Have you ever woken up with an earworm that you just can’t seem to get rid of? Cognitive behavioral therapy for rumination is used when people feel like their thoughts keep looping in the same way. It’s like that one song lyric playing over and over and over again in your head. It can become extremely frustrating, especially when you can’t focus on other, more important thoughts. That’s how individuals with rumination can find themselves feeling every day.
Rumination is a cycle of negative thoughts that are continuous and never-ending. Ruminating thoughts never lead to any sort of progress, which can cause severe interference with everyday life. But, luckily, rumination-focused cognitive behavioural therapy can help individuals overcome these thoughts.
What Is Rumination?
Rumination refers to a cycle of constant and obsessive dwelling on negative thoughts and feelings that have no end or point of completion. Typically, rumination focuses on negative self-talk, past mistakes, and other situations that create feelings of distress.
Why Do People Ruminate?
Rumination can often occur as a symptom of OCD, anxiety, and depression. People often ruminate because they believe it will reduce distress, help them to understand their problems, and problem-solve or avoid future mistakes. However, the truth is the complete opposite; ruminating thoughts have no true ending or completion. So, often, rumination actually worsens the symptoms and effects of existing mental health disorders. Mental health disorders that often cause rumination include anxiety disorder, depression, and OCD.
What Does Rumination Look Like?
Ruminating thoughts can focus on everything and anything. They can focus on something as small as leaving the TV on at home to something as arbitrary as the purpose of life. The one commonality that all ruminating thoughts share is the distress and interference in daily life that they inflict.
Rumination in Existing Mental Health Disorders
- Ruminating thoughts in OCD may look like obsessive thoughts on whether they blew out a candle or not or whether they did something to offend a loved one. When it comes to rumination in OCD, individuals question themselves and constantly analyze and replay their obsessions in their head.
- Rumination in depression typically focuses around self-criticism, negative past events, and past regrets. This may look like a focus on failures and feelings of inadequacy.
- Rumination in depression can trap individuals in a depressive cycle, prolonging and intensifying the depressive episode.
- Rumination in anxiety may look different depending on which kind of anxiety disorder an individual suffers from. Individuals with social anxiety may experience ruminating thoughts focused on potential judgment or their own interpretations of social interactions. Individuals with general anxiety disorder may ruminate about potential catastrophes or uncertain events.
What is Rumination-Focused Cognitive Behavioural Therapy (RF-CBT)?
Rumination focused cognitive behavioural therapy treats rumination as a maladaptive habit rather than just a symptom. Thus, in RF-CBT, the goal is to understand the thoughts and behaviors related to rumination in order to ultimately break and replace the habit. Through RF-CBT, individuals will be taught the skills needed to recognize and change ruminating thoughts. RF-CBT is considered to be the best therapy for rumination.
How RF-CBT Works
Therapists help patients overcome rumination through a series of RF-CBT sessions. The key components that therapists will work on overtime include:
- Functional Analysis
Identifying the triggers, warning signs, and consequences of rumination. This helps to understand why ruminating thoughts occur and what specific thoughts and behaviors need to be changed to stop them.
- Shifting to from Abstract Thinking to Concrete Thinking
Therapists will walk patients through cognitive restructuring where they can learn to replace unhelpful, abstract thoughts with more concrete, realistic thoughts. This may look like shifting thoughts from “Why am I such a failure? Why can’t I do things right?” to more grounded thoughts like “This isn’t my best work, how can I do better next time?”
- Replacing Rumination with Action
Engaging in positive action, like walking or practicing a hobby, when feeling an impending ruminating state can help to distract and reduce the consequences of ruminating thoughts. Since rumination can worsen existing depression and anxiety, practicing positive behaviors before rumination sets in can help to avoid worsening anxious and depressive episodes.
- Practicing New Skills
Rumination is a habit, and it can’t be broken in one session. It is important to practice new skills outside of therapy for ruminating thoughts sessions and to keep working with a therapist. Working on your skills in between sessions helps to reinforce learned behaviors and positive thoughts and trains the brain to replace ruminating thoughts with them.
Embrace a Better Way: Cognitive Behavioral Therapy for Rumination
Cognitive behavioral therapy for rumination works because it just changes how you respond to them. You learn to spot the spiral earlier, stop rehearsing the past, and actually move forward. That’s the difference between staying stuck and getting relief. And when therapy for ruminating thoughts is done right, it feels like someone finally handed you the off-ramp.
That’s what we do at Embrace Now. We’re a therapy practice in Conshohocken, PA, and we see clients across 41 states in-person and via telehealth. We specialize in anxiety, OCD, phobias, social anxiety, relationship anxiety, and panic. Book your free consultation today. Let’s have a conversation about how RF-CBT can help you stop spinning and start living again.
Reviewed by Dr. Sandra, Licensed Psychologist
Frequently Asked Questions
A1. No. Rumination isn’t the same as OCD, but it becomes an OCD symptom when it’s repetitive and done to get rid of anxiety or “solve” a thought. In OCD, rumination is a mental compulsion, like replaying a conversation to check for mistakes, while regular rumination is more about general worries or regrets. Therapists call it “rumination OCD” when this mental reviewing is the main issue, and they treat it with Exposure and Response Prevention just like any other compulsion.
A2. Notice when you’re doing it and label it quietly, like saying, “I’m ruminating again,” then set up a daily 10 minute “worry window” to think things through. Outside that time, redirect yourself with a walk or a puzzle, and if the rumination is about a real problem, turn it into one small action step you can take today. If it’s persistent or tied to OCD, therapies like cognitive behavioral therapy for rumination or ERP work really well, so don’t be afraid to talk to a therapist.
Q3. How to Stop Ruminating Thoughts
A3. Catch it early by telling yourself, “This isn’t helpful thinking,” then do a quick reset with a few slow breaths or by naming three things you see in the room. Schedule a short “thought window” once a day, and when rumination pops up at other times, jot down “I’ll think about this later” and switch to something physical like standing up or stretching. Switch from replaying to problem-solving by asking, “what’s one small thing I can do?” and doing it, even if it’s not perfect.
A4. Treat OCD rumination as a mental compulsion, not real problem-solving, by labeling it “this is my OCD talking” and then refusing to analyze the thought any further. Try a mini exposure by letting a worrying thought sit in your mind for about a minute without trying to figure it out or answer it. Pull yourself into the present by using your five senses or doing a simple task like folding laundry, and for severe cases find an OCD therapist who uses ERP.
Cognitive Behavioral Therapy for Rumination – Free Consultation to Break Overthinking
Schedule a free 10 minute consultation call with a CBT therapist for rumination, Dr. Nancy Vreeland
Dr. Nancy Vreeland specializes in Cognitive Behavioral Therapy (CBT) for rumination, overthinking, anxiety, OCD, and related conditions.