Have you ever been stuck on a single thought, a string of thoughts, or a topic that you keep returning to in your mind over and over again? Perhaps you keep mentally replaying images of that awkward date you had with your long-term crush, thinking about how things could have gone differently. Or perhaps you are apprehensive about an upcoming project and are rehearsing all the ways it could go wrong. Mental rehearsal is a normal and universal experience. However, if you find that you tend to dwell excessively on certain experiences – especially negative ones – you may be engaging in rumination.
What exactly is rumination? It’s defined as a tendency to repetitively fixate on the causes, meaning and consequences of one’s distress. Rumination is characterised by a style of thought (repetitive and obsessive) rather than the specific content of thoughts; however, it most often involves a preoccupation with negative content. Moreover, some evidence suggests that rumination may reflect difficulties with disengaging from negative information, as opposed to a tendency to easily engage with it.
If you tend to ruminate, you may be wondering what the harm is. Often, rumination starts as an attempt to make sense of, and move on from, a frustrating, depressing or anxiety-inducing experience. Other times, it stems from the desire to solve a problem or prevent one from occurring in the future. In these instances, rumination might help you feel as though you are more in control and that you are capable of handling problems or threats. But frequent rumination can induce chronic stress and worsen mental health difficulties.
Researchers have divided rumination into two subtypes: brooding and reflection. Brooding involves passively dwelling on one’s distress without active attempts at problem-solving, and it has been consistently associated with a host of negative mental health outcomes. If you find yourself repetitively wondering what you’ve done to deserve your current situation or simply fixating on how poorly a recent conversation went, you might be engaging in brooding rumination. Reflection, on the other hand, is more analytical and involves attempts to understand the reasons for one’s distress. This might look like repetitively analysing recent events and thoughts in an effort to better understand your feelings. Despite the potential benefits of problem-solving and understanding one’s thoughts and behaviours, reflective rumination, too, has been linked to mental health problems.
The mental health outcomes related to rumination are wide-ranging. Researchers have linked rumination to the onset, continuation and recurrence of multiple psychological disorders, including major depressive episodes, anxiety disorders, post-traumatic stress disorder, alcohol/substance use disorders, and eating disorders. And a meta-analysis that I conducted found that rumination is associated with suicidal ideation and attempts, both concurrently and prospectively over time. These findings highlight that this style of thought is not merely a symptom of one disorder, but potentially a driving feature of many.
Rumination worsens negative emotions, and vice versa, causing a vicious cycle
The apparent perniciousness of rumination raises questions about what accounts for its relationship with mental health problems. What features of rumination might be most harmful? And are there other factors that combine with rumination to increase one’s mental health risk?
Some of my research has examined multiple features of rumination – the frequency, duration and content of negative thoughts, and how easy or difficult they seem for someone to control – to see which of these is most strongly and uniquely related to symptoms of depression, anxiety and suicidal ideation. My colleagues and I collected online survey data on rumination and mental health symptoms from hundreds of adults. Our findings were clear: a lack of perceived control over one’s thoughts was the feature of these thoughts that most clearly predicted the severity of mental health symptoms. This suggests the possibility that improving perceptions of control over one’s own thoughts may be an important way to target rumination and mitigate mental health symptoms.
There are various potential factors in explaining why rumination (especially when it feels out of control) might contribute to negative mental health outcomes. In samples of students, community members and patients, research has found that various forms of rumination are linked to agitation, sleep problems, poorer relationships, disruptions in memory and problem-solving, hopelessness, negative emotions, and impulsive and dysregulated behaviours. One model explaining the pernicious role of rumination – the ‘emotional cascade’ model, developed by Edward Selby – proposes that rumination worsens negative emotions, and vice versa, causing a vicious cycle. For example, perseverating on negative emotions after a break-up (eg, What did I do to deserve this pain?) will likely increase the severity of these emotions, which will, in turn, likely increase the frequency and intensity of ruminative thoughts. Eventually, to break the cycle, one might turn to unhealthy behaviours – such as emotional eating, drinking too much, or calling the ex-partner repeatedly – to try to decrease the distress.
The co-occurrence of negative emotions and rumination might also contribute to suicide risk. In a recent study that assessed adults with severe suicidal ideation several times each day for two weeks, we found that engaging in rumination increased the strength of the relation between current negative affect (depression, anxiety, hopelessness, agitation, and irritability) and suicidal thoughts in the moment. In other words, negative emotions were more strongly tied to suicidal ideation among those who were ruminating at the time.
Taking all the research together, it appears that rumination may serve as a catalyst in the relationship between negative emotions/experiences and various mental health outcomes.
Rumination becomes problematic only when it is habitual and associated with negative contexts and moods
Of course, rumination does not always lead to negative consequences, and several distinct theories have been proposed for why people do it in the first place. Susan Nolen-Hoeksema suggested that rumination may occur in an attempt for individuals to better understand themselves and their problems. Adrian Wells and Gerald Matthews have proposed that rumination develops after the detection of a conflict between one’s goals and one’s actual environment and thoughts. Research into the various roles of ruminative thinking is ongoing, but the prevailing thought is that it could be a way of regulating negative emotions and progressing towards goals via problem-solving – and that rumination becomes problematic only when it is habitual and associated with negative contexts and moods.
Fortunately, there are a number of steps that you can take to reduce rumination if it seems to have become problematic. These may help, in part, by improving your perceived and actual control over your thoughts. If you start to notice that you are stuck on a particular set of thoughts, some potential strategies include:
- Distraction: when you first realise that you’re starting to ruminate, it can be helpful to find a short-term distraction to break the thought cycle. The most helpful strategies may include those that are (a) mentally or physically intensive, like completing a puzzle or going on a run; (b) sensation-rich, like curling up in a soft blanket, holding an ice cube, or lighting a candle; or (c) involve another person, like calling a family member or playing a game with a friend. It’s important to note, however, that research has indicated that attempting to suppress your thoughts (eg, by actively pushing them away, as opposed to refocusing your attention on something else) is actually counterproductive and can worsen distress.
- Practising mindfulness: mindfulness can be thought of as connecting with the present moment while engaging with inner and outer experiences completely and nonjudgmentally. In addition to sitting down in a quiet place and focusing on one’s breath for several minutes, mindfulness can also take forms such as mindful driving (eg, focusing on the weight of the vehicle, the texture of the road, the sound of the tyres and traffic around you, and the feeling of your seat and steering wheel); mindful eating (eg, paying attention to the aromas, textures and flavours of your food as you slowly take bites); or intentionally focusing on any other single activity at a time (as opposed to multitasking). Focusing on breathing or on things experienced through the five senses has been shown to calm the body and mind, leading to reduced rumination.
- Reinterpreting your thoughts: people often ruminate after something bad has happened or they think that they have made a mistake. You might tend to catastrophise and magnify these experiences, so taking a step back, ‘checking the facts’, and imagining yourself coping well with the worst-case scenario could be helpful if you find yourself ruminating. You could ask yourself: What is the evidence for this thought? What is the evidence against this thought? How could I cope if this situation actually came to pass?
For more severe ruminators, particularly those who perceive their thoughts as difficult to control, there are several empirically supported psychotherapies designed to target ruminative thinking:
- Rumination-focused cognitive behavioural therapy (RF-CBT) involves identifying the causes of rumination and aims to foster more concrete, process-focused and specific thinking – as opposed to ruminative thoughts, which are often abstract, obsessive, and focused on numerous possible outcomes. Unlike traditional CBT, which focuses on modifying the content of thought processes, RF-CBT focuses on modifying the process of thinking. Thus, it may be particularly useful for individuals who perceive their thoughts as incessant and out of control, and who would like to change not only what they think, but also how they think.
- Mindfulness-based stress reduction (MBSR) incorporates mindfulness meditation, body awareness, yoga and explorations of one’s patterns of thinking, feeling and acting to cultivate attention and emotion regulation while reducing rumination and worry. Individuals who experience difficulties engaging with the present moment (due to fixations on the past or a potential future) and who are not in tune with their bodily sensations may benefit from MBSR.
- Acceptance and commitment therapy (ACT) aims to develop and expand psychological flexibility, thereby improving one’s ability to adapt thoughts and behaviours to better align with one’s values and goals. Individuals who experience rigid thought processes, who have difficulty imagining alternative options, and who struggle to accept their thoughts may benefit from ACT.
Across each of these psychotherapies, clinicians will routinely assess patterns of ruminative thinking through questionnaires, figure out specific mechanisms to explain why rumination is occurring, and then develop strategies to mitigate the frequency and impact of these thought patterns.
Rumination can be an easy trap to fall into. Although it can initially seem like a helpful tool for problem-solving and processing emotions, rumination can quickly become difficult to control and may ultimately worsen the effects of negative feelings. But even when thoughts feel impossible to escape, there are ways to get unstuck – and to help protect your mental health in the process.