0:04 Have you ever noticed after a storm that everything feels okay again? The rain stops, the lightning stops, but also the cloud break. Uh but we all know that the weather will not stay like that. There will be rain again. There will be storm again. A storm is also a recurrent phenomena. I studied as a clinical psychologist and scientist over 25 years how it's possible that in depression people often also have a recurrent storm. So it's also not a one-time
0:51 storm. And I want to share with you what I discovered. So a little bit of a reality and this is what we know from science. Depression is not only very prevalent, it also loves to come back and maybe all of you know someone who have experienced a depression or maybe yourself and so it's very prevalent but loves to come back and we know already after you have experienced one episode the chance of get like old I have to say about 50% of the people will have another one and We also know if you have experienced say three or more episodes the chance of
1:39 getting a next one is 90%. So there is definitely an urgency there how to tackle this and we also know that many people do not recover fully but still have some symptomatology. For instance, you don't sleep as well as you did for your first depression. you have a bit of concentration problem and often you think of yourself I'm worthless and we know this is called partial remission that not only you have a higher risk for a recurrence but also within a couple of months and what I tried to do in the past 25 years to see how can we work on understanding to stay well after
2:26 depression but most importantly also what to do about it. So, is it very difficult or hopeless to get to long-term recovery? The good news I have, no, it is possible. However, it's not enough to feel better after uh depression. It's important to stay better. So, what factors do play a role that you can actually change? So I studied this in my intervention lab and what did we find? First of all, we found that beliefs about yourself or others or the world, we call it dysfunctional beliefs are risk factors
3:12 for relapse. What are we talking about? for instance that deep down you have the idea I'm a loser or in the end people will find out I'm not a good person or in the end people will see me as a failure and we know that these thoughts can pop up not all the time but they can pop up instantly just like a pop up on your screen and they drive your emotions. This is a risk factor. Another one is emotion regulation. What we feel during the day. And there has been a lot of research showing that if you have a lot of negative feelings and going up and down, it is a risk factors. But we discovered that also
3:58 your positive feelings and how they go up and down are indeed also a risk factor for relapse. And we do know that what you experience during the day as daily stress, for instance, having a flat tire, just a daily thing that can happen to you is a risk factor for relapse. And there's the idea about scarring literally that you get marks after an episode, after a depressive episode, just like a scar you can have on your hand and after that it still feels a bit it's a bit vulnerable. It's not the the rest like the rest of the skin. And the scarring after an episode could be psychologically or also
4:44 neurobiologically for instance in the brain. And what did we find out? H on this one, I have to say mixed evidence that you indeed get a scar every time after an episode and thereby you're more you're more vulnerable to get a next episode. So what you could say, we do not really know whether this indeed is the case, but what we do know how to disrupt the rhythm of depression. I worked on a psychological intervention that is specifically designed to target these risk factors. So what you can do about it to change it and it is only
5:31 eight sessions and you can you get it at the moment that people are completely recovered or partially recovered and you can do it in 8 weeks and this by the way needs to be given by licensed psychologists or psychiatrists that are trained to do this. We call this preventive cognitive therapy specifically to prevent relapse. So what are the ingredients? Now it focuses on these beliefs like that you deep down think I'm a loser. It's not all the time there when you're feeling good but it's a pop up if things happened or that you deep down have the idea I'm born to be unlucky. So we focus with specific techniques
6:19 to challenge these beliefs. Actually people learn this themselves and thereby we activate positive networks. Actually we use fantasy. Another ingredient is that you get a brain training to better encode and also recall all kind of positive experiences you have even positive feelings. And this is actually quite simple intervention. Uh people can easily learn this and we know this improves for the future your emotion regulation but also problem solving when you're having challenges in life. And we create a personalized prevention plan. So then you know what to do to stay well but also when you're
7:08 sort of going down a bit. Now you could say what's the evidence indeed of course we studied whether it does any good. So in my intervention lab at Amsterdam we studied the effect in a lot of randomized control trials and what we do in these trials based on chance. People who were remitted or partially remitted got preventive cognitive therapy eight times 8 weeks or they got for instance treatment as usual and later on I talk about people who got anti-depressants and what did we find in all these studies we found substantial lower relapse risks risks up to two
7:54 years so that's nice and most importantly especially for the people that actually needed the most individuals who have more episodes because that's a risk factor. Within the team, we also examined how enduring is the effect, what is the long-term effect, and we followed people up that receive preventive cognitive therapy or based on chance didn't get it. And we found effects up to 20 years. So, they were better protected against relapse. For instance, the uh percentage of fewer relapses was 53%. Which is substantial. And importantly also if
8:40 people had have a relapse, it took far more longer almost 5 years versus already within 1.6 years. And you could think, yeah, but if you still have a relapse, does it do any good? But this can be the difference between whether or not you can return to work or finalize your courses or maybe have a stable a stable relationship or not. So how about anti-depressants? And actually this question was one of my patients said okay there is something that is promising to prevent relapse but is it good for me then to stop the anti-depressants or is it better to add
9:28 this to anti-depressants and why this was such a good question because most of the people that get treatment for depression worldwide still get anti-depressants but also to prevent relapse. So they take anti-depressants years and years to make sure that they do not relapse. Um so what I managed to do is actually to do a three arm randomized control trial. This is lots of talk just to explain. Let's first check if you're continuing the anti-depressant to prevent relapse and you add preventive cognitive therapy based on chance. Do you have a better prognosis? Do you have a lower relapse
10:15 risk? And indeed, we found, and that's the lower green line, that there is a 41% risk reduction over 2 years for those who got the combination. So, it's clear even after remission on top of anti-depressants, it's superior to get both. And this is only 8 weeks and you're done. But then people ask me, "Yeah, but can I stop my anti-depressants?" So we also examined this. So we compared continuation of anti-depressants to with guidance of psychiatrists and and general practitioners stopping the anti-depressants and getting only preventive cognitive therapy. And what did we find? There's no difference. What
11:03 does this say? If you it's superior to do the combination on top of anti-depressants. But if you really insist on stopping anti-depressants, do it with a doctor and then it's wise to get preventive cognitive therapy because then your relapse risk over two years is not higher. Okay. And now you might wonder but what changes with preventive cognitive therapy? Do indeed these risk factors change? And we studied this in the last 25 years. And what did we find? Indeed, preventive cognitive therapy targets cognitive beliefs. And thereby we can explain part of the effect but not all of it. We also found part of the effect
11:50 explained by that individuals that got it are better in dealing with daily stress. Hey, that's important because it's a risk factor. And in addition, we conducted in collaboration with a neuroscientist a brain study and we found that those who got preventive cognitive therapy improved their positive emotion regulation and thereby the negative emotion regulation and also an impact on their beliefs was there. So we do find on all these risk factors that it does change with preventive cognitive therapy and this was compared to people who based on chance got treatment as usual. So some indications there that there is
12:38 hope. You might wonder does this work for everyone? And we did a lot of work and thanks to many collaborating partners in the world to bring all individual data of people who collaborated on these studies of people that had have uh depressive episodes and what did we find out? It's actually very simple outcome. It does work for people with very different characteristics but also for those who have uh for instance more severe depressions or a longer or shorter depression. We didn't test it in bipolar depression so-called manic depression but in uniolar depression we do find good effects.
13:23 So and what are we working on now? Maybe this might also work for anxiety disorders. And now we're testing this in young people that not only had have depressive disorders but also anxiety disorders and we created a supermarket of digital interventions. Now we're not going to share this in the world because first we want to see is it bulletproof? Does it really work? So in essence with preventive cognitive therapy, we're one to help people to move beyond surviving depression. It's about staying well, giving the tool to to detect yourself early changes to take preventive action and to keep
14:08 recovery strong over time. And importantly, the individual gets the tool him or herself. And the deeper lesson is actually it's not about avoiding depression. It's about learning how to stay well every day and not only at the moment you feel down. The good news is it's not hopeless. It's very doable to do. There have been many many individuals that actually already got preventive cognitive therapy in the world. It's actually effective not only on look shortterm also long term and if you're interested you can approach a psychologist or a general practitioner or psychiatrist because
14:55 it's now available in many languages. So back to the weather and the storm and the recurrency. Of course we cannot control the weather. We cannot control the rain, but we can choose to to to maybe get an umbrella, right? That's something we can do. And if there's a storm, we could think on forehand about how about that we build a shelter so that I'm safe. And in fact, when we working on disrupting the rhythm of depression, it's sort of a shelter. And that's something people can do themselves with help of preventive
15:40 cognitive therapy. I thank you for your attention.
