Suppressing negative thoughts may improve mental health

Also this month, a paper detailing that our mental health might in fact be improved by suppressing negative thoughts...

James - Time now to introduce our second neuro news guest. Francis Madden is a trainee clinical psychologist, currently learning his trade at the University of Oxford. How are you doing today, Francis?

Francis - I'm very good, thank you. How are you?

James - I'm very well. You're going to be telling us about an interesting emerging theory on how we might stay on top of our mental health, but as you're going to be dropping into Naked Neuroscience as a regular guest, we hope, let's help our listeners get to know you a little bit better. I mentioned you are going to be sharing your insights with us as you continue studying towards your goal of becoming a fully fledged clinical psychologist. What is one of those, what do they do, and what made you want to be one?

Francis - So a clinical psychologist is a very varied role. So first and foremost, it involves being a therapist, giving psychotherapy to clients of all different ages and psychological difficulties. And for that we primarily use cognitive behavioural therapy or CBT.

James - Just so we are clear, what kind of conditions might people have that you are trying to help them deal with?

Francis - All sorts. So I've worked in training so far in anxiety, which could be general or specific. It could be about social situations, it could be about specific phobias, fear of spiders being classic, but also if you have panic attacks on a regular occasion. Depression, obsessive compulsive disorder, OCD, I could go on. But essentially a very wide range of different presentations. And then beyond a therapeutic role, a clinical psychologist will also work as a scientist practitioner, contributing to new research that's developing.

James - We're talking in a month where we've had World Mental Health Day. In a sentence, could you boil down the research you've chosen to bring to the table?

Francis - So this study is from the Cognition and Brain Sciences Unit at Cambridge University, and it found that the mental health of its participants was improved by training people to suppress their unwanted thoughts.

James - So right off the bat, this seems to contradict a lot of what I thought I knew about mental health. Perhaps we start there with the perceived wisdom on this topic. You'll often hear mental health campaigners or medical professionals urging us to get our worries, our anxieties out in the open, to talk about them, whether it be with our families or our friends or health professionals. What's the reasoning behind that messaging? Getting us not to shy away from negative thoughts, but to confront them?

Francis - I wonder if I could ask you to do something for me now, James, and also the people listening. I wonder if we could just take 10 seconds to think about anything that you like, and I want you to think about anything at all, I just want you to not think about a white bear.

James - It's not going so well.

Francis - Yeah. How are you finding it?

James - Very difficult.

Francis - So this is what Daniel Wegner and his colleagues found in a paper from 1987. They found that people who had to suppress the thought of a white bear ended up thinking about it more often than people who were asked to express the thought of a white bear whenever it crossed their mind. And this is because when we try to suppress a thought, our mind ends up monitoring whether we are thinking about it, which ironically can make it more likely to happen, so this theory goes. And the white bear is obviously a trivial example, but this idea applies to anxious thoughts or depressive thoughts and so on. But there's been evidence since the late eighties about this sort of idea of thought suppression, ironically, leading to the exact thing that it tries to avoid.

James - You've made me think about, at primary school, 'the game,' the rules of that particular game being if you think about 'the game', you lose.

Francis - I didn't want to ruin that for everyone.

James - We get onto this new study, reversing this perceived wisdom in a way. My first question related to it though is how can someone even be trained in the first place to suppress negative thoughts at all? Like you explained, ask me not to think of a white bear and that's the last thing that I'm able to do.

Francis - So what they asked the participants to do was to think of fears that were personal to them, things that might happen within the next couple of years. So this was done during the height of the Covid 19 pandemic, so one of the fears that people generated was that they would get Covid or their parents would get Covid. They were asked to take this fear and then think of a cue word that might cue in that fear. So, for example, with Covid, the cue word might be 'hospital.' And then, later on, in the training phase of the study, the participants were shown their cue words that they created. They might be shown the word 'hospital', and when they were shown the word hospital, they were made to recognise the event to which that referred. But, after that, they were asked to just immediately stop any future imagination of the event, try to block it and keep it out of mind. Not even to replace that with the thought of something else. It was actually just being asked to keep the mind blank, which is obviously quite a challenge.

James - What were the results?

Francis - 120 participants across 16 different countries went under three days of this training, and each day they tried to suppress the thoughts of their fears 12 times, 36 repetitions in total. And what this led to, there was no ironic increase in the amount of times that this fear occurred. So they asked the participants whether they could remember the suppressed fear, how clearly or strongly they felt about them, and then how they felt in general as well. And they also asked them again three months after the training phase took place. And essentially the participants who were asked to suppress their negative thoughts actually ended up better off than the participants who weren't asked to suppress their negative thoughts on these indexes of memory and emotions and sort of mental health in general.

James - Interesting. How does this square with the training that people like you go through when they're studying to become clinical psychologists? Is this something of a watershed moment for our understanding of how to better our mental health? Do we have to start thinking about psychotherapy in different ways now?

Francis - I was definitely surprised to see these findings given that my training has almost entirely given me the opposite impression. When I deliver cognitive behavioural therapy, for example, I'm asking clients to put their thoughts on the table and then we're going to examine the evidence for them and against them. But I think in terms of a watershed moment, often in psychology especially, the literature ends up being quite messy. And I think the conclusion I draw from this is that, as we hear a lot as trainee clinical psychologists, different therapeutic approaches work for different people. And even within the same person, different approaches might work at different times. So while in cognitive behavioural therapy, traditionally, we might ask someone to challenge and confront their negative thoughts. There might be a time where that is too difficult, for example, in PTSD, post-traumatic stress disorder, that's a real challenge to ask someone to bring up their thoughts about a traumatic event from their lives. And so thought suppression might form a kind of strategy. I don't want to speak to give any clinical advice to anyone from this podcast, but I think, speaking hypothetically, something like thought suppression as described in this study could be used as a kind of technique maybe for when someone doesn't feel ready to get those thoughts out onto the table, just a way to manage it day-to-day that doesn't require that incredible bravery and vulnerability of going to therapy and doing the detailed in-depth thought challenging. So I wonder whether this can sit alongside the literature that does exist about challenging thoughts and what we'd call cognitive restructuring. So I think it's really exciting to see such a different, distinct finding to what I've been accustomed to.

James - Spoken like a true professional. Thank you so much for your insights, Francis. That was really helpful.

Francis - Thank you.