Preventing the next depression

Someone who has suffered from depression in the past, has an increased risk of suffering from it again. Yet, this is often given little attention when treating any symptoms of depression. Marie-José van Tol , Professor of 'Mood and Cognition’, studies what people who are prone to depression can do themselves in order to prevent recurrence.

^{Text by Dorien Vrieling; photos by Reyer Boxem}

To address the elephant in the room straight away: No, coping with depression is not about trying hard enough. Whether or not someone will get depressed depends on a variety of factors, your genes for example— for some people it runs in the family—and whether you experienced a happy childhood. These are things that are beyond your control. ‘The last thing I want to say is that you have yourself to blame if you are depressed,’ Professor of Cognitive Neuropsychiatry Marie-José van Tol states. ´There are a lot of vulnerable issues at play here that are difficult to fight.´ And on top of that, someone who has already been depressed, runs more risk of another depressive episode.

That is the bad news, and Van Tol wants to make that very clear. You cannot control everything. But that doesn’t mean there aren’t any ‘buttons’ you can press yourself - while in therapy, under supervision - as she puts it. That is a useful insight, because treatment for depression is often mainly focused on fixing already existing problems — not on preventing another episode.

Helpful thoughts

One of those buttons is cognitive functioning, which includes concentration, memory, the ability to focus on whatever you are doing, for example. Not only is cognitive functioning weaker during a depression, but also after recovery, Van Tol says. ´People who have been depressed sometimes say: ´I stopped living up to my potential.´ Those cognitive problems are also linked to the chance of getting depressed again. ‘If you are coping with a lot of cognitive problems, it can be more difficult to control your emotions. If something happens that makes you sad or gloomy, it is more difficult to distract yourself for a moment or think positive thoughts to lift your mood again.’

Mental armour

What if you could improve that cognitive functioning in a way that allows you to better control your state of mind? That is what Van Tol studies in a large-scale study, for which she received a  € 800.000 Vidi grant  from the Dutch Research Council (NWO). ‘I want to know how we can arm ourselves by means of a defence system from within the brain.  Bad things are bound to happen in the future, that is something you cannot avoid. But even though you sometimes might slip, how can you prevent yourself from ‘going down that rabbit hole’ again?’

Motivation

Motivation seems to play an important role in cognitive functioning. Before you decide to put an effort into something, or to give it your attention, you often make some kind of cost-benefit analysis. If something is worthwhile, and you will get something out of it, you are more likely to take it up and complete it. But if on the other hand, you don’t see the point of it, you will find it difficult to keep focused.’ Van Tol researches how forms of therapy that are commonly used for treating people with depression can be geared more towards motivation. ‘It is just like filing your tax return. Not many people enjoy that, but when you consider that it keeps financial problems at bay, it’s doable. So, if you link a boring task like that to something important, then there’s a reward in doing it. We want to find out if we can use the rewards hidden in doing things you find important as a means of training your cognitive functioning.'´

Fantasizing

Another button you can press yourself, according to earlier research conducted by Van Tol, is the content of your thoughts. Anyone who spends some time every day fantasizing feels better about themselves. ‘In our study, the core of that fantasy was: what if you’d thought more positively about yourself, what would that do to you? We then encouraged participants to imagine in great detail how they would arrive at work. Whatever happened, even if they immediately knocked over a cup of coffee, they would be appreciated. How would that feel? It turned out that after they had fantasized, people had fewer spontaneous negative thoughts and that these thoughts were less focused on the past. The way you think about yourself has a direct influence on how you feel and the content of your thoughts.´

Thoughts that stick

In a current study, Van Tol dives deeper into the applicability of that fantasizing practice. ‘Suppose you would practise that kind of daydreaming for a while every day, via an app on your mobile phone, would that also have an effect on how much you worry? We hope that it will make the worrying less disruptive, that it occurs less frequently and that it does not ‘stick around’ as much, or becomes an endless cycle. In the study, the impact of fantasizing is compared to the effect of mindfulness. Having a daily meditation practice, looking at your worries without judging, also helps. We want to know what works best for whom. It could be that fantasizing about positive things might be especially helpful for people who have negative thoughts about themselves, and that mindfulness could actually help if you tend to get stuck in your thoughts.’

Open discussion

More and more people suffer from mental health problems such as depression, according to several studies. Earlier this year, psychiatrist Christiaan Vinkers asked in the Volkskrant whether the increased openness to discussing psychological complaints might be having the opposite effect. Does all the talking actually help? Van Tol is clear. ´The problems have indeed increased, but that is also the case in countries where mental problems are not discussed that much.’ Besides: even in the Netherlands, not everyone feels free to talk about depression. ‘There is still a lot of loneliness associated with mental suffering, my research indicates. As long as that’s the case, I think it’s a good thing to openly discuss it in society.’

About Marie-José van Tol

Marie-José van Tol (1980) is a Professor of Cognitive Neuropsychiatry at the UMCG and Chair of the Young Academy of the Royal Netherlands Academy of Arts and Sciences (KNAW) She obtained her Master’s degree in Clinical and Health Psychology at Utrecht University and then earned her PhD from Leiden University on the similarities in the brain between people with depression and anxiety disorders. In 2015, she became Assistant Professor at the Department of Biomedical Sciences at the UMCG in Groningen. In February, Van Tol won the AcademieKus 2024, a price that is awarded by the Algemene Onderwijsbond (Education Union, AOb), because of the way she is committed to achieving equal rights and less of a hierarchy within the academic world, ‘Everyone Professor!’.