Do you ever find yourself playing with uncomfortable memories of the past in your head, over and over again to the point that it triggers strong feelings? This is called rumination.
What is rumination?
Rumination is defined as a thinking pattern that is focused on memories that are generally associated with strong emotions that can be distressing (Sansone & Sansone, 2012) and can look like racing repetitive thoughts. Unlike reflecting on recent events to identify areas of growth or process emotions, rumination can cause anxiety, stress, and sadness, and it can lower your self-esteem and bring about other strong feelings.
For those dealing with a mental health condition, their symptoms can be amplified by this thinking pattern. For example, if you are facing a depressive episode and begin to overthink a time you were rejected by a friend, this will likely increase your depressed mood and isolation.
Rumination can also be accompanied by other cognitive distortions. Cognitive behavioral therapy suggests that there are patterns of thinking and cognitive distortions that can increase symptomatology.
Let’s look at some examples of rumination combined with other cognitive distortions:
- “I was so awkward when I talked to my teachers when I was in high school. I have always been such an awkward person.”
- All or nothing and discounting the positive:
- “I had too many bad grades during my first year of undergrad. I could never call myself a good student”
- Jumping to conclusions:
- “My last relationship was very traumatic; I will never have a good trusting relationship.”
Why are these repetitive thoughts not stopping?
We all have different ways of thinking and perceiving the world around us. CBT suggests that our automatic thoughts, those that come to mind readily when we encounter a situation, are shaped by our core beliefs. I like to think of core beliefs as a pair of glasses through which we see the world. We all have a different pair and therefore different perceptions.
Core beliefs are the views that we hold about ourselves, the world, and others. These are influenced by various aspects of our life including our relationship with our caregivers, family values, the communities we have lived in, friends, education, culture, age, ethnicity, trauma history, and others. Human beings are so complex that all aspects of our lives play a role in the pair of glasses that are our core beliefs.
Following these foundations would explain why two children getting a “C” have a different response and why this event will impact each child differently in the future. The child that sees this as a growth opportunity is more likely to not ruminate on this memory. On the other hand, the child that sees it as a failure will likely remember this event and interpret it as proof of “I am a bad student” or “I am a failure.”
In a way, when our glasses become darker or more negative, so will our perception and ultimately our rumination patterns affecting our emotions, increasing stress and lowering our self-esteem.
Rumination, anxiety, and OCD
As discussed, rumination can exacerbate symptoms of existing mental illness. Let’s explore what this looks like for those with anxiety and obsessive-compulsive disorder.
First, let’s define this diagnosis. Generalized Anxiety Disorder (GAD) is characterized by anxious mood, excessive worry that is difficult to manage (even when the person tries to), impaired sleep, and impaired functioning (such as difficulties at work or in school).
Obsessive-Compulsive Disorder (OCD) is characterized by obsessive thinking patterns that cause emotional distress and lead the person to engage in compulsive behaviors. OCD is a big source of distress for the person because they have extreme difficulty not engaging in said compulsions.
Remember the cognitive distortions we mentioned earlier? Think about fortune jumping to conclusions and apply this to anxiety. For example, “My supervisor said they want to meet with me. My presentation wasn’t so good, maybe they hated it and I am going to get fired.” For those with anxiety and related disorders, rumination can increase overthinking and anxious mood and can even cause panic attacks.
Rumination is characteristic of OCD in that the individual spends a significant amount of time worrying or analyzing things. It presents in all forms of OCD such as contamination, somatic, hoarding, religion, or others. Obsessions of rumination can look like persistent thinking about perfection, numbers, and cleanness. On the other hand, rumination related to compulsions may look like having a mental list to make sure you secured the house properly after having already left and making sure that you followed the steps in the morning routine to be sure that “nothing bad happens.”
Taking steps to avoid rumination
- Ask yourself, “what evidence do I have to support this?” and “I am basing this on my emotions, and is it possible that my thoughts are not true?’
- Practice mindfulness and gently, with compassion and without judgment, become aware of your experiences.
- Use distractions that will help keep your mind busy such as reading or watching your favorite Netflix show.
- Focus on your life goals and the steps you can take today and this week to get there. This can help with shifting your focus towards something you wish to accomplish vs things that have already happened.
Therapy can help
Various therapeutic approaches and interventions focus on improving and/or coping with rumination:
- CBT: As discussed, Cognitive Behavioral Therapy focuses on understanding thinking patterns, emotions, and behaviors. Therefore, it offers a variety of interventions to become aware of and question your thoughts or reframe them. Some of these include cost-benefit analysis, de-catastrophizing, Socratic questioning, and putting thoughts on trial or finding the evidence. CBT also offers coping skills to manage the emotions that can arise from rumination.
- ACT: Acceptance and Commitment Therapy can involve a less active role in challenging thoughts than CBT. It incorporated mindfulness to bring awareness to the thoughts and sensations without having to change them. This also means that when you are having ruminating thoughts you do not have to follow them and take your mind downhill. It means that you observe the thought, accept it’s existence, understand that you don’t have to do anything with it, and it holds no power. A common mindfulness intervention is to imagine your thoughts flowing like fallen leaves on a gentle stream.
- DBT: Dialectical Behavioral Therapy also has mindfulness to it where one can learn tools to navigate rumination as well as become aware of the sensations that come with it. DBT also offers other tools as part of distress tolerance and emotional regulation. Some of these include radical acceptance (the understanding that there are things in the past that cannot be changed), using your senses to regulate, grounding, the opposite of emotion, wizened mind, decreasing emotional vulnerability, and others.
- Mindfulness: Either as a component of the approaches mentioned above or on its own, this is a wonderful practice to help us notice the emotions, sensations, and thoughts that come up for us as well as to bring awareness to the present moment.
If rumination is something you struggle with, ask your therapist about their approach to supporting you through this. Know that we therapists welcome questions that can help you feel supported in a safe, judgment-free space.
Written by: Gloria Aguilar Guano, MA.
At Clarity Clinic, we have highly trained staff who specialize in therapy and psychiatry services. To learn more about how we can support your mental health, call Clarity Clinic on (312) 815-9660 or schedule an appointment today.