Women, Nolen-Hoeksma finds, are far more prone to ruminate when they are depressed than are men. This, she proposes, may at least partly explain the fact that women are diagnosed with depression twice as often as are men. Of course, other factors may come into play, such as women being more open to disclosing their distress or having more in their lives to be depressed about. And men may drown their depression in alcoholism, for which their rate is about twice that of women.
Cognitive therapy aimed at changing these thought patterns has been found in some studies to be on a par with medication for treating mild clinical depression, and superior to medication in preventing the return of mild depression. Two strategies are particularly effective in the battle.16 One is to learn to challenge the thoughts at the center of rumination—to question their validity and think of more positive alternatives. The other is to purposely schedule pleasant, distracting events.
One reason distraction works is that depressing thoughts are automatic, intruding on one's state of mind unbidden. Even when depressed people try to suppress their depressing thoughts, they often cannot come up with better alternatives; once the depressive tide of thought has started, it has a powerful magnetic effect on the train of association. For example, when depressed people were asked to unscramble jumbled six-word sentences, they were much better at figuring out the depressing messages ("The future looks very dismal") than the upbeat ones ("The future looks very bright").17
The tendency for depression to perpetuate itself shades even the kinds of distractions people choose. When depressed people were given a list of upbeat or ponderous ways to get their minds off something sad, such as the funeral of a friend, they picked more of the melancholy activities. Richard Wenzlaff, the University of Texas psychologist who did these studies, concludes that people who are already depressed need to make a special effort to get their attention on something that is completely upbeat, being careful not to inadvertently choose something—a tearjerker movie, a tragic novel—that will drag their mood down again.
Mood-lifters
Imagine that you're driving on an unfamiliar, steep, and winding road through fog. Suddenly a car pulls out of a driveway only a few feet in front of you, too close for you to stop in time. Your foot slams the brake to the floor and you go into a skid, your car sliding into the side of the other one. You see that the car is full of youngsters, a carpool on the way to preschool—just before the explosion of glass shattering and metal bending into metal. Then, out of the sudden silence after the collision, you hear a chorus of crying. You manage to run to the other car, and see that one of the children is lying motionless. You are flooded with remorse and sadness over this tragedy....
Such heart-wrenching scenarios were used to get volunteers upset in one of Wenzlaff s experiments. The volunteers then tried to keep the scene out of their minds while they jotted notes about the stream of their thoughts for nine minutes. Each time the thought of the disturbing scene intruded into their minds, they made a check mark as they wrote. While most people thought about the upsetting scene less and less as time went on, those volunteers who were more depressed actually showed a pronounced increase in intruding thoughts of the scene as time passed, and even made oblique references to it in the thoughts that were supposed to be distractions from it.
What's more, the depression-prone volunteers used other distressing thoughts to distract themselves. As Wenzlaff told me, "Thoughts are associated in the mind not just by content, but by mood. People have what amounts to a set of bad-mood thoughts that come to mind more readily when they are feeling down. People who get depressed easily tend to create very strong networks of association between these thoughts, so that it is harder to suppress them once some kind of bad mood is evoked. Ironically, depressed people seem to use one depressing topic to get their minds off another, which only stirs more negative emotions."
Crying, one theory holds, may be nature's way of lowering levels of the brain chemicals that prime distress. While crying can sometimes break a spell of sadness, it can also leave the person still obsessing about the reasons for despair. The idea of a "good cry" is misleading: crying that reinforces rumination only prolongs the misery. Distractions break the chain of sadness-maintaining thinking; one of the leading theories of why electroconvulsive therapy is effective for the most severe depressions is that it causes a loss of short-term memory—patients feel better because they can't remember why they were so sad. At any rate, to shake garden-variety sadness, Diane Tice found, many people reported turning to distractions such as reading, TV and movies, video games and puzzles, sleeping, and daydreams such as planning a fantasy vacation. Wenzlaff would add that the most effective distractions are ones that will shift your mood—an exciting sporting event, a funny movie, an uplifting book. (A note of caution here: Some distractors in themselves can perpetuate depression. Studies of heavy TV watchers have found that, after watching TV, they are generally more depressed than before they started!)
Aerobic exercise, Tice found, is one of the more effective tactics for lifting mild depression, as well as other bad moods. But the caveat here is that the mood-lifting benefits of exercise work best for the lazy, those who usually do not work out very much. For those with a daily exercise routine, whatever mood-changing benefits it offers were probably strongest when they first took up the exercise habit. In fact, for habitual exercisers there is a reverse effect on mood: they start to feel bad on those days when they skip their workout. Exercise seems to work well because it changes the physiological state the mood evokes: depression is a low-arousal state, and aerobics pitches the body into high arousal. By the same token, relaxation techniques, which put the body into a low-arousal state, work well for anxiety, a high-arousal state, but not so well for depression. Each of these approaches seems to work to break the cycle of depression or anxiety because it pitches the brain into a level of activity incompatible with the emotional state that has had it in its grip.
Cheering oneself up through treats and sensual pleasures was another fairly popular antidote to the blues. Common ways people soothed themselves when depressed ranged from taking hot baths or eating favorite foods, to listening to music or having sex. Buying oneself a gift or treat to get out of a bad mood was particularly popular among women, as was shopping in general, even if only window-shopping. Among those in college, Tice found that eating was three times as common a strategy for soothing sadness among women than men; men, on the other hand, were five times as likely to turn to drinking or drugs when they felt down. The trouble with overeating or alcohol as antidotes, of course, is that they can easily backfire: eating to excess brings regret; alcohol is a central nervous system depressant, and so only adds to the effects of depression itself.
A more constructive approach to mood-lifting, Tice reports, is engineering a small triumph or easy success: tackling some long-delayed chore around the house or getting to some other duty they've been wanting to clear up. By the same token, lifts to self-image also were cheering, even if only in the form of getting dressed up or putting on makeup.