Stop the presses! Abreaction works if it is concrete

We already know that abreaction never worked. Early successes (like Anna O.) were the result of placebo insight. And the benefits of Dianetics derive solely from the human interaction; being listened to is intrinsically therapeutic.

Not only does abreaction not help, it actually hurts. First, repetitive thinking in general worsens depression. Second, all past-based psychological interventions (psychodynamic therapies) also worsen depression. Ruminating on past traumas—whether alone and compulsively or “guided” by a professional—worsens depression.


Psychodynamic therapy actually worsens depression

Antonuccio, David O. & Danton, William G. (1995). Psychotherapy Versus Medication for Depression: Challenging the Conventional Wisdom With Data.

The inefficacy of abreaction has always depressed me. I find the method appealing. It is reasonable in theory and attractive in practice—largely because it appears to be a mechanical technique.

The Dianetics model of abreaction is even more appealing. In the Dianetic simplifying model, every past experience leaves an impression composed of two separate tracks running in parallel—the perceptic track and the somatic track. By reliving the perceptual details of a past traumatic incident in the presence of a well-wishing listener, you “blow” the “charge” stored in the somatic track. A more modern interpretation would say that recounting the episode makes it malleable to reinterpretation and in present time. By recounting the details again and again, you replace the bad emotions with those you are having during the retelling—being-cared-for, the primary maternal experience of safety. Retelling an episode renders it ontologically malleable.

Over time, the episode becomes merely a series of objective facts. The painful feeling and sad meaning are replaced with equanimity.

Sounds great! Too bad studies have shown that it actually only makes things worse or does nothing at all. A great, fun, reliable, mechanical method for deleting both pain and self-defeating automatic behavior is nothing but an expensive placebo. I wish it were helpful; I’d love to actually try it.

You can imagine my delight when I found a recent article showing that abreaction does work—but only if it is a certain kind.

It turns out that there are some useful distinctions to be made within the abreaction paradigm. One them—whether the abreacting is abstract or concrete—is the pet project of Ed Watkins:

Watkins, Edward R., Baeyens, C. B. & Read, R. (2009). Concreteness training reduces dysphoria: proof-of-principle for repeated cognitive bias modification in depression. Journal of Abnormal Psychology, Vol 118(1), 55-64.

Moreover, the CBM method has recently been used to investigate whether abstract processing causally influences emotional reactivity. In one study, after a failure experience, higher levels of trait rumination were associated with lower levels of positive affect, but only for participants who previously practiced abstract processing of emotional scenarios (“think about the causes, meanings, and implications of each situation”) and not for participants who had practiced more concrete processing (“focus on how the event happened”; Moberly & Watkins, 2006). In three replications, participants who practiced focusing on imagined emotional scenarios in a more concrete way demonstrated smaller increases in negative affect following a subsequent failure compared with participants who practiced more abstract processing when focusing on the same emotional scenarios (Watkins, Moberly, & Moulds, 2008).

Things got worse for abstract abreactors, but better on those employing a Dianetics-style concern for details.