Welcome to our February article on over-thinking negative thinking that is called ‘ruminative thinking’. We all worry to a greater or lesser extent and a factor in maintaining depression is the amount of repetitive thinking we engage in. Our problem-solving brain believes that going over difficulties in the past is helpful as it can enable us to learn from what went wrong. This is true and everything is great in moderation but we can easily get stuck in negative thinking loop.
What is ruminative thinking? Rumination can be triggered by a sense of low mood, by noticing some symptom of depression (feeling fatigued, unmotivated or sad), or having a negative thought about yourself, the future or the world. The metaphor stems from cows chewing the cud for hours to assist with digestion. However, whereas for cows the activity is benign, the metaphor when applied to humans seems to not only make things worse but appears to be the cement that keeps the depressive symptoms going.
We do things for good and important reasons. Perhaps we dwell on things because at the time we believe it might be helpful. It is usually about the past or else about our current existence. (Worry, by contrast, is usually about the future).
Please tick which, if any, of these positive beliefs about ruminating (if not recognised these can keep rumination going):
1) Thinking about why I am so sad will help me to prevent it
2) By dwelling on my past mistakes, I can resolve them and be a better person
3) Thinking about how bad I am will make me snap out of it
4) Thinking the worst stops me from being disappointed
5) By thinking about how bad I am, I feel I am being deservedly punished
6) Better not to build up any hopes so as not to be disappointed
7) By keeping myself feeling sad, it levels the keel of the boat, helping me to feel stable as if things were predictable
8) Thinking like this leaves me feeling sad but it seems to distance me from the pain and horror, at least for a while
9) Thinking about why I feel so sad is important if I am eventually going to sort things out
Unfortunately dwelling on the meanings and causes, on the symptoms and on your life’s circumstances actually prolongs and makes more intense the depressive symptoms. This reinforces strong emotional negative beliefs eg that you might be somehow flawed, unlovable or bad. The reasoning is all-or-nothing, emotional reasoning, uncritically jumping to conclusions, and reinforced by behaviours that buy into the rumination. This makes a compassionate reasonable approach towards yourself seem unconvincing (at least initially).
As you ruminate, you might then start to develop negative beliefs which give you the sense of no longer feeling in control. These negative beliefs create a feeling of anxiety and sadness that keeps the rumination going, perhaps deepening the low mood. Many people report feeling worse after ruminating. Please tick any of these examples of negative beliefs that you think might apply to you (or jot down any others that might come to mind).
1) How I feel is out of my control so I feel hopeless;
2) I’ve lost sight of my true self;
3) I am convinced something physical in my brain is causing my depression;
4) There is something very wrong with me if I am like this;
5) Perhaps, if I wait and hope long enough, this low heavy mood might lift;
6) I just can’t stop myself from repeatedly going over things in my head like this;
7) I am less good than others who are superior to me;
8) I have no control over the future so I feel hopeless; and
9) The world is a really bad place to be in.
People start to lose awareness of how much they ruminate as one of the effects of depression is a lapse in attention to things going on around you. Many people report a loss of a sense of time passing as they dwell on things. People can loose touch with their environment making a low mood and self-criticism more likely.
This can lead to thinking patterns that maintain depression being uncritically entered into.
It can lead to coping behaviours based on avoidance (with their own rewards of escape and relief) which maintain depression and prevent people from changing how they live.
People tend to feel tired and unmotivated. This is a breeding ground for feelings of guilt and inadequacy which result from failures to complete tasks. Often it leads to procrastination. All these provide triggers for more rumination.
People become fearful of depression and this fear is maintained by negative beliefs ie “I’m exhausted and fragile. My mind can’t take too much stress”. Often feelings of fatigue and low motivation might arise from depleted levels of dopamine in the brain and activities that connect you with your environment associated with pleasure and achievement allow you to lose these feelings of tiredness.
Basically, depression is an emotional disorder. Rumination offers a tempting and easy but essentially unsatisfactory way of trying to deal with the emotional turmoil. Becoming more connected with what is going on now in your environment is perhaps at first a bit more difficult but ultimately worthwhile.
People then become vigilant for early signs and symptoms of depression. Normal variations in levels of energy, stress or motivation are misinterpreted as the return of the depressive illness.
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Motivation is difficult when people are depressed or in a low mood owing to the failure of the brain to produce dopamine – the hormone that assists with drive. However, once a task is underway it becomes easier to complete. A good tip is the 5 minute rule. Do something for five minutes and you tick the box. With this modest target it is easier to motivate yourself, and once the five minutes is up you might choose to continue. This is about choices with consequences putting you in the driving seat, rather than an attempt to bully yourself by internal commands. Make sure the task connects you to your environment by leading to enjoyment and/or achievement, and is more likely to lift your mood. A special bonus might be undertaking a necessary task you might have been putting off. People then find hopefully a bettering of mood and increase in energy. This activity is not a quick fix and needs repetition. It is also helped by trying to address yourself in a kind, strong and respectful way as self-compassion can release many neuronal acres of the brain).
Important: This handout needs to be read in conjunction with the brief guide to behavioural activation. This suggests ways of freeing yourself from unhelpful rumination as described above. It could also be used with instruction with attention training technique and detached mindfulness below.
This brief outline owes a great deal to Professor Adrian Wells, the founder of metacognitive therapy. His book on “Metacognitive Therapy for Anxiety and Depression” is highly recommended and covers these issues in much greater depth.
Mindfulness and Acceptance and Commitment Therapy exercises are very helpful in managing ruminative thinking. Any activity that encourages us to be ‘in the moment’ combats the fuel for rumination such as taking a shower and focusing on the water, smells, sensations in our body. This link explains some simple ACT exercises and the basis of the therapy ACT Made Simple (actmindfully.com.au)
Seeking help
Take time to talk and reflect on what’s going on for you now. That may be talking to your partner, a family member, close friend. If you don’t feel able to open up to those close to you (perhaps as you don’t want to worry anyone), therapy can be beneficial. It offers a safe space to reflect on why you are experiencing low mood, look at positive ways to reduce and manage it, utilising practical strategies and techniques to cushion yourself.
If you are worried about a colleague, remind them about help that may be freely accessible such as an Employee Assistance Helpline, support through private healthcare, HR or occupational health teams. You may have a mental health first aider too in your organisation that has chosen to have special training on how to help people with difficulties.
Helpful links
ACT Made Simple (actmindfully.com.au)
How to Use Behavioral Activation to Treat Depression (verywellmind.com)
ACT: Acceptance and Commitment Therapy from Getselfhelp
How to stop ruminating – Access CBT
Living with – Clinical depression – NHS (www.nhs.uk)
We have a helpful section on our website about what to do if you/someone else is feeling stressed or mentally unwell Frequently Asked Questions – The Wellness Consultancy along with a list of useful self help resources on our website thewellnessconsultancy.org.
Rachel Wesley