How does ruminating about an obsession in OCD differ from worrying, generally?
Usually, worrying makes you feel anxious about something provable that has already happened or could happen in the future. Ruminating, on the other hand, is dwelling on intrusive thoughts about specific themes (e.g., harm coming to oneself or others). This type of mental review increases anxiety and doubts about what has or will happen relating to the harming obsession.
When addressing worry, we tend to use a combination of intuition while also reasoning with facts. This way, we usually find a satisfactory solution. Once the problem is solved, we move on. For pervasive concerns, such as those linked with a generalised anxiety disorder (GAD), it might be a little more complicated, especially when depression is involved. Still, again, ways to manage problems can be worked on by generating helpful strategies.
However, when people ruminate about an obsession, they tend to search for answers, repeatedly. By mentally scrambling around for solutions, albeit unsuccessfully, they worsen the problem. A person will deliberate about lost opportunities, disappointments, if-only statements and regrets. Also “shoulds” and “musts” come into ruminations, such as ‘I should have prayed harder’, ‘I must double-check my work is hundred percent’ or ‘If only I didn’t have OCD, I would be a better person’. Sorrow, grief, what to do about this or that, how to protect oneself or others, and fear about the future and what it holds, all add to the person’s problem.
So what’s the answer? Well, first, and before anyone can start to put helpful strategies into place, it’s important to recognise when negative reflection is happening. It helps to identify that while obsessions and ruminating both take place in the mind not to confuse the latter as the obsession. It can further help to remind oneself that ruminating is a thinking behaviour and, therefore, a corresponding mental compulsion related to the obsession.
For example, if the obsessive thoughts are that harm might come to oneself or someone else, then the thinking behaviour will usually be going over the “what-if” scenarios and fearing the worst. By identifying that you are ruminating, you are, in effect, doing what you would do when you notice yourself doing any other compulsion. You would then resist the thinking behaviour as you would with all other compulsions, which helps reduce obsessive thoughts.
By exercising control and becoming more aware of mental rituals, you can learn to “shift state”. It means being in the present, and using your five senses as you move your mind and body to something else, or being mindful of what you’re already doing. For instance, if you like the outdoors, you might choose to spend time in the garden, or the park. You would then practice being mindful of the scents, what you can touch, the sounds, and what you can see. Having a packet of strongly flavoured sweets in your pocket can be useful since you can pop one in your mouth and mindfully direct your attention to the taste.
But isn’t this like blocking obsessional thoughts, won’t ruminating start up again?
No, because obsessive thoughts are involuntary and cannot be controlled, but behaviours can be controlled, whether mental or physical. And so in this instance, you would be stopping a negative response when you shift state, not trying to stop an obsession. In other words, you would Acknowledge the intrusive thoughts are there, Accept they are there and Allow them to come and go while staying in the present. Leaning into raised anxiety while practising mindfulness is essential, too, because it teaches you that you can hold yourself up until anxiety reduces in its own time. By bearing with associated distress, you build a tolerance to it, and this is what leads to becoming less sensitised to the obsessional fear.
How can I make sure I don’t go back to ruminating?
One useful tip is to persuade yourself that any further ruminating will be given attention to in one hour. You would allow yourself a strict amount of time, let’s say 10 minutes only for mental review. It might be that when an hour passes you’ll have forgotten to come back and address the issue. However, if after an hour passes and you’re hard-pressed to fall back into ruminating, then ask yourself where it will lead? Next, persuade yourself to come back in another hour. The way out of this spiral is to be stubborn in training yourself to resist becoming preoccupied with negative thinking. Instead, becoming more in control of rationally prioritising your thoughts can help you find workable solutions.
In sum, ruminating happens when you deliberate at length about the problem. This circular thinking usually involves self-questioning. For example, ‘How do I know if I won’t hurt myself or someone else?’, ‘How can I prove or disprove I’m not gay?’, ‘I experienced a groinal sensation while holding my child, what if this shows I’m a paedophile?’ When all questions have been exhausted, they start over again. Mindfulness and the “shifting state” method can enhance exposure-response prevention in this type of situation. It helps you to more readily challenge your fears step by step (exposure) and resist all compulsions (response prevention) towards recovery.
Intuition and rational thinking can help provide solutions for general worries or for people who have a generalised anxiety disorder. Obsessions are involuntary as opposed to ruminating, which is a purposeful behaviour to search for answers that cannot be found in the mind. Since ruminating is a choice, it can be resisted. Shifting state is a helpful solution for ruminations since it is a strategy that helps you mindfully distract. By acknowledging, accepting and allowing intrusive thoughts to come and go during mindful exposures while resisting all compulsions, is essential. Also, leaning into raised anxiety and allowing the symptoms to reduce naturally is important when using this method.
© Carol Edwards 2018 Updated 2019.
Get a FREE online counselling consultation with Sunil Punjabi
Sunil Punjabi is a confident therapist and highly recommended for his expert approach in delivering exposure-response prevention for ruminations among other obsessional problems.
Sunil is available
- In-person, over the phone, or online, so that distance is not a constraint
- Between sessions, for quick consultations, if you get stuck somewhere
- To the caregiver for coping with the stress
Find more about what Sunil does at unshackle.in.