Breaking the vicious circle of depression

This article is based on research by Jordi Quoidbach

People in the grip of depression typically feel that clichéd advice to "just do something you enjoy" is unhelpful. They may even feel that such exhortations diminish the seriousness of the condition by implying that people only need to "buck themselves up and snap out of it." Nevertheless, like many clichés, it contains an important truth.

Whether depressed or not, most people know on some level that certain actions or activities might help lift their mood. So, why is it sometimes so difficult to do the very things we know might cheer us up, right when we need it the most?

Jordi Quoidbach of Esade's Department of People Management and Organisation has investigated this issue in a joint paper recently published in JAMA with Maxime Taquet (Department of Psychiatry, University of Oxford) and James J. Gross (Department of Psychology, Stanford).

Using a large-scale population study, they explored the question of impaired mood homeostasis – the ability to stabilise mood through choice of activities – and the patient's history of depression and low mood.

Mood homeostasis is the extent to which a person preferentially engages in mood-increasing activities

Mood homeostasis – steps towards self-help

The research defined mood homeostasis as the extent to which a person was able to choose and do uplifting, mood-elevating things, when their mood was down. These included activities such as exercise or self-care, which they knew might contribute to feeling a bit better.

A person with high mood homeostasis would tackle boring or unpleasant activities when they were feeling in a good mood already, and intuitively indulge themselves in some comforting kindness when they needed it.

It's a complex combination of self-awareness – the ability to notice and identify one's mood in the first place, self-discipline and time preference: the personal qualities needed to get necessary difficult things done at the time when the strength of mind is available, rather than when they become most urgent and desperate.

The research identified a clear link between the two factors: a low level of mood homeostasis, and a history of depression. Knowing which is the chicken and which is the egg in terms of causality, however, is a subject for further study. Does a lack of ability to choose the right mood-stabilising activities trigger depression, or are people who are prone to suffer from depression more likely to make poorer choices about how to prioritise their commitments and pass their time?

What we want to do vs. what we have to do

Our lives are shaped by a mixture of tasks and commitments. Some fill us with joy and some do not, and part of grown-up life is managing this and getting things done in order to stay healthy, earn a living and achieve similar goals.

Most of us manage this balance when our emotional health is good. "Letting things go" on the self-care front or in the domestic environment can be a clear sign that someone is suffering from a deterioration of mood.

Quoidbach and his associates found that we achieve mood homeostasis naturally, by a combination of avoiding things that lower our moods and doing things that raise our moods. The people they studied with a history of depression were simply worse at striking this balance, at taking the natural self-corrective actions that make a difference.

The researchers did note that many of the effects of engaging in single activities might on their own be tiny. But when they combine together, the cumulative effects can be powerful, leading to the downward spiral so often seen in someone sliding into a depressive episode – or more positively, starting to emerge from it and experiencing the build-up of good effects and the motivation to do more and more challenging and thus mood-lifting things.

What about when choice is gone?

The researchers are interested in exploring this lesson in the context of the current constraints on personal activities that is affecting millions around the world: the global lockdown in response to the coronavirus pandemic.

While the connection between being stuck indoors and an anticipated impact on mental health feels obvious and intuitive, the role of mood homeostasis as the mechanism to explain it will doubtless be the subject of much future research, when the world returns to a "new normal" and attempts to make sense of this strange time.

The ability to choose how we spend our time is a powerful reinforcement of self-worth and agency

Many of the mood-uplifting activities mentioned in Prof. Quoidbach's paper include outdoor activities, socialising and connecting with others: precisely those things currently off-limits for so many. Furthermore, the ability to choose how we spend our time is a powerful reinforcement of self-worth and agency. That is something that life under lockdown takes away, as well as forcing more inward-looking and solitary activities.

Helping people to help themselves

Whatever the circumstances, the present research findings have important implications for the future treatment of depression. While the authors recommend additional research to understand the direction of the causal link between mood homeostasis and clinical mental state, it's clear that the potential for improved therapeutic interventions are there to be developed.

Teaching patients to understand how to identify and improve their level of mood homeostasis really could "help them to help themselves." Advice that has always seemed too flippant and inadequate to offer any ray of light to those in the grip of the disease in the past might yet have practical use.

Original research article: Taquet M, Quoidbach J, Gross J et al. Mood homeostasis, low mood, and history of depression in 2 large population samples, JAMA Psychiatry (2020)