A New Treatment for Depression
For six months, clinical psychologist Jennice Vilhauer, Ph.D, had been working with a man who was struggling with depression. He was having a hard time shifting his negative thinking, and kept talking about his bleak circumstances. In one session, Vilhauer asked him: “So where is the light at the end of the tunnel?”
He looked at her with a blank stare and admitted there wasn’t one.
“Well no wonder you’re depressed. Your life is awful, and you can’t see any way it is going to get better,” she said.
“But I don’t know how to change my life,” he told her.
“Well, from now on, the course of our work together is going to be creating that light at the end of the tunnel,” she said.
A year later Vilhauer’s client transformed his life, leaving his dead-end job to build a successful business.
Vilhauer recounts this story in her book Think Forward to Thrive: How to Use the Mind’s Power of Anticipation to Transcend Your Past and Transform Your Life.
She began asking her other clients about the light at the end of the tunnel, and was surprised to find many of them didn’t see one either. “Most of them didn’t know how to change their future, and many of them didn’t even believe it was possible,” she writes in her book.
This inspired Vilhauer to start searching the psychology research for information on future thinking and eventually create Future-Directed Therapy (FDT). FDT helps people with depression create positive expectations about their future and then take action to achieve their goals, leading them to thrive and have a greater sense of well-being.
FDT is best for mild to moderate depression and for people who struggle with motivation and have been stuck for a while, said Vilhauer, assistant professor at the Emory University School of Medicine and the Director of the Outpatient Psychotherapy Program at the Emory Clinic.
FDT is based on the understanding that the brain is anticipatory in nature, she said. “We are constantly evaluating our experiences based on what we expect those situations to mean for us as we go forward in life.”
People use past experiences to predict the future. They generally take actions consistent with their expectations, not with their goals or desires, she said. Many of us don’t even realize that our negative expectations are what lead to negative outcomes by creating self-fulfilling prophecies, Vilhauer said.
She shared this example: If a person wants a meaningful relationship, but believes their past relationships have been failures, they likely hold the expectation that a new relationship will fail again, too. As they begin a new relationship they might be sensitive to any signs that it’ll go bad, and quickly break it off after a conflict, as opposed to trying to work through the problem. Another relationship ends, and then reinforces the person’s expectation that they’re not good at relationships.
In FDT the therapist would help this person recognize the problem and change their expectations to align more with what they want, such as a successful relationship, she said. “Then the client would work on identifying the obstacles to their goal and create a plan for how to achieve it.”
FDT focuses on what people would like to achieve instead of what they don’t want in their lives. People with depression often focus an inordinate amount of their thoughts on what they don’t want in life, she said. “We can only think a certain number of thoughts or actions. If the majority of your thoughts and actions are about the things you don’t want, you’ll end up with a life you don’t want.”
She explains to her clients that our thoughts and actions are limited resources like money: We don’t go to the store and spend all our money on items we don’t want, and yet that is what many people do with their thinking.
Thinking about what we want activates positive emotions along with mental functions that boost your ability to achieve your aspirations.
As she writes in Think Forward to Thrive, “Whenever you think about your desired future state, several solution-generating, problem-solving mechanisms in your brain kick into gear. However, when you focus on what you don’t want and you experience the resulting negative emotions, this inhibits the area of your brain responsible for these functions from working properly.”
FDT is generally taught in a classroom type group setting. It is a 20-session treatment that lasts 10 weeks. Clients attend the class twice a week for 90-minute sessions. The first session focuses on teaching skills. The second session focuses on applying those skills to the person’s daily life. Clients also can learn FDT skills in a one-on-one setting with an individual therapist.
FDT is divided into two phases. The first five weeks focus on the cognitive process. This phase “teaches people how their thoughts directly create their future experiences,” Vilhauer said. The second half of treatment focuses on taking action — “implementing the changes they’ve made in their thinking.” This phase also teaches people specific skills, goal-setting and problem-solving, she said.
A common misconception about FDT is that it’s all about positive thinking. According to Vilhauer, FDT is “about teaching people how to think effectively about the experiences they’re trying to achieve in life so they can create more positive experiences for themselves.”
That’s because when your thoughts focus on achieving a goal — and things are going well — you’re far more likely to engage in actions that’ll lead to that behavior, she said.
“I like people to realize that they don’t have to be limited by their past experiences,” Vilhauer said. She includes this quote from Joseph Nuttin in her book: “It is far more important for man to know whom he wants to become than who he is now.”
Future-Directed Therapy helps people with depression discover who they want to be and teaches them the steps to get there. In other words, it helps them find and move toward the light at the end of the tunnel.
This page includes two studies conducted by Vilhauer and her team on FDT’s effectiveness.
This book examines the future-oriented nature of our brains.
This article explores the evidence that people are driven by the future.
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Tartakovsky, M. (2018). A New Treatment for Depression. Psych Central. Retrieved on September 26, 2020, from https://psychcentral.com/lib/a-new-treatment-for-depression/