How Rumination May Be Keeping You Prisoner to Anxiety and OCD
Let me guess...
It feels like there's a never-ending NASCAR race in your mind—the cars being racing thoughts that produce scary thoughts, intrusive images, distressing memories, and catastrophic predictions.
Your mind just keeps spinning, spinning, spinning.
Eventually, it makes you feel like a prisoner to an endless race you never even signed up for.
We get it. And we can help.
As clinical mental health therapists, we often hear clients describe themselves as "overthinkers." They tell us they can't relax because their minds are constantly spiraling out of control.
But here's what often surprises them:
They're not just having anxious thoughts—they're doing something with those thoughts, often without even realizing it.
That process is called rumination.
When working with us, clients are often surprised to discover just how much they've been ruminating without knowing it. Once they begin recognizing this pattern, many finally understand why their anxiety or OCD has continued to feel so persistent.
What Is Rumination?
Professionals in the mental health field have traditionally described rumination as repeatedly thinking about past or future life events.
You've probably heard it explained like this:
Thinking about the future is anxiety.
Thinking about the past is depression.
While there's truth to that, our understanding of rumination has expanded significantly over the past several years.
Today, we recognize that rumination isn't simply what you're thinking about—it's also how you're engaging with your thoughts.
This distinction is important because it helps explain why so many people continue to feel stuck in anxiety, panic, or OCD recovery.
One of the biggest misconceptions about rumination is that it feels productive.
Most people aren't ruminating because they enjoy worrying. They're trying to solve a problem, prevent something bad from happening, or finally feel certain.
Unfortunately, the very thing that feels protective often becomes one of the biggest things keeping anxiety alive.
What many people with anxiety disorders or OCD don't realize is how much rumination contributes to both their anxiety symptoms and their reluctance to engage in exposure therapy.
As specialists continue learning more about rumination, greater attention has been placed on how people mentally respond to fear—not just the fear itself.
Dr. Michael Greenberg, a specialist in anxiety and OCD treatment, has identified several common ways people engage in rumination.
As you read through the list below, see if any of these feel familiar.
Ways We Can Ruminate
Rumination doesn't always look like obvious worrying.
Sometimes it happens so automatically that we don't even recognize we're doing it.
Common forms of rumination include:
Trying to figure something out
Directing attention toward thoughts or feelings
Mentally staying on guard
Trying to push thoughts away or prevent them from entering awareness
Using mindfulness or distraction with the goal of making thoughts disappear ("bad mindfulness")
Engaging in excessive self-talk
Many of these behaviors feel helpful in the moment because they create the illusion that we're solving the problem.
In reality, they often keep us mentally locked onto the very thing we're trying to move away from.
Rumination Is a Choice (Even Though It Doesn't Feel Like One)
Many of our clients tell us,
"I overthink."
"I worry constantly."
"I obsess."
But what's actually happening is a little different.
They're engaging in rumination—they just don't recognize it yet.
This distinction matters because it changes how we approach treatment.
An obsession is an intrusive thought, image, urge, or sensation that shows up automatically.
That's something we don't have control over.
A compulsion, on the other hand, is effortful.
It's something we do in response to the obsession.
When you respond to an intrusive thought by trying to figure it out, monitoring your body, mentally reviewing evidence, or repeatedly reassuring yourself, you're actively directing your attention toward the obsession.
Those mental behaviors are compulsions.
And rumination is one of the most common mental compulsions we see.
One reason rumination keeps people stuck is because it doesn't feel like a behavior.
It simply feels like thinking.
That's why so many people believe they have no control over it.
The good news is that once you learn to recognize rumination as something you're doing—not just something that's happening to you—you can begin practicing a different response.
That doesn't mean you'll stop having intrusive thoughts.
It means you can gradually change how you relate to them.
A Real-Life Example
Let's say Johnny has health anxiety or OCD.
Johnny's core fear is that he has a serious illness, but no one has been able to diagnose it.
He recognizes there's very little evidence that anything is medically wrong, and he's been evaluated by multiple healthcare professionals.
Yet the fear still feels convincing.
Whenever an intrusive thought about his health appears, Johnny immediately begins engaging with it.
He may monitor his body throughout the day, scanning for abnormalities—a new ache, a tickle in his throat, an unusual sensation, or a small change in his skin.
He may spend hours researching symptoms online, hoping Dr. Google will finally provide the answer everyone else has missed.
Or he may mentally review every food he has eaten, every chemical he's been exposed to, or every illness he's encountered, trying to solve the mystery.
Johnny might even repeatedly tell himself,
"I'm going to be okay."
Or engage in excessive prayer in hopes that it will prevent something bad from happening.
Here's what's important:
Johnny isn't doing these things because he wants more anxiety.
He's doing them because he's trying to feel safe.
That's what makes rumination so deceptive.
It masquerades as problem-solving.
But each attempt to gain certainty teaches his brain that this fear deserves more attention.
Instead of reducing anxiety, it quietly strengthens it.
But What If There Really Is a Problem?
At this point you may be thinking,
"But what if there actually is a problem?"
Or,
"Why is it such a big deal if I do this?"
Fair questions.
After all, our brains are designed to solve problems. If there really is something wrong, we want to pay attention to it.
However, there's a reason Johnny is seeking mental health treatment.
He's suffering from anxiety that's interfering with his ability to live a normal life.
Now, Johnny could continue searching for answers by visiting more specialists, spending more time researching on the internet, or constantly monitoring his body for evidence of illness.
But all of those behaviors come with significant costs:
Time
Energy
Worsening anxiety
Conflict within relationships
Avoiding places or situations that trigger anxiety
Here's the irony.
Johnny believes he needs to ruminate so he can finally feel better or feel safe.
But once he begins recognizing rumination for what it is, he realizes that he's actually fueling the very anxiety he's trying to eliminate.
That's one of the biggest traps anxiety sets for us.
The behaviors that feel protective in the moment often become the very behaviors that keep anxiety going over time.
So What Do We Do Instead?
Once we understand that rumination is a mental compulsion—and something we actually have some influence over—the goal changes.
Instead of trying to make the thought disappear, we learn to let the thought be there without continually directing our attention toward it.
This is often easier said than done.
Your brain has likely spent months—or even years—learning that every scary thought deserves your full attention.
Changing that habit takes practice.
Fortunately, one concept makes this much easier to understand.
Attention vs. Awareness
Attention is the mental muscle you use to intentionally focus.
You use it to:
Read a book
Watch a movie
Have a conversation
Solve a math problem
Notice a beautiful sunset
Awareness is different.
Awareness includes everything that's happening in the background of your experience.
For example, as I type this article, my attention is directed toward my computer screen and keyboard.
At the same time, I'm aware that my neighbor is using an incredibly loud leaf blower.
I'm aware of birds chirping outside.
I'm aware of the wind moving through the trees.
Those sounds exist in my awareness, but they don't have my attention.
The same thing can happen with anxious thoughts.
An intrusive thought can remain present in your awareness without becoming the center of your attention.
This is an important distinction because many people believe they only have two options:
Solve the thought.
Get rid of the thought
But there's another option.
You can allow the thought to exist in your awareness without continuing to engage with it.
It's worth noting that there isn't always a perfectly clear line between attention and awareness.
Sometimes they overlap.
That's okay.
As you begin practicing this skill, you'll gradually become better at recognizing when you've shifted from simply noticing a thought to actively engaging with it.
Why Redirecting Your Attention Matters
Johnny does have some control over where he directs his attention.
The difficult part, of course, is resisting the powerful urge to direct that attention back toward the fear of a possible illness.
Like any new skill, this takes practice.
It's also important to recognize another common fear among people with anxiety and OCD.
Many people believe their anxiety will stay forever if they stop trying to solve it.
They think,
"If I don't keep thinking about this, I'll never feel better."
Or,
"If I stop trying to figure this out, something bad will happen."
Fortunately, that's typically not what we see.
In our clinical work, we often find that when clients begin reducing rumination and become more intentional about where they direct their attention, they start noticing meaningful changes over the next several days.
The anxiety may not disappear overnight.
The intrusive thoughts may still show up.
But the urge to engage with them often begins to lose its intensity.
That's because the brain is slowly learning that every intrusive thought doesn't require immediate action.
Isn't Redirection Just Distraction?
Some therapists may argue that this approach is simply another form of distraction.
I see it differently.
Distraction is often used to escape uncomfortable thoughts or emotions.
What we're talking about here isn't escaping anxiety.
We're allowing the thought to exist while choosing not to engage with it.
That's a very different process.
In fact, this is an exposure exercise.
Rather than chasing certainty by answering every frightening question your mind demands, you're exposing yourself to uncertainty by allowing those questions to remain unanswered.
This is exactly what Exposure and Response Prevention (ERP) is designed to teach.
You're practicing uncertainty instead of trying to eliminate it.
And that's where meaningful recovery happens.
Interestingly, we've also found that once clients become more skilled at reducing rumination, exposure exercises themselves often become less overwhelming.
Instead of exhausting themselves mentally before the exposure even begins, they're approaching it with a different relationship to their thoughts.
That shift can make a tremendous difference.
Putting This Into Practice: The Choice Point
Once you've determined that your obsession or fearful thought isn't rational or helpful, you've arrived at what I call the choice point.
At this point, you have two options.
You can continue directing your attention toward the perceived threat by continuing to ruminate...
Or...
You can choose to respond differently.
That doesn't mean the thought disappears.
It means you're making a different choice about where your attention goes.
Here's what that can look like.
1. Acknowledge and Label the Thought
When the thought enters your awareness, simply acknowledge it.
For example:
"I'm noticing a thought related to my health anxiety."
Or,
"There's my OCD trying to pull me back into figuring this out."
You don't need to do this every single time.
The goal is simply to notice what's happening before automatically getting pulled into rumination.
2. Make Space for the Emotion
Allow the emotion to be present with openness and self-compassion.
You don't have to like feeling anxious.
You don't have to convince yourself everything is okay.
Instead, practice allowing the discomfort to exist without immediately trying to make it go away.
3. Redirect Your Attention
Intentionally direct your attention somewhere else.
That could be the conversation you're having, the task you're working on, your surroundings, or even simply sitting quietly.
The important part isn't what you direct your attention toward.
It's that you're no longer directing it toward the obsession.
4. Let the Thought Remain in Your Awareness
Allow the feared thought or feeling to stay in the background for as long as it wants.
Don't argue with it.
Don't reassure yourself.
Don't try to solve it.
Simply allow it to exist without engaging with it.
5. Expect to Slip Up
You're human.
You'll catch yourself ruminating again.
That's okay.
Rather than criticizing yourself, simply notice what happened and gently redirect your attention again.
Recovery isn't about doing this perfectly.
It's about practicing the skill over and over until it gradually becomes more natural.
A Helpful Check-In
If you notice your anxiety continuing to climb, pause and ask yourself:
"Am I ruminating right now?"
Then follow it with another question:
"How am I directing my attention toward this thought?"
Sometimes simply recognizing that you've slipped back into rumination is enough to help you make a different choice.
If You Remember One Thing...
If there's one idea I hope you take away from this article, it's this:
Thoughts are automatic. But rumination is what we do after the thought shows up.
That distinction is incredibly important.
You may not be able to stop intrusive thoughts from entering your awareness.
But you can gradually learn to change how you respond to them.
Like any new skill, redirecting your attention takes practice.
Some days you'll notice yourself ruminating dozens of times.
That's okay.
Every time you notice it and choose a different response, you're teaching your brain that uncertainty doesn't always require immediate action.
Over time, that's often when anxiety begins to lose its grip.
Frequently Asked Questions
Is rumination a compulsion?
It can be.
When rumination is used to gain certainty, reduce anxiety, or make yourself feel safer, it functions as a mental compulsion. Although it isn't visible like handwashing or checking, it can keep the anxiety cycle going in much the same way.
How do I know if I'm ruminating?
Ask yourself:
"Am I trying to solve, analyze, or gain certainty about this thought?"
If you're repeatedly reviewing evidence, mentally debating, researching, monitoring your body, or reassuring yourself, there's a good chance you've shifted from simply having an intrusive thought to actively ruminating.
How State of Mind Therapy Can Help With Rumination
Let's be honest—these skills can be difficult to put into practice on your own.
Rumination often becomes such an automatic habit that many people don't realize they're doing it until someone helps them identify the pattern.
Working with an anxiety or OCD therapist can help you recognize the subtle ways rumination shows up, understand what keeps it going, and build practical skills for responding differently.
At State of Mind Therapy, we use evidence-based approaches like Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) to help clients reduce rumination, develop a healthier relationship with uncertainty, and regain freedom from anxiety and OCD.
If you're ready to take the next step, schedule your free 15-minute phone consultation to see if we're the right fit to help you.
