How Rumination May Be Keeping You Prisoner to Anxiety/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, images, memories, and catastrophic predictions. Your mind keeps SPINNING, SPINNING, SPINNING! Eventually, it makes you feel like a prisoner to this endless race that you never even signed up for.
We get it. And we can help.
As clinical mental health therapists, we often see people struggling with - what we often hear as, “overthinking.” Our clients tell us that they just can’t relax because their mind is in constantly spiraling out of control and they can’t stop the SPINNING! But the truth is - they are doing something and they are most likely doing it without even realizing they’re doing it. This is a process called rumination. When working with us, clients are often surprised how much they’ve actually been ruminating without even knowing it!
What is rumination?
Professionals in the field have often suggested that mental rumination is thinking about past or future life events.
It’s often been said that when we are ruminating about the future, we are dealing with anxiety - and when we’re thinking about the past, we are in the arena of depression.
I believe most therapists continue to be in alignment with this definition of rumination.
However, this definition has recently been vastly expanded, and thankfully so - because we are now seeing at least one reason why people continue to find themselves stuck in their anxiety, panic, and OCD recovery.
What most people with an anxiety disorder or OCD don’t understand is how much their rumination contributes to their anxiety symptoms as well as their reluctance to engage in their exposure treatment plan.
The mental health research field has begun to realize that more attention needs to be focused on how a sufferer is engaging in rumination. Dr. Michael Greenberg is also a specialist in the field of anxiety and OCD. Dr. Greenberg has established a very detailed list of ways he’s seen clients ruminate - see if you can relate below.
Ways We Can Ruminate:
Trying to figure something out
Directing attention/monitoring thoughts and feelings
Keeping ones guard up (mentally)
Pushing away thoughts, trying to not let thoughts enter ones awareness
Using mindfulness or ‘bad distraction’
Engaging in self-talk
Rumination is a Choice (but often feels like it’s not)
Many of our clients will tell us “I overthink, worry, or obsess.” But actually, what they are really saying is that they are engaging in rumination (but they don’t know it).
Obsessions are when a thought shows up automatically. which is something we have no control over.
A compulsion is effortful. So when you engage with the thought using any of the 6 examples listed above, you are actively directing your attention towards it (compulsion).
Rumination keeps people stuck because they don’t realize their mental behavior can be a mental compulsion. Clients often feel like rumination is something they don’t have control over, but I’m here to tell you otherwise.
Let me provide an example of why this is an unhelpful behavior and how it may be keeping you prisoner to your mental health disorder.
Let’s say that Johnny Doe has been diagnosed with health anxiety OCD. Johnny’s core fear is that he has an illness, but nobody is able to come up with a diagnosis. Johnny recognizes that he has minimal evidence of a medical issue, but his fear is very convincing and overwhelming. Johnny has also been medically cleared numerous times by medical professionals, but he’s still partially inclined to believe that he’s contracted some sort of illness (even thought there’s zero objective evidence of an illness).
Because Johnny tends to experience obsessional thoughts about being sick or having an underlying condition that is not being addressed, he may begin to engage in various forms of rumination, such as directing attention/monitoring, trying to figure it out, and self-talk.
Monitoring may include scanning their body for any type of abnormality (skin defect, noticing minor aches and pains, tickle in throat, weird sensation, etc.).
Johnny may also try to “figure it out” by engaging in research throughout the internet (Dr. Google) - hoping to find an answer to their feared/hypothesized illness.
Or Johnny may try to figure it out by thinking about all the toxic substances he has recently been exposed to as a means to hopefully solve the mystery of his “illness.”
Johnny may also use positive self-talk compulsively, by saying something like, “I’m going to be ok” or use excessive prayer in his mind in hopes that this will prevent his illness from continuing.
Johnny is utilizing rumination as a means to establish a sense of safety or protection against a (most likely) mentally fabricated, phantom illness. However, what this behavior is actually doing is maintaining his high anxiety state.
Now you may ask, “well what if there is a problem?” or “why is it a big deal to do this!? “
Fair question!
However, there’s a reason why Johnny is seeking out mental health treatment: he is suffering with anxiety and struggling to live a normal life.
Now Johnny could continue to find answers by visiting more specialists, spending more time on the internet or more time monitoring his body for more evidence of illness, but this all comes with significant costs:
Time
2.Energy
3. Worsening anxiety
4. Conflict with relationships
5. Avoiding going to places that trigger anxiety
Important note: Ironically, Johnny is doing a bunch of rumination because he feels like he needs to do it - so he can then hopefully feel better/safe. However, once Johnny sees what he is doing, he realizes that he’s actually worsening and fueling his anxiety/OCD.
So what do we do once we have come to understand that rumination is a compulsion and something you actually do have control over?
We must let the thought be there, and not direct our attention to the feared thought that’s in our awareness!
Attention vs. Awareness
Attention is the mental muscle you use to read a book, engage in communication, solve a math problem, watch a movie, notice the sunset, etc.
Awareness is anything that you notice in your mental periphery.
For example, as I type this sentence, my attention is directed toward my screen and keyboard.
But in my awareness I notice that I can hear my neighbor’s ridiculously loud leaf blower, I can hear birds chirping, and I can hear the sound of the blustery wind whooshing through the trees.
Attention and awareness are two very discrete attributes of the brain.
However, it’s worth noting that there is no distinct line where attention and awareness meet.
But that’s ok - once you begin to practice re-directing your attention, you will notice the difference between the two.
So The Point Is…
Johnny does have some degree of control of where he directs his attention.
The hard part of course is resisting the strong urge to direct attention to the fear of a possible illness (but trust me, with practice you can do this).
It’s also important to note that people with anxiety/OCD disorders are also often afraid of experiencing their current emotional state forever.
Often, people believe that their anxiety will stick around FOREVER if they don’t continue to direct attention towards their perceived problem. However, that’s typically not the case.
Often what we see in our clients is - if they are successful at not continuously ruminating and are able to maintain some control of their attention - after 2-3 days they begin to notice improvements in their anxiety symptoms as well as a reduction in the urge to ruminate.
Some therapists may argue that this approach is distraction. But actually, it’s not.
This is actually an exposure exercise because we’re not allowing ourselves to pursue certainty - or in other words, we’re exposing ourselves to uncertainty by not answering the questions/fears of the mind that’s demanding answers. It is here (bathing in uncertainty) where we need to be in anxiety and OCD recovery.
Additionally, once an individual gets practice having more control of their attention muscle and they’re no longer engaging with unhelpful thoughts screaming in their awareness - we find that exposure exercises (intentionally triggering one’s anxiety in a particular context) are often less anxiety provoking!
Putting All Of This Into Practice: The Choice Point
Once you have determined that your obsession or fearful thought is not rational or helpful, you’ve arrived at the choice point.
Here there are two choices: continue to direct your attention towards the phantom threat by continuing to ruminate, or, you can redirect your attention through these steps:
Aknowledge and label the thought once it enters your awareness (ex. “I’m noticing a thought and fear related to my health anxiety”). Note: you don’t need to do this every time
Open up and make space for the emotion to enter your mind and body with radical acceptance and compassion towards it
Direct your attention to anything else or simply to nothing - as long as it’s not directed to the feared/obsessional thought or feeling
Let the feared/obsessional thought or feeling camp out in your awareness as long as it needs to without fighting or resisting it
You’re human - so you will slip up - just notice that you did slip up and direct your attention back away from the unhelpful thought or feeling
If you find yourself still really anxious - you’re probably ruminating - time to check-in with yourself by asking, “Am I ruminating right now? How am I directing my attention to this thought?”"
Repeat
That’s it.
Not engaging in rumination is hard work. we get that. So if you are struggling with this, don’t give up. This doesn’t mean your brain is broken, you just need to keep at it.
The human mind has been evolved to notify us of any sense of danger. The mind is like a problem-solving, analytical, judgmental, catastrophic thinking machine. And it does this really well!
The problem with this default mechanism is that sometimes it sends out a false alarm to our conscious mind (where we notice thoughts).
Fortunately, humans have the ability to notice this alarm, which often presents as various physical or mental symptoms: increased heart rate, sweating, racing thoughts (what if’s), predicting the worst case scenario, and plenty more!
Once we are able to notice the fear signal, we can decide if this notification is helpful or unhelpful - and then we can direct our attention towards whatever we want (even if it’s towards nothing).
How State of Mind Therapy Can Help With Rumination
Let’s be honest - it can be hard to put these skills into practice.
With the help of an anxiety or OCD therapist, you can learn about the ways in which you ruminate and set up a plan for practicing effective skills.
To get started, schedule you free 15-minute phone consultation to determine if we would be a good match to help you gain freedom from anxiety and OCD.
Written by Justin Matthews, LGSW
Justin is a therapist that specializes in helping individuals get relief from anxiety and OCD by teaching them how to be more flexible with their unhelpful thoughts so they can spend more time doing what matters.