Participant characteristics

Nineteen participants (16 females) aged 16–19 years (mean = 18.2, standard deviation; SD = 1.2) were recruited in the UK. Eight (42%) participants were White, five (26%) were Asian/Asian British, four (21%) were Black/Black British, and two (11%) were mixed race. Thirteen (68%) participants had a clinical diagnosis of depression and/or an anxiety disorder, and six (32%) had subclinical self-reported symptoms. The time between the first depression/anxiety episode and the interview ranged from 6 months to 6 years (mean = 3.1, SD = 1.9). The demographic characteristics of participants are presented in Table 2.

Table 2 The demographic characteristics of participants

Five domains were identified: domain one, the impact of mood on the future thinking capability; domain two, the impact of mood on images, thoughts, and feelings about the future; domain three, social influences; domain four, reflections on personal worries and expectations about the future; and domain five, personal coping. Each of them includes two to four themes (for a list of themes, see Table 3).

Table 3 Overview of the coding structureDomain 1: The impact of mood on the future thinking capability

The concept of Capability refers to the quality of being able to think about the future. It includes the cognitive ability to engage in future thinking and the willingness and motivation to proactively think and plan for the future. Two themes were identified: varied ability and motivation and stuck in the past (see Table 4).

Table 4 Themes and quotes of ‘The impact of mood on the future thinking capability’ during poor mental health and well stateVaried ability and motivation

Participants frequently talked about a lack of physical and mental capacity to think about the future when they were depressed and/or anxious. Some attributed it to being focused on and overwhelmed by what was going on at the time, leaving no ‘space’ to think about the future at all.

“I was feeling like I couldn't go on any longer, cause it's feeling too low, too down. I was struggling so much that I couldn't think about the future. I knew the future was there, but I couldn't get out of the bubble.” [01; male, 18, clinical depression and anxiety]

Others avoided thinking about the future, as they feared it would further worsen their mental health.

“I would avoid thinking about it, because it would, one, make me more stressed, and two, make me more sad.” [06; female, 19, subclinical depression and anxiety]

Some participants also described the time of poor mental health as ‘passive living’, in ‘autopilot mode’ and ‘zombie working’, where they followed routines and worked on what had to be done, without considering the consequences of their actions in the future.

“I physically and emotionally couldn't imagine anything beyond. … It was more of a day-by-day thing, so it wasn't like five years into the future, not even a year, just literally taking each day at a time and trying to hold onto something each day.” [16; female, 19, clinical depression]

Stuck in the past

During the poor mental health state, adolescents reported dwelling upon the past more than the future. They tended to think more about the events that had happened, especially those with negative consequences, such as their past mistakes. The future was often less considered or not thought about at all.

“Whenever I thought about the future back then, it was never good. … What I thought would be only getting worse, never getting better. I would dwell upon the past; as for the future back then, I didn't even have an image.” [04; female, 16, clinical depression and anxiety]

During the well state, adolescents were more future-oriented and thought more about the future than the past. A few participants generally became more reflective and introspective and thought more about both the past and the future.

“I’ve learned that, forget about the past and move forward. I don't pay attention to what has happened because that's gone. You need to be thinking about tomorrow.” [01; male, 18, clinical depression and anxiety]

“I try to focus more on the future, but I also remember the past. The past has made me the person that I am.” [10; female, 19, clinical PTSD]

Domain 2: The impact of mood on images, thoughts, and feelings about the future

This domain captures the images, thoughts, reflections, and feelings adolescents had about the future and includes four themes: valence, vividness, agency and structure (see Table 5).

Table 5 Themes and quotes of ‘The impact of mood on images, thoughts, and feelings about the future’ during poor mental health and well stateValence

During poor mental health states, adolescents’ future thinking was predominantly negative. Participants reflected that when they had been depressed and anxious, they had been irrationally negative about the future, afraid of academic failure, failing their own and others’ expectations and never feeling good enough.

“Mainly negative, I don't remember thinking anything positive.” [05; female, 19, clinical depression and anxiety]

During the well state, adolescents were generally hopeful for the future. They believed their expectations and hopes for the future would come true.

“I used to think that the future will also be bad. So like goals, targets, I never used to have those, just living for the moment. But right now, I've set up goals and targets, and I'm actually hopeful for the future and how it will be.” [02; female, 19, subclinical depression and anxiety]

Vividness

During the poor mental health states, participants described a disconnection with their positive future selves. Some were unable to visualise the future at all. Others described it in terms of ‘black, blank and blurry’ images. In contrast, they had vivid images of a negative future self and their fears and worries about the future were described in rich detail, which even felt like reality.

“Cause I was so negative being in depression, it just became like there was no light at the end of the tunnel. It was so blurred in the whole process that I couldn't think what am I moving towards?” [01; male, 18, clinical depression and anxiety]

“I could see myself just not having done well, coming back home and having to answer questions, just staying in my room and crying, because I couldn’t do it. It was more vivid than other images of the future.” [08; female, 19, clinical depression]

During the well state, adolescents saw their future in more detail and specificity and described more connections to a positive future self. They were able to generate clear images of a future self and speculate their future targets and plans to achieve them.

“I've got a lot of things that I look forward to. I'm always thinking one step ahead, about third year, and what speciality, what skills.” [05; female, 19, clinical depression and anxiety]

Agency

During poor mental health states, some participants described a lack of agency, where they did not feel in control of their future or their negative feelings. Some described it as being externally controlled, for instance, ‘a ghost or spiritual curse’, ‘a religious punishment’, and ‘a monster in my head’.

“Interviewer: Do you think you have control over the future?

Participant: No, not at all. … I felt like there was a huge lack of control, and I felt that in terms of every aspect. … That lack of control was the most frustrating part because it's dehumanising in a way. Every aspect of life, like appetite, sleeping, friends, walking, was affected.” [19; female, 19, clinical depression and anxiety]

In contrast, in the well state, adolescents felt more control of their future and automatic negative thoughts. They became more flexible with planning for the future and accepted that some of it was beyond their control. They were also able to see a longer-term and larger-scale future instead of overthinking the small things right in front of them. They used evidence and scientific thinking to combat worries and were able to distinguish perception from reality.

“I can't think of anything else that would play a bigger part than my own choices and my own vision.” [08; female, 19, clinical depression]

Structure

When thinking about the fears and worries for the future during the poor mental health state, participants described ruminating on and being with their thoughts in negative cycles. They worried that a single negative event would lead to a series of subsequent events or something even worse (serial thinking). They also felt negativity would be enduring while positivity was only temporary by constantly playing down their achievements and successes.

“I felt so out of control with my emotions that I felt like it was going to be like that forever. I would think, I've been like this for a month and a half, it's never gonna end, I'm gonna continue like this for the rest of my life.” [06; female, 19, subclinical depression and anxiety]

When well, some participants were able to shift their focus from negative fixated thoughts about minor details. This allowed them to let go of the negativities and regrets and free themselves from the vicious cycle of being caught up in rumination. Some described this as ‘feeling more focused again on what’s important’.

“I used to be so focused on overthinking the thing that was gonna come up. Now I can look at more things, at the bigger picture, so my whole life perspective, sequencing and timeline.” [05; female, 19, clinical depression and anxiety]

Domain 3: Social influences

The Social influences domain refers to the direct and indirect influences from young people’s family and peers on their future thinking. The social context has both negative and positive influences on participants’ future thinking. This domain includes two themes: social pressure and support from friends and peers, and pressure from parents and financial hardship (Table 6).

Table 6 Themes and quotes of ‘Social influences’Social pressure and support from friends and peers

Talking about the future with friends and peers could bring fear and anxiety. Social pressures could exacerbate the anxiety about one’s future.

“There are those people who believe in you, and they believe you can really do it, but as always, we have people who’re so negative and they discourage you in everything. … Why do you think you are special? People failed before, why would you succeed?” [11; male, 18, clinical depression and PTSD]

However, the influences from friends and peers were described positively as well. Engaging other people in thinking about the future provided encouragement and inspiration and brought hope and excitement. Participants talked about having seen people close to them recover from depression and achieve their hoped-for future through hard work, which helped them feel more optimistic. Social support throughout depressive/anxiety periods also brought hope about the future.

“It’s a good inspiration, when I saw that person got out of depression, worked hard and succeeded, it motivated me to concentrate in my dreams and goals, and just stop getting sad most of the time. So I thought even my life can be that way. I had a more optimistic way of thinking.” [02; female, 19, subclinical depression and anxiety]

Pressure from parents and financial hardship

Family and parents made future thinking stressful for adolescents when the future they wanted for themselves deviated from the one their parents wanted them to have. This also made adolescents feel they lacked control over their future.

“My education wise, at that time, they [my parents] were making all my decisions for me. That’s why I felt like I had zero control of my future, and that whole thought process would spiral in my head all the time. I wouldn’t have considered [the future], because everything was done, all the decisions were made.” [04; female, 16, clinical depression and anxiety]

Growing up in a socioeconomically disadvantaged household also created more pressure to think about the future, as these adolescents had to plan how to create a more positive future for themselves.

“I think what worries me is money, if I’m not able to get a good job, to pay off my bills, to live the expectations of life I’m looking forward to, because I haven’t had that in life, I come from a deprived neighbourhood. I don’t wanna be on benefits. I wanna do something in life, I hope that it is a positive future ahead for myself.” [01; male, 18, clinical depression and anxiety]

Domain 4: Reflections on personal worries and expectations about the future

This domain captures participants’ reflections and interpretations about their past worries and hopes, and how different styles of future thinking affected their mood. It includes two themes: the impact of Future thinking on mood; and optimism, pessimism, and future expectations (Table 7).

Table 7 Themes and quotes of ‘Reflections on personal worries and expectations about the future’The impact of future thinking on mood

Although the relationship between future thinking and mood can be bi-directional, participants said that there was a stronger impact of future thinking on mood than the other way around. However, the relationship was not straightforward. Future thinking could cause negativity and anxiety when they were in a depressed/anxious state, and even thinking positively about the future did not improve their mood. However, the participant who engaged in future thinking as a strategy to remain hopeful recalled it having a positive impact [19]. In the well state, there was generally less influence of future thinking on adolescents’ mood, as one participant said:

“I can think a lot further into the future without getting upset, and I guess I let myself have fun imagining things.” [18; female, 16, clinical mixed depression and anxiety episodes].

Optimism, pessimism, and future expectations

When reflecting on periods of depression and anxiety, participants talked about how surprised they were when their ‘unrealistic’ positive expectations came true, and how worries they firmly believed would come true did not. Participants looked back at how they had underestimated their possible future achievements and overestimated the chance of failure:

“Initially I thought I’d do really bad in my GCSEs, and that didn’t really come true. I thought I’d probably do quite bad in my A-levels, and I did better than I thought I would. And I thought I’d get to university, but I’ve done better than I thought I would.” [05; female, 19, clinical depression and anxiety].

They also reflected on over-worrying and overthinking in general and how they subsequently learnt from these reflections to combat current worries and fears. They became more conscious and aware that they may have exaggerated their chance of failure. As a result, they were able to identify over-worrying more sensitively and challenge those thoughts with past experiences:

“I’d tell myself that, looking back, I had nothing to worry about, it was all self-inflicted.” [04; female, 16, clinical depression and anxiety]

“I think that right now, I’m doing a lot better, and I’m seeing it like a learning experience because now I look back at it, I can analyse myself the way I felt, in order for me to avoid going back to that hole in the future.” [06; female, 19, subclinical depression and anxiety]

Domain 5: Personal coping

Personal coping refers to how young people cope with the negative emotions that come with future thinking. It includes two themes: engaging in future thinking as a strategy to combat depression; and scientific thinking, to challenge perception with evidence (Table 8).

Table 8 Themes and quotes of ‘Personal coping’Engaging in future thinking as a strategy to combat depression

When comparing future thinking during the poor mental health and well states, participants talked about being able to focus more on the future and less on worries and fears during well periods. They could plan the future more flexibly and look at the bigger picture instead of fixating on recurring negative thoughts, being rigid about set plans and rejecting the alternatives. They also acknowledged that some things were out of their control and allowed for more freedom visions for the future.

“I realise how things can change in an instant, and it does impact how I think about the future in that, I try not to be as rigid with ‘this must happen, if I don’t get this job, I’m not going to be happy’. It also makes me realise that things happen and we don’t have that much control over them.” [07; female, 19, clinical anxiety]

Alongside diverting the focus from the past to the future, there was also more focus on the present, enjoying the moment, taking things slowly, emphasising the process more than the outcome, and a generally more flexible approach to planning what they wanted to achieve.

“It has allowed me to take things slow and not want to rush to get to a specific place. … Before, I would get more stressed if I didn’t get specific things done on time. Now I’m a lot calmer about it.” [06; female, 19, subclinical depression and anxiety]

Among the 19 participants interviewed, one participant [09; male, age 16, subclinical depression and anxiety symptoms] stood out. Unlike the other adolescents who lost the motivation and capability to think about their personal future when depressed, he actively engaged in future thinking as a strategy to deal with his depressive symptoms and had vivid imagery of his future self throughout poor mental health periods.

“There's a song, by BTS called Pied Piper. … So during my really depressing period, I would just listen to that song, and it kept me going. Even if I felt bad now, I knew it would end so that I could get into that future state. … So me thinking about bad stuff from the past or from now, I thought about the future to counteract it, to give me hope in that times.”

Whilst other participants described a disconnection with a positive future self and an inability to visualise images of the future self, he had worked to create a detailed and positive future outlook during poor mental health periods. He intentionally engaged in future thinking, especially the pictures of a positive hoped-for future self, to protect himself against low mood and improve his motivation and confidence to achieve the ideal future self.

“The detail of me being a mathematician in the future is extremely detailed. It’s me in front of a blackboard, with my hot chocolate and marshmallows, drinking, doing the problem on the board, just thinking really hard.”

Scientific thinking to challenge perception with evidence

Participants also actively used strategies to manage and combat automatic negative thoughts by facing and dealing with them rather than avoiding them. Participants talked about engaging in scientific thinking, by challenging their perception with evidence rather than falling into the ruminative cycle.

“I’m much better at analysing these thoughts and thinking, do they make sense? Are they logical or are they just something I don’t really need to worry about and I need to distract myself from?” [18; female, 16, clinical mixed depression and anxiety episodes]

It should be noted that adolescents in this study had either depression and/or anxiety symptoms, or both, in the past. Although the study did not set out to distinguish between the two, one participant explicitly commented on the distinct impact that depression and anxiety had on her [19; female, 19, clinical depression and generalised anxiety disorder]. She described not thinking about the future at all during depression, while anxiety being the opposite, overthinking and overanalysing the future:

“So for depression, it’s avoidance, denial to see the future; and anxiety, it’s overanalysing, overthinking and also irrational thoughts. Depression is very different in the way that the future is not even a consideration; anxiety is the polar opposite, it’s on your mind, it’s intrusive, it’s over control, like overpowering.”