Rumination in Anxiety and OCD: How to Break the Cycle
Have you had distressing thoughts that pull you in? Do you try to solve something in your head but can’t get to an answer? You might be stuck in a cycle of rumination. Though all people ruminate from time to time, some get caught in the loop frequently. It can be hard to focus on anything else. Getting unstuck can feel challenging, but breaking free is possible. Let’s learn more about rumination, what it’s like in different disorders, and how treatment can help.
What is rumination?
Rumination is the process of engaging with thoughts to figure them out, understand them, or remove discomfort. It usually follows an intrusive thought, which happens against someone’s will. Rumination becomes an active process when having the thought turns into analyzing it or pushing it away. It is seen in many disorders such as OCD, anxiety disorders, PTSD, and depression.
Symptoms of Rummination
Some common signs you might be experiencing rumination are:
Having frequent intrusive thoughts
Analyzing the meaning of thoughts
Mentally planning for or preventing something negative from happening
Trying to push away or get rid of thoughts
Feeling stuck in the past or future
Lack of focus on other things
Still feeling symptoms of anxiety, sadness, or fear despite mental efforts
Though rumination can feel like a way to find certainty, it actually leaves you more uncertain. Trying to figure out an answer without new information often keeps you stuck. It’s like asking the same question over and over, expecting a different response. Even if you find relief, thoughts tend to come back, urging you to ruminate again. Engaging in mental actions can take hours, making it hard to be present. School, work, or important relationships can slip away. Because rumination is difficult to see on the outside, others may not understand the weight of this struggle.
Why do I ruminate?
To prevent something bad from happening
One reason why you might ruminate is to prevent something bad from happening to you or someone else. Often, after having an intrusive thought, getting a false sense of certainty that it won’t happen is the goal. Someone with OCD might feel that having a negative thought will bring it into existence. For example, if they fear that something harmful will happen to their family, they might ruminate about it, rationalizing it as untrue. If you have social anxiety, you might mentally plan before an event. If you’re going over worst case scenarios to feel prepared, it often creates more anxiety. Maybe you experienced a traumatic event and ruminate about it to make sure it won’t happen again. Realistically, the mental energy spent trying to prevent something doesn’t actually impact whatever that thing is.
To figure something out
Another reason you may ruminate is to figure out an answer. Maybe you forgot if you locked the door, replaying the moment in your head over and over. Or maybe you were reminded of a memory from your past, and question whether it makes you a bad person or not. You might feel the urge to recall the details, trying to remember the moment exactly. The hard part is, rumination can make the details blurry. Often, your perspective is skewed by anxiety about the meaning of something. This can cause you to zoom too far in, unable to see the bigger picture. Unlike problem-solving, rumination doesn’t create solutions. It urges you to keep focusing on thoughts until you feel temporary certainty.
To relieve distress or anxiety
Rumination is also used to get rid of distressing emotions. The thoughts and images you experience are often uncomfortable. They can create fear, anxiety, sadness, anger, and disgust. Sitting with these emotions is not easy - rumination can feel like you’re doing something to make them go away. Mentally planning, analyzing, or replaying can provide short term relief. But once another thought pops up, the cycle of distress and needing to ruminate will happen again. This can be tiring and creates higher anxiety over time. Learning to sit with distress and not rely on rumination to feel better is a core part of treatment.
What does rumination look like in different disorders?
Rumination is seen in many different disorders. The thought process is usually similar, but the content is different. Here are some ways it shows up in those with different diagnoses:
Rumination in OCD
If you have OCD, you’re familiar with the pattern of intrusive thoughts, anxiety, and compulsions.
Obsessions create fear and the need to do something to get rid of it. The behaviors used to reduce anxiety are in the form of physical or mental compulsions. Rumination is a common mental compulsion in OCD. This can turn into hours of focusing on thoughts, trying to figure out if they are true or not. This could also be replaying a past event or planning for a future one. This process can apply to any subtype. An example of this cycle is in relationship OCD. Someone with this subtype might fear that their partner is not the right person for them. They may ruminate on details from a recent conversation or fixate on memories from months back. Mentally checking their feelings when they are with or without their partner can also be rumination. They might believe these rituals will give them clarity. However, it usually leads to feeling more anxious and confused.
Rumination in Anxiety Disorders
Rumination is common in those with anxiety. When worries come up, you might be quick to overthink. You might try to find solutions to a feared outcome or have a hard time focusing on anything else. Rumination can be seen more frequently in certain anxiety disorders.
In Generalized Anxiety Disorder, someone may overthink or analyze different parts of their life. Maybe they recently had a job interview and are stuck thinking about what-ifs: What if I didn’t get the job? What would life look like if I got it? What did they think of me?
Or maybe they are a student and just took a test. They might have a hard time concentrating on anything but their test, trying to figure out if they will pass it.
In Panic Disorder, rumination is centered around physical sensations. It can also be about the possibility of another panic attack. They might mentally check their body for signs, like a racing heart. They also review past moments or contexts when they have had a panic attack before. Planning to prevent another panic attack can also be rumination.
Rumination in Depression
For those with depression, getting stuck in negative thoughts can happen often. Experiencing sad or distressing thoughts can create feelings of worthlessness. These feelings often become stronger once ruminated on. For example, someone might recall ways their life has gone wrong and think about these things for hours. Though their brain may have given them a negative thought, spending time analyzing further thoughts can be compulsive. It can actually cause them to remember more distressing details. This creates drawn-out feelings of sadness and hopelessness, fueling depressive symptoms. When something bad happens, they may be more likely to blame themselves, tying it to past experiences. They might try to figure out why their life has turned out a certain way. However, they are usually unable to come up with solutions or steps to feel better.
Rumination in Trauma
In those with PTSD, flashbacks and intrusive thoughts about the traumatic event are common. Ruminating about the meaning of trauma can make this experience more intense. This might look like trying to remember a detail, figuring out how you could have prevented it, or questioning if you deserved it. It may include mental planning to make sure you don’t get triggered or doing anything to prevent it from happening again. Rumination can impact how you view yourself. You may feel the urge to think about who you were before it happened and compare that to who you are now. This can lead to negative spirals and self-blame. Like in other disorders, rumination can feel productive, but really is a cycle of the same thought patterns. It can make you feel more hopeless, fearful, and anxious than before.
How is rumination treated in therapy?
Rumination can be a challenging cycle to break on your own. Luckily, effective treatments exist. With the help of a trusted therapist, building skills to respond differently to stuck thoughts is possible. Treatment can be different based on what diagnosis you have. One of the most important steps in any treatment is awareness. Rumination can sneak up on you so fast that you might not realize when you engage in it. Identifying what you ruminate about and when it happens is key. Your therapist will explain what rumination is, how it is different from other thought processes, and understand how it has affected your sense of self.
Learning new ways to respond to distressing thoughts is also a part of treatment. When you are able to realize when rumination begins, you have the opportunity to take a different path. In OCD treatment, this might be a part of Exposure and Response Prevention (ERP). Purposely choosing to not engage with intrusive thoughts can be an exposure. When thoughts pop up, you might respond with “Maybe, maybe not” or “This is not important right now”. Resisting rumination and sitting with discomfort will be hard in the moment, but make it easier to manage over time. When dealing with any kind of rumination, radical acceptance can be helpful. Instead of figuring out the meaning of thoughts, accept that they may or may not be true.
Treatment for rumination in depression or PTSD may have different considerations. Rumination can be fueled when there is less to occupy your mind. Those who spend lots of time in bed or at home because of their symptoms may ruminate more often. Treatment for depression can include behavior activation - engaging in things like exercise or activities. This might create less space for rumination to begin. Practicing mindfulness and observing thoughts without judging them can also be helpful. Separating yourself from the thoughts can make it easier to not engage with them. For those with PTSD, focusing on the process of rumination instead of the content of the thoughts can be helpful in stopping the cycle. Working towards self-compassion instead of self-blame can help you shift away from the need to ruminate. Noticing when rumination starts and shifting to another behavior can be a part of Trauma-Focused CBT.
Breaking the cycle and taking back control
Breaking free from rumination is possible. Although it can feel all-consuming, small steps add up. Building awareness, practicing skills both in and out of therapy sessions, and not engaging with intrusive thoughts can put you in control. When rumination starts, you’ll know how to respond. Being able to move through your day without getting sidelined by long thought spirals can bring a sense of freedom. Even when you do get caught in rumination, you will learn to respond with compassion and a shift of focus. More mental space will give you a chance to understand yourself and your values. You might feel more present at school or work and re-engage in things that you enjoy.
Treatment for OCD Rumination in San Diego, CA
At Resilience Counseling, our team of OCD therapists help people break the cycle of rumination. We work with kids, teens, and adults, using evidence-based strategies to manage distress. We take a compassionate approach, meeting you where you’re at. Specializing in OCD, anxiety, trauma, and depression, we understand how rumination shows up in different conditions. Helping you understand what’s going on and take steps to change how you respond to intrusive thoughts can provide relief. We value meeting you where you are at. Understanding how rumination has uniquely impacted you helps us create individualized treatment plans.
Managing discomfort and distressing emotions is not easy. Supporting you through this process can help you towards greater control and freedom. Whether you have experienced rumination for years or are recently impacted by it, we are here to walk alongside you. Breaking free and tapping into your true values is possible. If you or a loved one struggles with rumination, we’re here to help you take the next steps. We offer in-person therapy in San Diego or virtual to anyone in California. Contact us today to learn more about how we can support you.
Katherine Pica OCD Therapist - San Diego, CA
Katherine Pica, LCSW, is the Founder and Clinical Director of Resilience Counseling and has worked int he field since 2007. She supervisors and trains the practice’s OCD therapists with a focus on Exposure and Response Prevention (ERP) and EMDR for trauma. Katherine brings extensive experience treating OCD to both her clients and the clinicians she mentors.
In addition to her clinical work, Katherine also serves as the Training Director and board member for OCD SoCal, where she is actively involved in increasing OCD awareness, education, and community support throughout San Diego and Southern California.
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