Rumination, and how to get out of the loop

Rumination is one of the strongest predictors of depression onset, severity and relapse in the research literature, and it is almost never what people bring to an appointment.

What it is

Repetitive, passive focus on distress, its causes and its consequences, without moving towards action.

Characteristically it asks why questions: why did this happen, why am I like this, what does it mean about me.

It is distinguished from problem-solving by the absence of any conclusion, and from reflection by its abstract, evaluative and self-focused quality.

People who ruminate generally believe it is helping them understand something, which is the belief that keeps it running.

Why it is harmful

Longitudinal studies have found rumination prospectively predicting the onset and duration of depressive episodes.

It amplifies and prolongs low mood.

It impairs problem-solving, paradoxically, by keeping thinking abstract.

It reduces the likelihood of seeking support, and it depletes the willingness of others to provide it.

It interferes with sleep, particularly at night when there is nothing else to attend to.

And it is associated with more general negative interpretation of memory and of the future.

The abstract–concrete distinction

The most useful single concept here.

Rumination operates at a high level of abstraction: why am I so useless, why does this always happen.

Concrete thinking operates at the level of specifics: what exactly happened, in what sequence, what did I do, what could be done differently.

Experimental work has found that shifting people from abstract to concrete processing reduces the harmful effects, and this shift is the basis of rumination-focused cognitive behavioural therapy, which has trial evidence for depression.

The practical version: when you notice the why questions, replace them with how and what questions.

Not "why do I always mess this up" but "what specifically happened and what is the next step".

Catching it

Which is harder than it sounds, since rumination does not announce itself.

The markers: circling the same content without progress; a sense of effortful mental work with no output; questions beginning with why; time passing without noticing; and physical stillness combined with mental activity.

Certain situations are reliable triggers — commuting, lying awake, showering, exercising alone, any low-demand activity.

Noticing your own pattern of when it happens is more useful than trying to catch it in general.

Interrupting it

What has evidence.

Attention shifting to something absorbing enough to require concentration, since undemanding distraction is inadequate.

Physical activity, which has both an attention effect and a physiological one.

Concrete processing, as above.

Behavioural activation — scheduling activity — which is effective for depression partly by reducing the empty time in which rumination occurs.

Mindfulness training, which builds the capacity to notice the process starting rather than to be inside it, and which has specific evidence for relapse prevention.

Self-distanced perspective: thinking about the situation as an observer, or in the third person, which experimental work has found reduces distress compared with immersed reflection.

And time-limiting: a set period to think it through, then stopping, which respects the belief that the thinking has value while capping it.

What does not work

Trying harder to think it through, which is the thing being done already.

Suppression, which produces rebound.

Talking about it repeatedly with the same person in the same way — co-rumination, which has been shown to strengthen the pattern and to increase symptoms even while feeling supportive.

Alcohol.

And waiting for resolution, since rumination has no natural endpoint.

The night-time version

Particularly common and worth handling separately.

Write it down before bed rather than carrying it, since the unrecorded thought is rehearsed to prevent forgetting.

Use a designated worry or rumination time earlier in the day.

Get out of bed if it has taken hold, since lying there associates the bed with it.

And accept that decisions made at three in the morning are unreliable, which is a useful thing to have decided in advance.

When to get help

When rumination is persistent and accompanied by low mood, hopelessness or loss of interest.

When it is interfering with sleep and functioning.

When it centres on guilt, worthlessness or self-blame, which is characteristic of depression rather than of ordinary reflection.

And urgently if it includes thoughts of self-harm or suicide.

General information only, not medical advice. Consult a qualified clinician about persistent low mood, and seek urgent help if you have thoughts of harming yourself.