Rising Above Rumination
By Bruce Campbell
Note: Chronic illness brings physical suffering from symptoms, but it also creates mental suffering, caused by things like worry, uncertainty, regret, guilt and grief. The articles in this series focus on ways to ease the second type of suffering, psychological pain.
When something goes wrong, one reaction we often have is to go over it in our mind. The impulse is a healthy one: thinking about an issue or experience can lead to insight. But sometimes we get stuck in negative loops, going over an experience repeatedly and feeling worse and worse the longer we do.
This form of mental suffering is called rumination, meaning an unproductive focusing on negative thoughts and feelings. The word comes from the verb ruminate, which means "to chew the cud."
If rumination is an issue for you, you can lessen its effects by creating a two-step plan to use when you feel stuck in unproductive thinking. As with most strategies in this series, the ones you’ll find here take practice, but can bring significant gains over time.
Step 1: Set a Limit on Your Rumination
If you recognize that you have a tendency to think about a single topic for extended periods of time, learn to ask yourself, "Is this train of thought productive?" If the answer is “No,” set a time limit for further thinking on that topic, then check in with yourself when you reach the limit. If you still feel stuck, go to step 2.
Step 2: Create a Distraction Plan
You can pull yourself out of rumination by turning your attention elsewhere, often called distraction. Distraction involves immersing yourself in some absorbing activity so your mind is pulled away from a unproductive track into a more productive direction.
Here are several distraction strategies people in our program have used. You can experiment to find the strategies that help you and then have a set of responses ready when you slip in to rumination.
Use Positive Self-Talk
Deliberately replacing negative thoughts with realistic, positive ones can change mood. For example, if you are in a relapse, your self-talk may turn negative and you find yourself saying things such as, “Another relapse…Whatever I do, I seem to end up here and that makes me worry that I’ll never get better and might even get worse.”
You can interrupt the negative cycle and start a positive spiral by saying consoling words to yourself, such as, “All my relapses up to now have ended, so this one will probably run its course, too.” Self-reassurance can help you relax and quiet the inner voices that insist you'll never get better.
(Learning how to make self-talk more positive and more realistic is called Cognitive Therapy, a well-researched and effective approach for treating overly negative thinking. For a detailed description, see the last article in this series: Changing Self-Talk: A Cognitive Therapy Primer.)
Connect with Others
Connecting with someone you trust, in person or via a phone call or email, can be helpful because of the suggestions you receive, the reassurance you get or just from feeling connected to another person.
One person in our program said about handling relapses, "It's much harder to be alone when I'm crashed, so I find a friendly voice on the phone for comfort." Another wrote, "I have found it very useful to talk with another person when I'm in the middle of a crash. Often it doesn't matter what we talk about; just feeling connected to something beyond myself helps lift my spirits."
Do Something Physical
Taking action in some form leads you to immerse yourself in activity, thus providing distraction from negative thoughts. It also quiets voices of futility by providing an opportunity for accomplishment. Depending on your functional level and responsibilities, you might do some housework, begin preparing a meal, check in with someone via email or a call, do some exercise or do an errand.
Pursue Healthy Pleasures
A fourth strategy is to immerse yourself in a pleasurable activity. This might be a hobby, like beadwork or scrapbooking. Or it could be something intellectually challenging, like a non-fiction book or a course on tape or DVD. Or it could be immersing yourself in fiction in the form of a novel, TV show or movie. The goal is to find an activity you find both absorbing and rewarding.
This strategy comes with a caution: the activity should be a healthy pleasure. Not all distraction are good. Examples of unhealthy distractions include alcohol, mindless eating, and some forms of media, if they focus on violence or negative feelings (e.g. sad songs).
Try Writing
Considerable research indicates that writing about traumatic or stressful events in a way that combines factual description and emotional reactions has positive health benefits. Giving verbal form to emotionally powerful experiences seems to bring understanding.
In the words of James Pennebaker, who has done considerable research in this area, many people found the value of writing was in gaining insight: “Rather than explaining that it felt good to get negative emotions off their chests, the respondents noted how they understood themselves better.”
Many of the studies of writing about difficult events involved people writing for 20 minutes or so each day for several days. For more, see Pennebaker’s book Opening Up and also the article Writing is Good Medicine. (Note: If you find that using this strategy leaves you feeling stuck, it may be more effective as an alternative to rumination, rather than a response.)
In sum, if you sometimes find yourself stuck in negative thinking, learn to take positive action to change your thinking and lift your spirits.
Similar to the anti-depression strategies discussed in the article Planning for Depression, you can decide ahead of time how you will shift your attention when you catch yourself in unproductive rumination This could be a written plan or a mental checklist.
The important thing is that you anticipate rumination and, by giving it advance thought, know how you will respond when it happens.
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