Shortly after her youngest daughter was born, in 2000, Mary experienced her first serious depression. “I was living in Ireland and was having all these really repetitive negative thoughts,” she recalled. “I just felt like I should disappear. That I was useless.” After going on Prozac, Mary (names have been changed) recovered, but over the years she found herself vulnerable to periods of dark thought.
Analytical by nature, Mary read up on depression and made an effort to talk about it with her daughters, Ellen, now 15, and Laura, 14. Though Laura had a sunny disposition, Mary fretted about Ellen, who was sensitive and moody. “She’s always been a worrier,” Mary recalled. “Even when she was tiny, buckled up in her car seat, she’d ask, ‘Do you have your keys? Do we have enough gas?’”
The girls' bias for noticing sad faces had completely disappeared. They also had lower heart rates and cortisol levels—signs that they were experiencing less physiological stress.
Mary had reason to be concerned. Children whose mothers have had clinical depression are at higher risk of developing depression themselves, and girls are considered to be particularly vulnerable; one study has found that more than half of girls with depressed mothers will go on to develop depression themselves.
When Ellen was eight, Mary and her husband, who by then had moved to the Bay Area, separated. Though Ellen had always been reserved, she withdrew even further. “She wasn’t finding a lot of pleasure in stuff,” Mary said. “She took it so hard.” In her reading, Mary came across an ad recruiting girls for a research study focused on preventing depression in the daughters of depressed mothers. She talked with Ellen, who agreed to sign up. “I wanted to do whatever I could to keep her from going through the same thing,” Mary said.
The study was run by Ian Gotlib, the chair of Stanford’s psychology department, who has spent the past 30 years studying the mechanisms that drive depression. Genetics and environment are the best known of these, but Gotlib was hoping to explore a different question: Does a girl’s risk of developing depression depend on what she pays attention to?
At 63, Gotlib is slightly built, with a long, kindly face that makes him resemble Henry Winkler. His office is tidy and spare, uncluttered in a way that seems to reflect the orderliness of his own thoughts. Gotlib’s interest in attention grew out of an odd phenomenon he’d observed: that girls at higher risk of depression tend to focus on sad faces rather than on happy ones. (Typically, people do the opposite.)
This attentional bias toward unhappy images was significant, Gotlib thought. While the girls’ focus on sad faces wasn’t something they were doing consciously, its cumulative effect over years might be discouraging. By registering fewer happy expressions, Gotlib theorized, the at-risk girls would end up with a biased sense of how dark the world actually was.
By itself, this was not a new idea. Almost 50 years ago, scientists recognized that depressed people experienced the world through a powerful filter: While bad news (unhappy faces, a discouraging message) resonated forcefully, happy news hardly seemed to register. Depressed people were also prone to assuming the worst, gravitating toward dark possibilities even in ordinary situations—a tendency known as interpretational bias. (Shown the word growth, depressed people more readily associated it with cancer than with a simple increase in size.)
Because these biases were so instinctive, psychologists theorized, they acted as a kind of flywheel that reinforced depressive tendencies. One study found that college students with a negative attentional bias were up to seven times more likely to develop major depression at some point.
Gotlib’s theory was that a girl’s risk might go down if her attentional bias could be reprogrammed. He devised a simple experiment to see if it was possible to change how the girls habitually saw the world, by retraining what they noticed.
To start, each girl was given a laptop programmed to flash pairs of faces with different expressions, which might be happy, sad, or something more neutral. After the faces had been displayed for a second, a dot would appear where one of the faces had been. The instant the girls spotted the dot, they hit a key on the corresponding side.
One study has found that almost 60 percent of girls with depressed mothers will go on to develop depression themselves.
When the dots were programmed to appear randomly, the test enabled Gotlib to measure each girl’s attentional bias by comparing how quickly she reacted: A girl who is already looking at the sad face will respond faster when a dot appears in the same location.
Next, Gotlib covertly programmed the laptops so that the dot would appear only under the happy or neutral faces, then sent the girls home to practice for a week. During this time, the girls unconsciously shifted their attention to the happy and neutral faces, where the dot was more likely to appear.
By the end of the week the girls’ bias for noticing sad faces had completely disappeared. They also had lower heart rates and cortisol levels—signs that they were experiencing less physiological stress.
Gotlib plans to follow the group for at least five years, to determine whether the training ultimately helps protect the girls from developing depression in late adolescence and adulthood. These kinds of attention-shifting exercises have already been shown to help adults with anxiety disorders, and while that’s been less true for depression, Gotlib believes that such interventions may prove more effective if started early. He also recently began a study aimed at addressing interpretation bias in depressed teens using exercises that nudge the kids away from negative assumptions. Ultimately, he envisions a day when such exercises would be available via a phone app—one that could quickly test for cognitive bias, then offer a variety of programs to help people change what they notice or how they react.
For now, at least, Mary reports that Ellen is doing well. She plays soccer, gets good grades, and has a close circle of friends. “She’s a lovely person,” Mary says. “Authentic, funny, and thoughtful. She’s still a teenager, but in general, I’d say she’s really happy.”
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