Rumination, or dwelling on negative thoughts, is thought to be associated with both anxiety and depression. Women tend to ruminate more often than men, which helps explain the higher incidences and persistence of depression in women. One of the most effective ways to stop rumination is to treat the underlying anxiety and depression causing it with medicine and behavioral therapy. Treatment options include:

  • Psychotherapy
  • Counseling
  • Meditation
  • Yoga
  • Positive self-reflection
  • Exercise
  • Walks in nature
  • Medications for underlying anxiety, depression or substance abuse

Obsessive rumination may benefit from Ed Watkins’ rumination-focused cognitive behavioral therapy (RFCBT) and traditional cognitive behavioral therapy (CBT), which both shift ruminative thoughts to more adaptive styles of thinking. Other interventions that address rumination are mindfulness-based interventions that improve attention control issues.

Rumination-Focused Cognitive Behavioral Therapy

Rumination is a common symptom that remains after standard CBT for depression. RFCBT is a psychobehavioral therapy that specifically targets rumination. RFCBT is undergoing clinical trials in comparison to CBT for depressed patients who are unresponsive to current behavioral therapy or counseling.

The idea of RFCBT is to develop strategies to promote concrete, specific thinking by modifying the thought process, whereas CBT tries to alter the content of the thoughts themselves. The ongoing trials will measure the severity of depressive symptoms after RFCBT and the level of worry, anxiety, rumination and the quality of life of the patients. Six months after the RFCBT, setbacks are assessed. Problem-solving training and substituting positive thinking for negative, unproductive thoughts are included in the ongoing process. Planning activities to avoid rumination and using compassion for oneself and others are two more goals of rumination-focused cognitive behavioral thinking.

Cognitive Behavioral Therapy

Historically, CBT for rumination showed some usefulness, especially for those with mild rumination. CBT is more useful for single negative thoughts rather than ongoing and successive ruminations that build upon each other. Rumination loops negative thoughts, so each thought precedes or follows the same thought. If the thought that begins the rumination can be changed or stopped, then thought-challenging CBT tools may prove useful. To date, there have been no randomized, controlled trials to evaluate the effectiveness of CBT for rumination.

Mindfulness

Mindfulness exercises for rumination start with identifying when a negative incident happens, accepting that it occurred, facing the truth of the matter honestly, being creative with addressing the negative thought, being thankful for all the good things in your life and developing inner self-control. According to a study published in the Proceedings of the National Academy of Sciences of the United States of America, a mindfulness activity as simple as going for a walk helps reduce rumination and the associated cognitive stress.

Schedule a time for self-reflection or problem-solving each day and vow not to think about negative thoughts until that time. If you happen to fixate on certain thoughts before that time, remind yourself that there is a time scheduled for such thoughts later in the day.

Another positive mindfulness tool is meditation. Thinking about positive experiences make people want to experience those happy emotions again, while painful thoughts cause a person to want to avoid that pain. Avoidance can lead to numbing or placating activities such as alcohol use, eating, sex, gambling or compulsive working. Mindfulness helps regulate emotions and reduces anxiety and depression.

According to a 2012 review published in Alternative Medicine Review, yoga has a beneficial impact on anxiety and stress. Some behaviors, supplements and herbs have shown promise addressing many psychological issues, including:

  • Exercise
  • Omega- 3 fatty acids
  • 5-HTP (5-Hydroxy Tryptophan)
  • GABA
  • Vitamin B complex
  • Magnesium
  • Ashwagandha
  • Kava root
  • Essential oils such as lavender and Roman Chamomile

Medications

The best medications for managing rumination are those that treat an underlying mental health condition such as generalized anxiety disorder (GAD), depression, obsessive-compulsive disorder and post-traumatic stress disorder. There are no FDA-approved medications for rumination specifically.

Medications to treat the symptoms of GAD include:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat anxiety, depression and panic disorder. They work by steadying the levels of serotonin and norepinephrine. Some SNRIs include:

  • Duloxetine (Cymbalta)
  • Desvenlafaxine (Pristiq)
  • Venlafaxine (Effexor)

Studies regarding the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating anxiety are conflicting. It appears that a placebo pill has an equal benefit to those with GAD and the side effects of some SSRIs can be significant and include sexual dysfunction and weight gain.

SSRIs and SNRIs for depression have shown efficacy and would likely help severe rumination. Once major symptoms are under control, therapeutic methods like RFCBT may prove even more useful.

Obsessive Rumination Outlook

Obsessive rumination is obsessive thinking. The underlying cause of rumination is unclear except that it is perhaps a learned behavior in response to childhood trauma, excessive criticism and helplessness. Genetics may play a role as many who ruminate have parents who also ruminate. The key to managing rumination is getting help early so that self-destructive behaviors (like alcohol or drug use) can be avoided. The outlook for obsessive rumination is fair to good with interventions like CBT and RFCBT. Medications can be used as needed for underlying conditions such as anxiety or depression.

If you or a loved one use substances to cope with rumination or another mental health disorder, contact The Recovery Village to discuss treatment options. Using individualized treatment plans that cater to each patient’s specific needs, The Recovery Village provides treatment that addresses substance use and co-occurring disorders to help patients attain a healthier future.

    

Aw, Li. “The Effects of Yoga on Anxiety and Stress.” Alternative Medicine Review, March 17, 2012. Accessed March 13, 2019.

Bratman, Gregory. “Nature experience reduces rumination and subgenual prefrontal cortex activation.” PNAS, July 14, 2015. Accessed February 25, 2019.

Ciesla, J. A. “Self-Directed Thought and Response to Treatment for Depression: A Preliminary Investigation.” APA PsycNET, 2002. Accessed February 25, 2019.

Hsu KJ. “Rumination is a risk factor for anxiety.” Anxiety.org, March 16, 2017. Accessed February 25, 2019

Hvenegaard M et al. “Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial.” Trials, March 25, 2015. Accessed March 13, 2019.

Neale, M. “The Guide To Mindfulness Meditation: How and why mindfulness can help.” Anxiety.org, June 6, 2017. Accessed February 25, 2019

Sugarman, Michael. “These antidepressants may have limited effectiveness.” Anxiety.org, January 30, 2018. Accessed February 25, 2019.

Watkins, Edward R. “Depressive rumination: investigating mechanisms to improve cognitive behavioural treatments.” National Center for Biotechnology Information, 2009. Accessed February 25, 2019.

Rumination Treatment
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