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Rumination

Rumination

What is Rumination?

Most people can relate to something getting stuck in their head and thinking about it for longer than they’d like; a thought, a song, an idea…. When it’s a song, we call it an ear worm, and for the most part it’s a pleasant experience. When it’s a thought, particularly a distressing negative one, it’s a far less pleasant experience called rumination. Rumination is defined as engaging in a repetitive negative thought process that loops continuously in the mind without end or completion. The pattern can be distressing, difficult to stop, and unusually involves repeating a negative thought or trying to solve an evasive problem. It can look like worrying about a future event, replaying a past scenario or trying to predict how something will play out. Sometimes it’s just turning the same thought in circles without much variation. Because the act of rumination tends to consume a lot of time and emotional energy, it can have serious consequences for one’s mental health.

Rumination is one of the co-occurring symptoms found both in anxiety disorders and depression. It is often a primary symptom in Obsessive-compulsive Disorder (OCD) and Generalized Anxiety Disorder. When people are depressed, the themes of rumination are typically about being inadequate or worthless. When rumination has a more anxiety-based theme, people tend to get stuck because the thoughts encourage the pursuit of answers to unanswerable questions and truths to unknowable truths.

Why do People Ruminate?

In the context of OCD, rumination is a compulsion. A compulsion, by definition, is intended to reduce the distress caused by an unwanted, intrusive thought or obsession. Compulsions may help reduce distress in the short-term, but often serve to maintain the OCD in the long-term.  Rumination is often misunderstood and evades being identified as a compulsion because people erroneously think that compulsions need to be actions or behaviors that are observable, such as washing hands or retracing steps. Rumination, on the other hand is a mental compulsion, and it is unobservable to others since it is entirely an internal process. So for example, if someone has contamination OCD, and they have an intrusive thought that something is dirty, their compulsion might be to wash their hands repeatedly (an observable action). Conversely, if someone has OCD with existential themes and has an intrusive thought about life being meaningless, their compulsion might be rumination and would sound like “how do I find more meaning if nothing has any purpose? If nothing is meaningful, then why do anything at all? Why are we even really alive?” (Unobservable internal process). Both are compulsions that start as a response to an intrusive thought and serve as a means to try to “solve” the problem presented by that intrusive thought.

In addition, sometimes the rumination feels out of control, like it is just occurring, but, by definition, it is a behavior or action that is being done by the person ruminating.  This is helpful information when it comes to treating rumination and ultimately reducing it.  Despite it’s design to solve a problem, ultimately, rumination becomes a problem to be solved in its own right, since extracting oneself from a compulsion can be very challenging.

People who ruminate will often report that they do not realize they are doing so until a considerable amount of time has passed, and they are uncomfortably far down the rabbit’s hole. Because rumination is an internal mental compulsion without outward observable behaviors, it can be a little difficult to diagnose and treat since it requires a fair amount of insight and awareness of the person who is engaging in it. This presents some challenges for treatment. A skilled therapist can help you identify the behavior as rumination and teach you skills to reduce it.

What to do if you Ruminate?

Awareness and willingness are key components in getting off the merry go round of rumination. Treating rumination in or out of the context of OCD is very possible and easier than one might think. The key element is recognizing the difference between “having a thought” and “actively thinking”. A thought (wanted or not) is a finite thing, a singular moment in time. On the other hand, actively thinking (rumination) is taking that thought and analyzing it, turning it over in the mind and over engaging with it. Put another way, pretend a thought is a can of paint. One can see it, notice it and still chose to walk past it, or one can see it, be intrigued about what color it is, wonder what it will look like on the wall, open it and start applying to the wall (that’s active engagement). A thought can exist in the mind without one choosing to actively think about it. One can see the paint, can hold in their mind some curiosities, but walk past it and chose to divert attention to something else.

STEPS IN DECREASING RUMINATION:

1) Identify the theme(s) of ruminative thoughts (let’s say it’s social anxiety concerns).

2) Catch the theme(s) quicker- accept that it’s an unknowable answer, a problem that you choose not to try to solve, and that solving it has not helped you but maintained your anxiety (i.e., “This is a familiar pattern; I tend to over analyze past social situations. I can’t possibly know what someone else was thinking so it’s not helpful to keeping replaying this”).

3) Recognize rumination is NOT problem-solving. Problem-solving and planning are active coping strategies, while rumination involves rethinking situations, analyzing them, and replaying them without forming an action plan or feeling a sense of resolution. If you felt resolution, you would not have to keep ruminating on the same theme. Rumination falsely gives you a sense of relief for a short time because it makes you believe you are preparing or doing something productive, but we know this is not true in the long run.

4) Distract to derail the thought process and occupy the mind elsewhere. If one’s mind is busy doing something else, it’s less likely to ruminate. It won’t divert itself, however; a person will need to make a conscious choice to redirect the thought process. This can be difficult at first since most people find comfort and value in ruminating because they usually feel as though they are close to finding the answer or that continuing to overthink prepares them in some way. You can also choose to stop ruminating; you do not have to direct your mind elsewhere (although this is easier). You can choose to decide not to analyze or solve the problem.

5) Expect it to recur time and time again. The questions that are presented are enticing and engaging, but that doesn’t mean you need to take the bait. Rumination is ultimately a choice and anxiety/depression are attention hogs that are likely to resurface and ask for attention.

6) Since we know that forbidding something often has a paradoxical effect and only results in a desire to do it more, the harder we try not to think about something, the more it will be on our minds. So sometimes setting aside a rumination time towards the end of the day can give room for reviewing the worries but not allowing them to take over. A timer is set for 15-30 minutes per day to allow for structured worry time.  It can be helpful to plan an activity for when the timer goes off so you do not become absorbed with the rumination, and you are able to discontinue more easily.

Rumination is something that requires a willing participant. It doesn’t happen to someone, it is something someone does to themself. With the help of a trained and qualified CBT therapist, reclaiming the power of your thoughts and freedom from rumination is possible and probably easier than you think. Feel free to reach out to one of our anxiety/OCD specialists at The OCD & Anxiety Center at 630-522-3124. We are here to help you stop ruminating and reclaim your life back!

Dina Scolan is a licensed therapist at The OCD & Anxiety Center.  The Center is located in two suburbs outside of Chicago.  She has devoted her career to specializing in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.

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1100 Jorie Blvd 132 & 243
Oak Brook, IL 60523

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