Popular belief and traditional psychological theory has held that suppressing negative or unwanted thoughts and bottling up your feelings or emotions can be mentally unhealthy. However, new research now contradicts this belief, with a finding that it may actually be beneficial to suppress some unwanted thoughts, as it improves mental health.
A recent study, which has been published in the journal Science Advances, has shown that mental health could be improved for up to three months after online training of suppressing unwanted thoughts.
"We're all familiar with the Freudian idea that if we suppress our feelings or thoughts, then these thoughts remain in our unconscious, influencing our behaviour and wellbeing perniciously," said Prof Michael Anderson, co-researcher and part of the teaching faculty at University of Cambridge. "The whole point of psychotherapy is to dredge up these thoughts so one can deal with them and rob them of their power. 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'.”
According to Prof Anderson, these ideas have become dogma in the clinical treatment realm, with national guidelines talking about thought avoidance as a major maladaptive coping behaviour to be eliminated and overcome in depression, anxiety and post-traumatic stress disorder (PTSD), for instance.
During the COVID pandemic, like many researchers, Prof Anderson had the idea to see how his own research could help people through the pandemic. His interest lay in a brain mechanism known as inhibitory control which is the ability to override our reflexive responses and how it might be applied to memory retrieval and, in particular, to stopping the retrieval of negative thoughts when confronted with potent reminders to them.
At the time, Dr Zulkayda Mamat, was a PhD student in Prof Anderson's lab and at Trinity College (Cambridge). She believed that inhibitory control was critical in overcoming trauma in experiences occurring to herself and many others she had encountered in life. She had wanted to investigate whether this was an innate ability or something that was learnt and, hence, could be taught.
“Because of the pandemic, we were seeing a need in the community to help people cope with surging anxiety. There was already a mental health crisis, a hidden epidemic of mental health problems, and this was getting worse. So with that backdrop, we decided to see if we could help people cope better,” she said.
Prof Anderson and Dr Mamat, thus, coordinated with the Medical Research Council (MRC) Cognition and Brain Sciences Unit, to enrol 120 participants from 16 countries for their trial, some of whom were recruited via social media sites. Participants included both, those with a history and no history of mental health problems. They periodically collected data on their mental health through exercises and tests.
The participants were asked to list 20 negative ‘fears and worries’ that could feasibly happen over the next two years, which were of current concern to them, as well as 20 positive ‘hopes and dreams’ and 36 neutral events. The researchers further asked them to give each negative, positive or neutral item a cue word (an obvious reminder which could be used to evoke the event during training) and a key detail (a single word expressing a central event detail) in the imagined scenario.
Participants were asked to rate each event on a number of points: vividness, likelihood of occurrence, distance in the future, level of anxiety about the event (or level of joy for positive events), frequency of thought, degree of current concern, long-term impact and emotional intensity.
Participants also completed questionnaires to assess their mental health, though no one was excluded, allowing the researchers to look at a broad range of participants, including many with serious depression, anxiety and pandemic-related post-traumatic stress.
Thereafter, the participants underwent 20 minutes of training in thought suppression via video-conferencing, during which they were confronted with their cue word for a period of four seconds. Of the total number of participants, 61 were in the ‘suppress-negative’ group and were asked to first imagine the event and then suppress any thoughts about it. Meanwhile, 59 participants in the ‘suppress-neutral’ group and were asked to imagine their event vividly. Each group had to undergo this process 12 times a day for three consecutive days.
After implementing this suppression training, researchers then measured how efficiently the suppressed thoughts had been stored and also assessed their general mental well-being. At the end of the third day, and again three months later, participants were, once again, asked to rate each event on vividness, level of anxiety, emotional intensity, etc and completed questionnaires to assess changes in depression, anxiety, worry, affect and well-being, key facets of mental health.
“It was very clear that those events that participants practiced suppressing were less vivid, less emotionally anxiety-inducing, than the other events and that overall, participants improved in terms of their mental health. But we saw the biggest effect among those participants who were given practice at suppressing fearful, rather than neutral, thoughts,” observed Dr Mamat.
Immediately after suppression training, the participants, who were asked to suppress unwanted thoughts, were found to recall the key detail of the event they had been concerned about, less often and less vividly. However, this was not the case for all participants. As six out of the 61 participants who suppressed unwanted thoughts, reported increased vividness of the unwanted thought after training. At the three-month follow-up, the researchers found that participants who had been asked to suppress thoughts had lower vividness and recall of detail when thinking about the event they had been concerned about.
Furthermore, from the group who had suppressed thoughts, those with worse mental health symptoms at the start of the study were observed to have a greater improvement in their mental health three months later. The mental health indices scores of participants with PTSD, who suppressed these thoughts, increased by almost 10%, compared to a 1% fall among those who did not. These mental health indices included both negative impacts (such as anxiety, depression and worry) and positive impacts (such as positive effect on well-being).
In general, people with worse mental health symptoms at the outset of the study improved more after suppression training, but only if they suppressed their fears. This finding directly contradicts the notion that suppression is a maladaptive coping process. Furthermore, except a few outliers, suppressing negative thoughts did not lead to a 'rebound', where a participant recalled these events more vividly. Researchers believe that these results are in line with the baseline rate of vividness increase that occurred for events which were not suppressed at all.
Although participants were not asked to continue practising the technique, many of them chose to do so spontaneously. When Dr Mamat contacted the participants after three months, she found that the benefits in terms of reduced levels of depression and negative emotions, continued for all participants, but were most pronounced among those participants who continued to use the technique in their daily lives.
“The follow up was my favourite time of my entire PhD, because every day was just joyful. I didn't have a single participant who told me 'Oh, I feel bad' or 'This was useless'. I didn't prompt them or ask 'Did you find this helpful?' They were just automatically telling me how helpful they found it,” she said.
In fact, Dr Mamat recalls how one participant was so impressed by the technique that she taught her daughter and her own mother how to do it. Another reported how she had moved home just prior to the COVID pandemic and so felt very isolated during the pandemic.
As Dr Mamat recalls from her conversation with this participant, “She said this study had come exactly at the time she needed it because she was having all these negative thoughts, all these worries and anxiety about the future, and this really, really helped her. My heart literally just melted, I could feel goosebumps all over me. I said to her ‘If everyone else hated this experiment, I would not care because of how much this benefited you’!”
While the findings are interesting, Prof Anderson agrees that more research is needed, as he said that, "What we found runs counter to the accepted narrative. 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.”
