The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time

by Alex Korb

When people with depression were told they were going to be shown negative pictures, they had more activation in the insula and the ventrolateral prefrontal cortex, indicating more visceral and emotional processing than nondepressed people would have.27 Surprisingly, when they weren’t told about the type of picture, their brains still reacted as if expecting a negative picture. In the face of uncertainty, their brains assumed the worst. On top of that, when they were uncertain, depressed people also had more worried dorsolateral prefrontal activity, as well as more self-focused emotional processing in the medial prefrontal cortex. This response to uncertainty can explain why people with depression are more likely to be pessimistic—the past was negative, so the future must be too.28