Overthinking is also called ruminations, the act of thinking carefully and for a long period about something. Rumination is the focused attention on the symptoms of one's distress, and on its possible causes and consequences, as opposed to its solutions.
According to the American Psychological Association, three common reasons for rumination can be identified:
- Having the belief that by ruminating, one will gain insight into his or her life or a problem.
- A history of emotional or physical trauma, and by ruminating they harbour the hope that they can overcome the pain and anguish.
- Facing ongoing stressors that cannot be controlled. Some ruminators may simply have more stress in their lives which preoccupies them.
Women seem to ruminate more than men. One possible reason could be that women tend to be more concerned about their relationships. Interpersonal relationships are great fuel for rumination and ambiguities abound in relationships. One can never really know what people think of him or her or whether they will be faithful and true.
The truth about rumination is that it oftentimes becomes the fast track to feeling helpless. Specifically, it paralyzes a person’s problem-solving skills. The person becomes so preoccupied with the problem that he is unable to push past the cycle of negative thoughts. Basically, rumination involves negative thought patterns that are immersive or repetitive. Many people slip into rumination when they are trying to process their emotions, but they become “stuck” in negative patterns of replaying past hurts without moving toward solutions or feelings of resolution. Ruminative thinkers go over the same information repeatedly without change and stay in a negative mindset.
Another downside about rumination is that it can turn caregivers and loved ones away. When people ruminate for an extended time, their family members and friends become frustrated and may pull away their support.
Many persons at my clinic do complain of the tendency to ruminate. Mental health conditions that are associated with ruminations include:
- Insomnia disorder
- Anxiety disorder
- Depressive disorder
- Obsessive-compulsive disorder (OCD)
For insomnia disorder, the persons are usually alright in the daytime but somehow at night when they lie in bed, they would start ruminating. As a result of the ruminations, they are not able to sleep.
Individuals with anxiety disorder would have other clinical features as well, including tension over the body, nervousness, palpitations, muscle aches, feeling worried in the daytime.
For depressed individuals, the content of their ruminations tends to be negative and there are also other clinical features like low mood, decreased appetite, loss of weight, poor concentration, decreased energy, suicidal ideations. Research has found that when people ruminate while they are in a depressed mood, they remember more negative things that happened to them in the past, they interpret situations in their current lives more negatively, and they are more hopeless about the future.
For OCD, there would be other features that the clinician would look for: obsessive behaviours (in the form of thoughts, urges, mental pictures or images, impulses) and compulsions (in the form of excessive washing and cleaning, checking, other rituals).
If rumination is not actively targeted in treatment, it will result in slower symptom reduction during treatment and can lead to a poorer response to therapy.
A useful way of treating rumination is cognitive behavioural therapy (CBT). CBT for ruminating involves a combination of learning new ways of thinking and behaving to stop ruminating. Unlike traditional talk therapy, CBT targets at the problems that need addressing, and focuses on current factors maintaining symptoms. CBT treatment for ruminating usually involves some combination of the following components:
Functional Analysis: It is a way of identifying all of the factors that serve to maintain ruminating. Through functional analysis, it becomes clear which behaviours need to change in order to stop ruminating.
Behavioural Activation: Behavioural activation involves increasing rewarding behaviour, as depression tends to cause people to withdraw from pleasurable or mastery-inducing activities. By shifting the mode of problem-solving from thinking to taking action, ruminating and depression are dramatically reduced. The key step here is to engage in activities that foster positive thoughts. One needs to engage in activities that can fill his or her mind with other thoughts, preferably positive thoughts. The best activity would be something physical like exercising or going for a long walk. Another key step here is problem-solving. People who ruminate oftentimes replay situations in their head. For instance, if a person is uneasy about a situation at work, it may be useful to ask a close friend for help so that they can brainstorm solutions.
Cognitive Restructuring: Cognitive restructuring involves identifying the unhelpful thoughts that are the focus of rumination, and learning new, more balanced ways of thinking about things. By replacing unhelpful ruminating with more reality-based thinking, it becomes easier to stop ruminating.
Positive Self-Reflection: Here we are looking at the opposite of rumination: adaptive self-reflection. When people practice adaptive self-reflection, they focus on the concrete parts of a situation and the improvements they can make. For instance, instead of wondering whether he or she will get a poor appraisal, a more constructive and proactive step is to ask the supervisor for some feedback and ways of improving performance at the workplace.
