design investigated the relationship between distress reaction and relapse after a prophylactic intervention. Depressed outpatients (N = 85) were randomized to 8 weeks of cognitive therapy focusing on well-being or mindfulness-based cognitive therapy. Participants were evaluated before and after treatment and followed up for two years to assess relapse status. The common neural interaction at both assessment points identified the static biomarkers of relapse, while the reactive change identified the dynamic biomarkers.

consequences

Disturbing mood induction elicited frontal lobe activation and sensory shutdown. Controlling for prior episodes, concurrent symptoms, and medication status, somatosensory disruption was associated with depression recurrence in a consistent pattern unaffected by prophylaxis, HR 0.04, 95% CI [0.01, 0.14]And s<.001. Treatment-related prevention was associated with reduced left prefrontal cortex (LPFC) activation, HR 3.73, 95% CI. [1.33, 10.46]And s= .013. On the other hand, the right LPFC showed an inhibitory connection elicited by dysarthria with the right somatosensory biomarker.

Conclusions

These findings support a two-factor model of relapsing-impaired depression in which persistent patterns of sensory disruption caused by dysautonomia contribute to seizure recurrence, but vulnerability may be attenuated by targeting frontal lobe regions that respond to clinical intervention. Emotion regulation during disease remission can be improved by reducing prefrontal cognitive processes in favor of sensory representation and integration.

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