Rumination, cognitive control deficits, cognitive saturation, and loss of inhibition are the major hypotheses used to explain depressive disorders. A few studies have nevertheless looked at the form of thought. In this study, we will test a double measurement of the number of thoughts and a double measurement of the flow of thought together with their correlation with well-being, mental pain, and depression.

Between May and September 2015, 68 subjects, initially admitted as emergencies for acute anxiety depressive disorders and/or suicide attempts and subsequently monitored as post-emergency outpatients in medico-psychological consultations agreed to complete a set of Visual Analogue Scales measuring their well-being, their mental pain, their estimated number of thoughts and the how agitated these thoughts are estimated to be. A double evaluation of the cognitive activity consisted of representation intrusive thoughts by filling a drawing of an aquarium to reflect the number of thoughts (by drawing fish) and cognitive turmoil (by drawing wavy lines). The depressive illness was evaluated using the Beck depression inventory and by rater-administered assessments using MADRS (Montgomery-Asberg Depression Scale).

These measurements are of good psychometric quality (sensitivity, accuracy, validity). The mental pain is related to mental turmoil. These results reveal positive correlations between the mental turmoil and the total score on the depression. The use of the aquarium makes it possible to distinguish the feeling of having “a lot of thoughts” from the feeling of having “agitated thoughts”. So, the total score of wavy lines shows positive correlation with the total score on the depression inventory (BDI) and the total MADRS score.

The results suggest that the phenomena of cognitive saturation and the sensation of mental restlessness play a major role in the etiopathogensis of depression. The analyses show that the cognitive dysregulation is situated more precisely at the level of the flow of thought rather than the level of the number of thoughts. A deterioration in the flow of thought increases the mental pain and the depressive symptoms, and reduces well-being. The sample is nevertheless small, and some bias appears in the filling of the aquarium boxes.