“It's safer to believe that others don't like me” – A qualitative study on the paradoxical value of negative core beliefs in depression

Depression is related to difficulty revising established negative self-beliefs in response to novel positive experiences. This propensity is in some way paradoxical because negative beliefs usually have many obvious negative consequences for the individual (e.g., feeling upset). Using a qualitative approach, the present study sought to explore what makes such negative self-beliefs valuable from the patients' perspectives. In 14 patients with major depression, we conducted semi-structured interviews that explored the perceived benefits of retaining an individually specified negative core belief as well as the perceived costs of changing it. In a deductive-inductive approach based on a recent theoretical model of the value of beliefs, we found eight themes that may explain why people with depression uphold negative beliefs (intercoder agreement: κ = .81): expectation management, certainty and control, avoiding cognitive dissonance, adaptivity in the past, protection of higher values, attachment and belonging, saving resources, short-term counterevidence. The two most frequently mentioned themes were that retaining negative beliefs helps patients sustain certainty and keep expectations low to prevent future disappointments. While previous research has advanced the understanding of how (i.e., through which mechanisms) people with depression maintain negative self-beliefs, the present study provides novel insights into why they do so.