Beneath the veil of thought suppression: Attentional bias and depression risk

The delayed, durable effect of expressive writing on depression, anxiety and stress: A meta-analytic review of studies with long-term follow-ups

BACKGROUND

Expressive writing is a promising tool to heal the wounds with words.

AIMS

This meta-analysis evaluated the current state of efficacy of expressive writing on depression, anxiety and stress symptoms among healthy and subclinical samples.

MATERIALS AND METHODS

Thirty-one experimental studies (N = 4012) with randomized controlled trials and follow-up assessments were analysed.

RESULTS

Results showed that expressive writing had an overall small but significant effect (Hedges' g = -0.12, 95% CI [-0.21, -0.04]) on reducing symptoms of depression, anxiety and stress. Change score analyses suggested that the intervention effect emerged after a delay, as evidenced by assessments at follow-up periods. Moderator analyses indicated that the effect sizes varied as a function of one intervention feature: interval. Studies that implemented short intervals (1-3 days) between writing sessions yielded stronger effects (G_diff  = -0.18, p = .01) relative to studies that implemented medium intervals (4-7 days) or long intervals (>7 days). The effects of expressive writing remained consistent across other intervention features including focus, instruction, number of sessions, topic repetition and delivery mode.

DISCUSSION

Together, these findings provide evidence for the delayed, durable effect of expressive writing and underscore the importance of scheduling writing sessions at short intervals.

CONCLUSION

Implications for incorporating expressive writing into clinical practice and daily life are discussed.

Effects of psilocybin versus escitalopram on rumination and thought suppression in depression

BACKGROUND

Major depressive disorder is often associated with maladaptive coping strategies, including rumination and thought suppression.

AIMS

To assess the comparative effect of the selective serotonin reuptake inhibitor escitalopram, and the serotonergic psychedelic psilocybin (COMP360), on rumination and thought suppression in major depressive disorder.

METHOD

Based on data derived from a randomised clinical trial (N = 59), we performed exploratory analyses on the impact of escitalopram versus psilocybin (i.e. condition) on rumination and thought suppression from 1 week before to 6 weeks after treatment inception (i.e. time), using mixed analysis of variance. Condition responder versus non-responder subgroup analyses were also done, using the standard definition of ≥50% symptom reduction.

RESULTS

A time×condition interaction was found for rumination (F(1, 56) = 4.58, P = 0.037) and thought suppression (F(1,57) = 5.88, P = 0.019), with post hoc tests revealing significant decreases exclusively in the psilocybin condition. When analysing via response, a significant time×condition×response interaction for thought suppression (F(1,54) = 8.42, P = 0.005) and a significant time×response interaction for rumination (F(1,54) = 23.50, P < 0.001) were evident. Follow-up tests revealed that decreased thought suppression was exclusive to psilocybin responders, whereas rumination decreased in both responder groups. In the psilocybin arm, decreases in rumination and thought suppression correlated with ego dissolution and session-linked psychological insight.

CONCLUSIONS

These data provide further evidence on the therapeutic mechanisms of psilocybin and escitalopram in the treatment of depression.

The reliability of attentional biases for emotional images measured using a free-viewing eye-tracking paradigm

Cognitive theories of anxiety disorders and depression posit that attentional biases play a role in the development, maintenance, and recurrence of these disorders. Several paradigms have been used to examine attentional biases in anxiety and depression, but information on the reliability of different attentional bias indices is limited. In this study we examined the internal consistency and 6-month test-retest reliability of attentional bias indices derived from a free-viewing eye-tracking paradigm. Participants completed two versions of an eye-tracking task-one that used naturalistic images as stimuli, and one that used face images. In both tasks, participants viewed displays of four images, each display consisting of one threat image, one sad image, one positive/happy image, and one neutral image. The internal consistency of the fixation indices (dwell time and number of fixations) for threat, sad, and positive images over the full 8-s display was moderate to excellent. When the 8-s display was divided into 2-s intervals, the dwell times for the 0- to 2-s and 2- to 4-s intervals showed lower reliability, particularly for the face images. The attentional bias indices for the naturalistic images showed adequate to good stability over the test-retest period, whereas the test-retest reliability estimates for the face images were in the low to moderate range. The implications of these results for attentional bias research are discussed.

Changing views of emotion regulation and neurobiological models of the mechanism of action of psychotherapy

Influential neurobiological models of the mechanism of action of psychotherapy attribute its success to increases of activity in prefrontal areas and decreases in limbic areas, interpreted as the successful and adaptive recruitment of controlled processes to achieve emotion regulation. In this article, we review the behavioral and neuroscientific evidence in support of this model and its applicability to explain the mechanism of action of psychotherapy. Neuroimaging studies of explicit emotion regulation, evidence on the neurobiological substrates of implicit emotion regulation, and meta-analyses of neuroimaging studies of the effect of psychotherapy consistently suggest that areas implicated in coding semantic representations play an important role in emotion regulation not covered by existing models based on controlled processes. We discuss the findings that implicate these same areas in supporting working memory, in encoding preferences and the prospective outcome of actions taken in rewarding or aversive contingencies, and show how these functions may be integrated into process models of emotion regulation that depend on elaborate semantic representations for their effectiveness. These alternative models also appear to be more consistent with internal accounts in the psychotherapeutic literature of how psychotherapy works.

Convergence in feeling, divergence in physiology: How culture influences the consequences of disgust suppression and amplification among European Americans and Asian Americans

Much empirical work documents the downsides of suppressing emotions. Emerging research points to the need for a more sophisticated and culturally informed approach to understanding the consequences of emotion regulation. To that end, we employed behavioral, self-report, and psychophysiological measures to examine the consequences of two types of emotion regulation (suppression and amplification) in a sample of 28 Asian Americans and 31 European Americans. Participants were shown a neutral film and then a series of disgust-eliciting films during which they were asked to regulate their response by suppressing or amplifying their emotional behavior (counterbalanced). Despite self-reporting equal levels of disgust, European Americans showed greater skin conductance reactivity than Asian Americans in both regulation conditions, but not in response to a neutral film. These findings extend work on divergence in the consequences of emotion regulation across different cultural groups, which could help identify optimal emotion regulation strategies for health and well-being.

Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals

Depression is associated with attentional biases for emotional information that are proposed to reflect stable vulnerability factors for the development and recurrence of depression. A key question for researchers is whether those who have recovered from depression also exhibit attentional biases, and if so, how similar these biases are to those who are currently depressed. To address this question, the present study examined attention to emotional faces in remitted depressed (N=26), currently depressed (N=16), and never depressed (N=33) individuals. Participants viewed sets of four face images (happy, sad, threatening, and neutral) while their eye movements were tracked throughout an 8-s presentation. Like currently depressed participants, remitted depressed participants attended to sad faces significantly more than never depressed participants and attended to happy faces significantly less. Analyzing temporal changes in attention revealed that currently and remitted depressed participants did not reduce their attention to sad faces over the 8-s presentation, unlike never depressed participants. In contrast, remitted depressed participants attended to happy faces similarly to never depressed participants, increasing their attention to happy faces over the 8-s presentation. The implications for cognitive theories of depression and depression vulnerability are discussed.

Evidence against mood-congruent attentional bias in Major Depressive Disorder

Depression is consistently associated with biased retrieval and interpretation of affective stimuli, but evidence for depressive bias in earlier cognitive processing, such as attention, is mixed. In five separate experiments, individuals with depression (three experiments with clinically diagnosed major depression, two experiments with dysphoria measured via the Beck Depression Inventory) completed three tasks designed to elicit depressive biases in attention, including selective attention, attentional switching, and attentional inhibition. Selective attention was measured using a modified emotional Stroop task, while attentional switching and inhibition was examined via an emotional task-switching paradigm and an emotional counter task. Results across five different experiments indicate that individuals with depression perform comparably with healthy controls, providing corroboration that depression is not characterized by biases in attentional processes.

Reduced striatal activation in females with major depression during the processing of affective stimuli

The extent to which affective reactivity and associated neural underpinnings are altered by depression remains equivocal. This study assessed striatal activation in fifty-one unmedicated female participants meeting DSM-IV criteria for Major Depressive Disorder (MDD) and 61 age-matched healthy females (HC) aged 17-63 years. Participants completed an affective reactivity functional magnetic resonance imaging task. Data were preprocessed using SPM8, and region-of-interest analyses were completed using MarsBaR to extract caudate, putamen, and nucleus accumbens (NAcc) activation. General linear repeated measure ANOVAs were used to assess group differences and correlational analyses were used to measure the association between activation, depression severity, and anhedonia. Main effects of hemisphere, valence, and group status were observed, with MDD participants demonstrating decreased striatal activation compared with HC. Across groups and valence types, the left hemisphere demonstrated greater activation than the right hemisphere in the putamen and nucleus accumbens, whereas the right hemisphere demonstrated greater activation than the left in the caudate. Additionally, unpleasant stimuli elicited greater activation than pleasant and neutral stimuli in the caudate and putamen, and unpleasant stimuli elicited greater activation than neutral stimuli in the NAcc. There were no significant associations between activation, depression severity, and anhedonia. Overall, depression was characterized by reduced affective reactivity in the striatum, regardless of stimuli valence, supporting the emotion context insensitivity model of depression.

En Route to Depression: Self-Esteem Discrepancies and Habitual Rumination

Dual-process models of cognitive vulnerability to depression suggest that some individuals possess discrepant implicit and explicit self-views, such as high explicit and low implicit self-esteem (fragile self-esteem) or low explicit and high implicit self-esteem (damaged self-esteem). This study investigated whether individuals with discrepant self-esteem may employ depressive rumination in an effort to reduce discrepancy-related dissonance, and whether the relationship between self-esteem discrepancy and future depressive symptoms varies as a function of rumination tendencies. Hierarchical regressions examined whether self-esteem discrepancy was associated with rumination in an Australian undergraduate sample at Time 1 (N = 306; M(age) = 29.9), and whether rumination tendencies moderated the relationship between self-esteem discrepancy and depressive symptoms assessed 3 months later (n = 160). Damaged self-esteem was associated with rumination at Time 1. As hypothesized, rumination moderated the relationship between self-esteem discrepancy and depressive symptoms at Time 2, where fragile self-esteem and high rumination tendencies at Time 1 predicted the highest levels of subsequent dysphoria. Results are consistent with dual-process propositions that (a) explicit self-regulation strategies may be triggered when explicit and implicit self-beliefs are incongruent, and (b) rumination may increase the likelihood of depression by expending cognitive resources and/or amplifying negative implicit biases.

Shorter gaze duration for happy faces in current but not remitted depression: evidence from eye movements

Cognitive theories of depression propose that depressed individuals preferentially attend to negative information and that such cognitive biases constitute important vulnerability and maintenance factors for the disorder. Most studies examined this bias by registration of response latencies. The present study employed a direct and continuous measurement of attentional processing for emotional stimuli by recording eye movements. Currently depressed (CD), remitted depressed (RD) and healthy control (HC) participants viewed slides presenting sad, angry, happy and neutral facial expressions. For each expression, four components of visual attention were analyzed: first fixation, maintained fixation, relative fixation frequency and glance duration. Results showed that healthy controls were characterized by longer gaze duration for happy faces compared to currently depressed individuals but not compared to remitted depressed individuals. Both patient groups (CD, RD) demonstrated longer maintained fixation (dwelling time) on all emotional faces compared to healthy controls. The present findings are in line with the presumption that depression is associated with a loss of elaborative processing of positive stimuli that characterizes healthy controls. Importantly, successful remission of depression (RD group) may result in positive attentional processing as no group differences were found between healthy controls and remitted patients on glance duration for happy faces.

Memory biases in remitted depression: the role of negative cognitions at explicit and automatic processing levels

BACKGROUND AND OBJECTIVES

Cognitive models propose that depression is caused by dysfunctional schemas that endure beyond the depressive episode, representing vulnerability factors for recurrence. However, research testing negative cognitions linked to dysfunctional schemas in formerly depressed individuals is still scarce. Furthermore, negative cognitions are presumed to be linked to biases in recalling negative self-referent information in formerly depressed individuals, but no studies have directly tested this association. In the present study, we evaluated differences between formerly and never-depressed individuals in several experimental indices of negative cognitions and their associations with the recall of emotional self-referent material.

METHODS

Formerly (n = 30) and never depressed individuals (n = 40) completed measures of explicit (i.e., scrambled sentence test) and automatic (i.e., lexical decision task) processing to evaluate negative cognitions. Furthermore participants completed a self-referent incidental recall task to evaluate memory biases.

RESULTS

Formerly compared to never depressed individuals showed greater negative cognitions at both explicit and automatic levels of processing. Results also showed greater recall of negative self-referent information in formerly compared to never-depressed individuals. Finally, individual differences in negative cognitions at both explicit and automatic levels of processing predicted greater recall of negative self-referent material in formerly depressed individuals.

LIMITATIONS

Analyses of the relationship between explicit and automatic processing indices and memory biases were correlational and the majority of participants in both groups were women.

CONCLUSIONS

Our findings provide evidence of negative cognitions in formerly depressed individuals at both automatic and explicit levels of processing that may confer a cognitive vulnerability to depression.

Emotional response inhibition in bipolar disorder: a functional magnetic resonance imaging study of trait- and state-related abnormalities

BACKGROUND

Impaired response inhibition and poor impulse control are hallmarks of the manic phase of bipolar disorder but are also present during depressive and, to a lesser degree, euthymic periods. The neural mechanisms underlying these impairments are poorly understood, including how mechanisms are related to bipolar trait or state effects.

METHODS

One-hundred four unmedicated participants with bipolar mania (BM) (n = 30), bipolar depression (BD) (n = 30), bipolar euthymia (BE) (n = 14), and healthy control subjects (n = 30) underwent functional magnetic resonance imaging during emotional and nonemotional go/no-go tasks. The go/no-go task requires participants to press a button for go stimuli, while inhibiting the response to no-go trials. In separate blocks, participants inhibited the response to happy faces, sad faces, or letters.

RESULTS

The BE group had higher insula activity during happy face inhibition and greater activity in left inferior frontal gyrus during sad face inhibition, demonstrating bipolar trait effects. Relative to the BE group, BD and BM groups demonstrated lower insula activity during inhibition of happy faces, though the depressed sample had lower activity than manic patients. The BD and BM groups had a greater response to inhibiting sad faces in emotion processing and regulation regions, including putamen, insula, and lateral prefrontal cortex. The manic group also had higher activity in insula and putamen during neutral letter inhibition.

CONCLUSIONS

These results suggest distinct trait- and state-related neural abnormalities during response inhibition in bipolar disorder, with implications for future research and treatment.

Decision-Making Dysfunctions of Counterfactuals in Depression: Who Might I have Been?

Cognitive neuroscience enables us now to decompose major depressive disorder into dysfunctional component processes and relate these processes to specific neural substrates. This approach can be used to illuminate the biological basis of altered psychological processes in depression, including abnormal decision-making. One important decision-related process is counterfactual thinking, or the comparison of reality to hypothetical alternatives. Evidence suggests that individuals with depression experience exaggerated emotional responses due to focusing on counterfactual decision outcomes in general and regret, i.e., the emotion associated with focus on an alternative superior outcome, in particular. Regret is linked to self-esteem in that it involves the evaluation of an individual's own decisions. Alterations of self-esteem, in turn, are a hallmark of depression. The literature on the behavioral and neural processes underlying counterfactual thinking, self-esteem, and depression is selectively reviewed. A model is proposed in which unstable self-representation in depression is more strongly perturbed when a different choice would have produced a better outcome, leading to increased feelings of regret. This approach may help unify diverse aspects of depression, can generate testable predictions, and may suggest new treatment avenues targeting distorted counterfactual cognitions, attentional biases toward superior counterfactual outcomes, or increased affective response to regretted outcomes.

Toward an integration of cognitive and genetic models of risk for depression

There is growing interest in integrating cognitive and genetic models of depression risk. We review two ways in which these models can be meaningfully integrated. First, information-processing biases may represent intermediate phenotypes for specific genetic influences. These genetic influences may represent main effects on specific cognitive processes or may moderate the impact of environmental influences on information-processing biases. Second, cognitive and genetic influences may combine to increase reactivity to environmental stressors, increasing risk for depression in a gene×cognition×environment model of risk. There is now growing support for both of these ways of integrating cognitive and genetic models of depression risk. Specifically, there is support for genetic influences on information-processing biases, particularly the link between 5-HTTLPR and attentional biases, from both genetic association and gene×environment (G×E) studies. There is also initial support for gene×cognition×environment models of risk in which specific genetic influences contribute to increased reactivity to environmental influences. We review this research and discuss important areas of future research, particularly the need for larger samples that allow for a broader examination of genetic and epigenetic influences as well as the combined influence of variability across a number of genes.

Exploring the factor structure of implicit and explicit cognitions associated with depression

Dual-process models of cognitive vulnerability to depression propose that implicit (automatic) and explicit (effortful) processes are involved in depression. The current study investigated the underlying structure of four implicit and four explicit cognitive biases associated with depression in an undergraduate sample (N = 355). An exploratory principal-axis factor analysis of implicit and explicit measures of self-esteem, dysfunctional beliefs, and memory for positive and negative stimuli produced a three-factor solution that was inconsistent with the dual process (two factor) account. Subsequent confirmatory factor analyses of biases exhibited by a hold-out sample also failed to support the hypothesized dual-process model and supported a three-factor solution. Overall, the results indicate that the latent structure of measures investigated in this study is not characterized by a clear differentiation between implicit and explicit cognition and that alternative models and measurement strategies should be investigated.

Anger suppression and subsequent pain behaviors among chronic low back pain patients: moderating effects of anger regulation style

BACKGROUND

Suppression of anger is linked to subsequent pain intensity among chronic low back patients, but it is not clear whether anger regulation style (trait anger-out, anger-in) moderates these effects or if aroused anger accounts for links between anger regulation style and pain.

METHOD

Chronic low back pain patients (N=58) were assigned to Suppression or No Suppression conditions for a task with harassing confederate and then underwent structured pain behavior procedures. Spielberger Anger Expression Inventory tapped trait anger-out (AOS) and anger-in (AIS).

RESULTS

Regressions tested Emotion Regulation condition × AOS and AIS effects on outcomes. AOS was related to grimacing and sighing for Suppression condition patients. AIS was related negatively to guarding and bracing for Suppression condition patients. Anger report partly mediated effects for AOS and AIS.

CONCLUSIONS

Anger regulation style moderated effects of state anger suppression on subsequent pain behaviors, effects that were partly explained by aroused anger.

Information processing of food cues in overweight and normal weight adolescents

OBJECTIVES

Based on cognitive theory (CT), the aim of this study is to investigate the cognitive processing of food cues in clinically overweight adolescents.

DESIGN

An experimental design with performance-based measures.

METHODS

Eighty-seven (45 overweight, 42 normal weight) adolescents between the ages of 12 and 18 years were examined. All completed an imbedded word task (IWT), containing high caloric food words and matched control words, as a measure of attention interference. A free-recall task was used to detect explicit memory biases. To study the effects of cognitive avoidance, participants were instructed to suppress thoughts about food or merely to monitor them, prior to completing the IWT and memory task.

RESULTS

No evidence was found for interference in the attention processing of food cues. Also, no effects of thought suppression were found. However, consistent with hypotheses, the overweight adolescents did show an explicit memory bias for food stimuli, not due to a more general negative evaluation of food words.

CONCLUSIONS

The results provide at least partial support for the applicability of CT to adolescent obesity. The study was the first to reveal a memory bias for high caloric food cues in overweight youngsters, which may well reflect a later-stage activation of food-related schemata. These may play a role in food-related preoccupations and overeating. The existence of an early-stage attention bias is less clear and requires further investigation.

How does stigma "get under the skin"?: the mediating role of emotion regulation

Stigma is a risk factor for mental health problems, but few studies have considered how stigma leads to psychological distress. The present research examined whether specific emotion-regulation strategies account for the stigma-distress association. In an experience-sampling study, rumination and suppression occurred more on days when stigma-related stressors were reported than on days when these stressors were not reported, and rumination mediated the relationship between stigma-related stress and psychological distress. The effect of social support on distress was moderated by the concealability of the stigma: Lesbian, gay, and bisexual (LGB) respondents reported more isolation and less social support than African American respondents subsequent to experiencing stigma-related stressors, whereas African Americans reported greater social support than LGB participants. Social isolation mediated the stigma-distress association among LGB respondents. In a second experimental study, participants who ruminated following the recall of an autobiographical discrimination event exhibited prolonged distress on both implicit and explicit measures relative to participants who distracted themselves; this finding provides support for a causal role of rumination in the stigma-distress relationship.

Effects of preoccupation on interpersonal recall: a pilot study

BACKGROUND

The aim of this pilot study was to examine whether priming preoccupation (rumination) in healthy participants adversely affects the processing of interpersonal information.

METHODS

Sixty female undergraduates with moderate or marked preoccupation proneness (selected on the basis of their high preoccupation on eating, shape, and weight issues) were randomized to receive either a general preoccupation prime, a standardized preoccupation prime, or a control prime. Following the prime, participants watched an 8-min videotape of a family interaction and then were asked free recall questions about the tape.

RESULTS

Participants who received the general preoccupation prime scored lower than the other two groups in response to free recall questions regarding emotion-related topics.

CONCLUSIONS

These findings suggest that when primed by everyday worries and concerns, individuals prone to preoccupation may have their capacity to recall emotion-related interpersonal information compromised.

Revealing negative thinking in recovered major depression: a preliminary investigation

Previous research suggests that formerly dysphoric individuals engage in effortful strategies (e.g., thought suppression) that may mask underlying depressive thinking. The addition of a cognitive load, such as recalling a 6-digit number, which interferes with effortful mental control, reveals depressive thinking in formerly dysphoric individuals. This preliminary study tested whether this effect of cognitive load on revealing negative thinking generalizes to formerly clinically depressed patients. Currently depressed patients, recovered depressed patients and never-depressed patients unscrambled sentences that could form either positive or negative statements, after random allocation to either cognitive load or no cognitive load conditions. The number of negative statements unscrambled was used as an index of negative thinking. Without a load, recovered depressed patients did not differ from never-depressed controls: both groups completed fewer negative statements than currently depressed patients. However, the cognitive load increased negative statements in the recovered depressed group, making them resemble the currently depressed group more than the never-depressed group. These preliminary findings extend previous demonstrations of cognitive load unmasking negative thinking in dysphoric students to a clinical population, suggesting that formerly depressed patients utilize effortful strategies to minimize the report of negative thinking, which is undermined by the addition of a cognitive load.

Benefits of expressive writing in lowering rumination and depressive symptoms

Depression-vulnerable college students (with both elevated prior depressive symptoms and low current depressive symptoms) wrote on 3 consecutive days in either an expressive writing or a control condition. As predicted, participants scoring above the median on the suppression scale of the Emotion Regulation Questionnaire (Gross & John, 2003) showed significantly lower depression symptoms at the 6-month assessment when they wrote in the expressive writing versus the control condition. Additional analyses revealed that treatment benefits were mediated by changes in the Brooding but not the Reflection scale of the Ruminative Response Scale (Nolen-Hoeksema & Morrow, 1991). A "booster" writing session predicted to enhance treatment benefits failed to have a significant effect.

Cognitive change process during group cognitive behaviour therapy for depression

BACKGROUND

This study extended that of Kwon and Oei [Kwon, S.M., Oei, T.P.S., 2003. Cognitive change processes in a group cognitive behavior therapy of depression. J. Behav. Ther. Exp. Psychiatry, 3, 73-85], which outlined a number of testable models based on Beck's cognitive theory of depression. Specifically, the current study tested the following four competing models: the causal, consequential, fully and partially interactive cognitive models in patients with major depressive disorder.

METHODS

A total of 168 clinically depressed outpatients were recruited into a 12-week group cognitive behaviour therapy program. Data was collected at three time points: baseline, mid- and at termination of therapy using the ATQ, DAS and BDI. The data were analysed with Amos 4.01(Arbuckle, J.L., 1999. Amos 4.1. Smallwaters, Chicago.) structural equation modelling.

RESULTS

Results indicated that dysfunctional attitudes, negative automatic thoughts and symptoms of depression reduced significantly during treatment. Both the causal and consequential models equally provided an adequate fit to the data. The fully interactive model provided the best fit. However, after removing non-significant pathways, it was found that reduced depressive symptom contributed to reduced depressogenic automatic thoughts and dysfunctional attitudes, not the reverse.

CONCLUSION

These findings did not fully support Beck's cognitive theory of depression that cognitions are primary in the reduction of depressed mood.

Emotionsregulation und Gedankenunterdrückung: Aspekte der Entwicklung von Depressionen und deren Implikationen

Zusammenfassung. Prominentes Merkmal von Depressionen ist die Störung der Regulation von Stimmungen und Emotionen. Emotionsregulatorische Aspekte werden allerdings häufig vernachlässigt bei der konzeptionellen Fassung und der Behandlung von Depressionen. Im vorliegenden Artikel wird die Rolle dieser Aspekte bei der Entstehung von Depressionen unter besonderer Berücksichtigung von Gedankenunterdrückung als eines Versuches von Emotionsregulation dargestellt. Der willentliche Versuch an etwas, das die Stimmung negativ beeinflussen könnte, nicht zu denken, hat nicht nur langfristig den paradoxen Effekt, dass dieser Gedanke infolge besonders häufig auftritt und die gedankliche Kontrolle verloren geht, sondern zeigt auch eine Reihe weiterer kognitiver wie emotionaler Folgen, die bei der Entstehung von Depressionen eine wichtige Rolle spielen. Die Implikationen dieser Befunde werden diskutiert und expressives Schreiben nach Pennebaker im Rahmen des Präventionsprogramms “JES!“ (Jugendpräventionsprogramm mit Expressivem Schreiben) als eine Möglichkeit emotionsregulationsfördernder Maßnahmen vorgestellt.