The surprising psychological benefits of framing depression as a functional signal

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A new study published in Social Sciences and Medicine suggests that framing depression as a “sign” with functional value, rather than just a disease, might be beneficial for those who suffer from it. The researchers found that those who viewed depression through this “signal” lens reported lower self-stigma and stronger beliefs in the adaptability and manageability of their condition.

Depression has traditionally been viewed through a disease-based lens, attributed to genetic, biological, or chemical imbalances. This biogenetic explanation, while reducing self-blame, has also led to unintended negative consequences such as increased stigma and reduced hope for recovery.

The researchers proposed a new way of looking at depression: as a sign that something in life needs more attention. This approach is based on evolutionary psychiatry and suggests that, like fear or sadness, depression might have an adaptive function.

“My research focuses on how people think and talk about depression. Biological explanations (eg the ‘chemical imbalance’ narrative) have been around for a long time, but research is showing that these messages can have negative consequences for people who are trying to improve,” said study author Hans S. Schroder. clinical assistant professor of psychiatry at the University of Michigan Medical School.

“So they were trying different explanations of depression beyond this disease-centered framework. I became interested in the idea that depression actually has a purpose in life that it’s trying to tell you that something isn’t working for you right now and you can be curious about your life to address depression.”

The researchers conducted a pre-registered, randomized controlled online study to assess the impact of framing depression as a disease or as a functional sign.

The study included 877 adults in the United States who reported a history of depression but had not engaged in extensive treatment. This specific inclusion criterion was chosen to focus on individuals whose perceptions of depression were less likely to be influenced by prior clinical interventions. The researchers used Dynata, an online market research firm, for recruitment, with the goal of closely reflecting the racial and ethnic makeup of the US population, based on census data.

Participants were randomly assigned to one of two conditions. In the biopsychosocial risk factor condition, depression was introduced as a disease, similar to cancer or diabetes, with a focus on its behavioral, environmental, and biological risk factors. In the cue condition, participants were presented with the notion that depression might serve an adaptive function, indicating the need for increased attention to certain areas of life.

The core of the intervention consisted of a series of videos designed to introduce participants to these different perspectives. The content has been carefully designed to ensure consistency in delivery, length and complexity across conditions, minimizing potential bias. Importantly, both conditions included messages designed to absolve participants of personal blame for their depression.

Participants in the cue condition reported lower self-stigma (I avoid interacting with others because I am a person with mental illness) and more adaptive beliefs about depression (experiencing depression can lead to new insights) than those in the biopsychosocial risk factor condition. This finding suggests that viewing depression as a functional sign, rather than a disease, could help alleviate some of the negative self-perceptions associated with mental health problems.

“We found that although the two explanations were highly related for talking about depression, the cue frame was more beneficial for stigma, suggesting that talking about depression as a function may be beneficial,” Schroder told PsyPost.

In addition, the study found that the signal condition was associated with an increase in what the researchers called “compensated efficacy” belief in one’s own agency and ability to overcome depression. This increase was observed even though the condition did not significantly alter participants’ sense of personal responsibility for their depression.

“There are many different ways to think about depression, not just one way,” Schroder said. “And our study shows that for some people, thinking that depression has a ‘purpose’ is your body’s way of telling you that something needs more attention in your life has benefits in terms of stigma and hope of recovery”.

However, the study found no significant differences between the two conditions regarding treatment-seeking attitudes. This result indicates that although functional cue framing may positively affect stigma and beliefs about the malleability of depression, it does not necessarily translate into greater inclination to seek treatment.

Interestingly, the researchers also discovered gender differences in the effects of cue framing. Although the positive impacts of this framing were observed in the general pool of participants, they were particularly pronounced among female participants.

This study opens new avenues for how we understand and deal with depression. Viewing depression as a signal rather than a dysfunction could lead to public health campaigns and more nuanced treatment approaches that focus on addressing life challenges.

But the study’s focus on treatment-naive individuals limits generalizability to those already in treatment. Furthermore, the observed effects were immediate and the long-term impact is still unknown.

“This was our first ‘signal framing’ study, and as such we used a sample of people using an online marketing platform who had never had any treatment before,” Schroder noted. “Therefore, we cannot yet generalize our findings beyond this sample. We do not yet know the long-term consequences of signal framing, as this was a one-time study.

“We really hope that we can continue to find out ‘which message works best for which person’ in terms of thinking and talking about depression. Some people find the signal framework really motivating to work on their depression, while others find other more useful explanations.”

Hans S. Schroder, Andrew Devendor, and Brian J. Zikmund-Fisher wrote the study, “Framing depression as a functional signal, not a disease: rationale and initial randomized controlled trial.”

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