Psychotherapists Flip Freudian Thinking on Treating Depression

Contrary to what is commonly taught in psychotherapy, blocking out negative thoughts might not be so bad for your mental health after all.

Learning to suppress bad thoughts may actually improve mental health, rather than unconsciously influence our well-being, a new study in the journal Science Advances reveals.

This study's findings follow Sigmund Freud's idea of people having a consciousness and a subconscious, where information that is not required can be suppressed.

"Compared to mental health assessments taken before training, people's mental health significantly improved," Michael Anderson, co-author of the study and professor of cognitive and behavioral neuroscience at the University of Cambridge, told Newsweek. "So, they reported less worry, less depression, less negative affect, and greater well-being."

However, other experts are skeptical about the study's findings.

"This is an interesting research study," Mike Musker, a senior research fellow in depression and mental health at the University of South Australia, told Newsweek. "It is a small study that would require further investigation, but it does challenge the dogma that we should talk about and air out traumas to help us move on or to diminish their intensity."

The researchers, hailing from Cambridge University's Medical Research Council (MRC) Cognition and Brain Sciences Unit, trained 120 volunteers from 16 countries to suppress thoughts about negative events that worried them.

"First, people listed a set of fears/worries that they had, and also neutral future events (like going to the optician) or positive future events. Next, they gave each of these events a title," Anderson explains.

One participant said that one of her fears was that her aging parents would get COVID and be hospitalized and put on ventilators. In this case, the fear was titled "hospital" and the researchers got her to list the details of the event as something like "breathing" or "COVID."

"Then, once they had told us about these distressing fears, we set them the task, over three days, of practicing thought suppression for their fears (or, in a control condition, participants suppressed their neutral events)," Anderson said.

"The suppression task was composed of trials in which a single word (one of their titles) would be displayed in the centre of the screen. If the title was in Green they would be told to think of and IMAGINE the event. If the title was in red, they were supposed to keep their full attention on the title, and to acknowledge the event that it referred to. BUT, after acknowledging it, they were to stop all thoughts they might have in react[ion] to the reminder—to shut them down. So no images, no stray thoughts of any kind; just keep looking at the reminder and confronting it, but simply "don't go there" when it came to any additional thoughts. The latter type of trial was called a NO-IMAGINE trial."

The "imagine" trials were always done for neutral or positive things, while the "no-imagine" trials were done for neutral events or fears. The volunteers were trained not to think about their fears over the course of three days, and saw a significant improvement in their ability to do so by the end of the study.

"Initially, on the first day, people were not very successful at this. But by the third day, people were highly successful—succeeding in almost every case, by their own report," Anderson said.

The researchers then found that not only had the volunteers gotten more successful at blocking out their fearful thoughts, but they had also seen improved mental health, including less worrying and less depression.

"Importantly, this effect was significantly greater for people who suppressed their fears, relative to the control group who received identical suppression training, but who only suppressed neutral events," Anderson said. "These mental health benefits persisted for three months, especially when it came to depression. These benefits arose because suppression impaired memory for the fears, making them less vivid, less distressing."

They found that 82 percent of the participants who had likely pandemic-related post-traumatic stress disorder reported reduced anxiety, and 62 percent reported improved mood.

One expert expressed concerned about these findings.

"For example, you are hearing lots of different things in the environment right now, but you are suppressing most of it," Musker said. "Your brain however hears it all and must filter the sounds you want to listen to.

"It is similar with memories and retrieving information, this has been done in an orderly fashion, so like the sound in our environment, our internal thought noise is suppressed too. Sometimes this mechanism is affected by the effects of anxiety or our mood."

Previously, it has been thought that suppressing thoughts makes mental health worse, such as by increasing anxiety.

"It's hypothesized that active suppression of these thoughts can lead to effects on our physical body through a system called the hypothalamic pituitary adrenal axis whereby our cortisol levels are increased. For example, in emergency service workers who constantly must suppress their emotions and it is known to have long-term consequences on physical and mental health," Musker explains.

"There used to be a period when it was thought it's important to debrief after a traumatic event, but this led to some people becoming worse after discussing what happened, that is it increased the trauma."

This new study appears to challenge this previous thinking. However, some mental health problems actively prevent individuals from being able to suppress thoughts.

"With anxiety disorder (including PTSD), major depressive disorder, and obsessional compulsive disorder, suppressing difficult thoughts often requires medication, supported by psychotherapy. Psychological techniques alone would not work, particularly in moderate to severe cases," Musker said.

Despite the concerns from other experts, Anderson is optimistic about the study results, as many of the participants felt that the technique helped them to such a degree that they carried on unprompted after the study ended.

"We didn't tell people to continue to use suppression over the 3-month delay interval prior to the following. Yet, 82 percent of the participants reported using it and most extended it to new fears and negative thoughts that were not the original subject of training," Anderson said. "This is strong evidence that people concluded that this was something useful and meaningful to them."

One participant even taught her daughter and her own mother how to suppress the thoughts.

"She said this study had come exactly at the time she needed it because she was having all these negative thoughts, all these worries and anxiety about the future, and this really, really helped her," Zulkayda Mamat, a Ph.D. student in Anderson's lab at the time, said in a statement. "My heart literally just melted, I could feel goosebumps all over me. I said to her 'If everyone else hated this experiment, I would not care because of how much this benefited you!'."

Do you have a tip on a science story that Newsweek should be covering? Do you have a question about mental health? Let us know via science@newsweek.com.

Update 09/27/2023 12:02 p.m.: A new headline was added to this story.