Abstract
BACKGROUND: Depression, as a globally high burden mental disorder, is closely related to individuals' psychological processing of external information in terms of cognitive biases, inadequate emotional regulation, and impaired social functioning. Literary works have gradually been incorporated into auxiliary psychological intervention tools in recent years due to their narrative structure and emotional clues that can trigger emotional resonance. However, existing research has mostly focused on the overall effectiveness of literary therapy, lacking empirical exploration of the specific mechanism of the core textual element of "character image" in regulating patients' emotions and cognition. Therefore, this study explores the influence of character images in English literary works on the cognition and psychological reactions of patients with depression, aiming to clarify the feasibility and mechanism of their use as a non pharmacological psychological intervention approach. METHODS: The study adopted a randomized controlled design and recruited 96 patients with mild to moderate depression, who were randomly divided into an experimental group of 48 and a control group of 48. The experimental group received literary text exposure of three types of character images (resilience, tragedy, and growth), while the control group read neutral texts with weaker emotional clues. The intervention period is 6 weeks, and the Self Rating Depression Scale (SDS), Emotional Stroop Task (EST), and Cognitive Reflection Test (CRT) are implemented before and after to evaluate changes in depressive symptoms, negative attention bias, and cognitive reflection ability. Research synchronous recording of reading behavior and psychophysiological data to form a comparable evaluation of intervention effectiveness. RESULTS: The experimental results show that character image traits have a significant impact on depression symptoms and cognitive processing. According to SDS, the depression level in the experimental group decreased by 27.4% after 6 weeks, significantly better than the control group's 12.1% (p<.01). In EST, exposure to resilient and growth oriented characters resulted in a decrease of about 15% in negative attentional bias, while tragic characters only decreased by 4.2% (p<.05). The CRT results indicate that growth oriented characters can increase cognitive reflection scores by 18.3%, which is better than other character types. Overall, different character images exhibit differentiated effects in improving emotions, regulating attention bias, and enhancing cognitive abilities. DISCUSSION: Research has shown that character images in literary works can serve as key psychological clues for regulating the emotions and cognitive processing of patients with depression, and have the potential for auxiliary interventions in the field of public health. Resilient and growth oriented characters are more likely to promote positive cognitive reconstruction, while tragic characters need to be applied cautiously under emotional support conditions. In the future, the sample can be expanded, brain imaging can be combined to explore its mechanism of action, and a precise literary intervention plan based on character traits can be constructed to enhance the application value of community psychological rehabilitation and digital public health services.