For many years, I have been interested in how depressed people make decisions that keep them stuck in bad situations, isolated and passive, while perpetuating their own misery. I reject the idea that depression is masochism—that depressed people want to punish themselves. Instead, I argue that depression is an evolved strategy to avoid further loss.
For example, imagine two individuals contemplating an “investment.” In each case, they consider investing $5,000 with a 50% probability of a $15,000 gain, but if they lose, they will lose all $5,000. How would a wealthy and a poor person think about this choice?
The first, Oliver the Optimist, has a net worth of $10,000,000, and he immediately takes the bet since he can absorb the loss, enjoys winning, and doesn’t fear losing. The second, Nathan the Neurotic, is down on his luck, and his net worth is $5,500. Nathan turns down the wager since he correctly realizes that, if he loses, he will have almost nothing left.
In this case, pessimism is the adaptive strategy since Nathan’s loss could mean annihilation, whereas for the wealthy person, the loss would be a minor inconvenience. Optimistic and depressed individuals think about choices like this. And for good reason.
Why Do Depressed People Avoid the Risk of Change?
My model of depressive decision-making was initially based on Modern Portfolio Theory, developed by Nobel Prize laureate Harold Markowitz. Many of the dimensions of decision-making draw on this earlier model of how different investors consider how to invest. Decision-making in everyday life involves judgment and a decision-making process.
Depressed people tend to look at options in terms of loss aversion—that is, avoiding loss at all costs—often because they fear they cannot absorb a loss. For example, a depressed person who is thinking of breaking off from a painful relationship that is going nowhere may “reason” that they cannot let go of this relationship because if they get any more depressed, their life would not be worth living. In addition, their depression is telling them that they have very little going for them (resources), they would be prone to high regret, they would suffer immensely, and even if there were a new life ahead, they could not wait for it to unfold (short time horizon) because there are few good options (scarcity). They would not enjoy them anyway (low utility). Thus, avoidance of change has a depressive logic to it.
Depressed thinking is characterized by the belief that someone cannot produce positive outcomes, that they will suffer their losses more than they will enjoy their gains, that they cannot absorb future losses, and that they cannot “stay in the game.” They decide that they will quit early and will, therefore, avoid risks at all costs. Thus, staying in the hell they know rather than the one they don’t know makes sense, reinforcing avoidance, passivity, and the vicious cycle of depression.
Cognitive behavioral therapy (CBT) can help depressed people realize that they are living a self-fulfilling prophecy, not because they want to be depressed, but because they are trying to avoid further loss. The patient and therapist can examine the wide range of rewarding behaviors that can be pursued using behavioral activation, activity scheduling, and pleasure predicting. The therapist can encourage a building-block approach to cumulative gains by emphasizing that the patient has to act better (for a long time) until they feel better, setting daily, weekly, and monthly goals, accepting gradual improvement rather than the need for sudden gains, expanding their set of values, and pursuing meaningful and rewarding behaviors.
In addition, CBT can help reverse regret by normalizing frustration, using mistakes as opportunities to learn, encouraging self-reward for progress toward goals, and setting realistic and flexible expectations. The young woman or man who is considering breaking off their relationship can examine the many positives they have (ask your friends, be your own friend) and make a plan to engage in productive activities toward their daily goals.
Therapy can help those who are struggling with depression recognize that it takes some time to make progress. (How long will it take to get into shape if you haven’t exercised in two years?) They can view frustration as getting closer to the goal — the more cold calls you make, the closer you get to a sale — realize that enjoying activities takes time and deliberate engagement, and acknowledge that there is more risk of being depressed by staying in a bad relationship than in pursuing a good relationship or an independent life. Every week someone stays in a bad situation is an opportunity that they have lost to make things better.
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CBT is not simply about feeling better; it’s about acting better. As a founder of CBT once said, “The real world is a natural reinforcer for positive behavior. Take action.”
To find a therapist near you, visit the Psychology Today Therapy Directory.