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Suppressing Distressing Thoughts 'Can Improve Mental Health'

Training people with mental health conditions to suppress intrusive thoughts might be an effective management strategy, despite being contrary to established treatment methods, scientists suggested.

People with conditions such as anxiety, post-traumatic stress, and depression often experienced distressing, intrusive thoughts, commented researchers from the University of Cambridge. However, conventional therapies often urged them to "avoid suppressing their thoughts" because intrusions might rebound in intensity and frequency, worsening the disorders, they pointed out. 

These ideas had become "dogma" in the clinical treatment realm, according to the authors of a new study, published in the journal Science Advances. "The whole point of psychotherapy is to dredge up these thoughts so one can deal with them and rob them of their power," explained Professor Michael Anderson from the Cambridge University Medical Research Council (MRC) Cognition and Brain Sciences Unit, who co-authored the investigation. "In more recent years, we've been told that suppressing thoughts is intrinsically ineffective and that it actually causes people to think the thought more – it's the classic idea of 'don't think about a pink elephant'", he underlined.

Co-author Dr Zulkayda Mamat — a PhD student at the time of the study — explained there was a need in the community to help people cope with "surging" anxiety. She believed that "inhibitory control" was critical in overcoming traumatic experiences, so wanted to investigate whether this was an innate ability or something that was learnt, and hence could be taught.

Suppressed Events Less Fearful and Vivid

The study involved 120 volunteers from 16 countries — 93 females, mean age 27 years — trained online to suppress thoughts about negative events that worried them.

Each participant was asked to think of a number of scenarios that might plausibly occur in their lives over the next 2 years – 20 negative 'fears and worries' that they were afraid might happen, 20 positive 'hopes and dreams', and 36 routine and mundane neutral events. The fears had to be worries of current concern to them, that had repeatedly intruded in their thoughts.

Participants completed questionnaires to assess their mental health before undergoing 20-minute daily online training sessions for 3 days. Participants were assessed on the third day, and three months later.

Both immediately after the training, and at 3 months, participants reported that suppressed events were less vivid and less fearful. They also found themselves thinking about these events less often. Moreover, the participants' mental health also improved, and there was no 'rebound', where a participant recalled these events more vividly, reassured the authors.

In general, people with worse mental health symptoms at the study outset improved more after suppression training, but only if they suppressed their fears. 

Participants high in trait anxiety and pandemic-related post-traumatic stress gained the largest and most durable mental health benefits, the authors highlighted. "We saw the biggest effect among those participants who were given practice at suppressing fearful, rather than neutral, thoughts," commented Dr Mamat.

The negative mental health indices of those with post-traumatic stress who suppressed negative thoughts fell on average by 16%, compared with a 5% fall for similar participants suppressing neutral events. Positive mental health indices scores increased by almost 10%, compared with a 1% fall in the second group.

Pervasive View and Century Old Wisdom Challenged

The findings challenged the "pervasive view" that thought suppression played a key role in the pathogenesis of mental health disorders and the "century-old wisdom" that suppressing thoughts is maladaptive, according to the authors. "What we found runs counter to the accepted narrative," commented Professor Anderson. "Although more work will be needed to confirm the findings, it seems like it is possible and could even be potentially beneficial to actively suppress our fearful thoughts."

Commenting on the study for the Science Media Centre, Luis Valero Aguayo, professor of psychology at the University of Malagá, levelled a number of criticisms at the study. These included the small number of people across many countries with "less than 10 people per country", which he warned meant the results could not be generalised, "but rather the opposite, because of the poor representativeness and cultural variability it can introduce into the data".

He also pointed out that the research was "conducted online", and that the "variability and poor control of the experimental setup itself give little reliability to the results".

María Cantero-García, lecturer in psychology at Universidad a Distancia de Madrid (UDIMA), was more positive and believed the study "could provide therapists with a more balanced understanding of negative-thought suppression" and could "offer additional tools to help people deal with their thoughts effectively".

However, it was essential that therapists continued to assess each situation "individually" and "consider the limitations and complexity" of this issue in their clinical practice, she stressed.

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