How does ruminating about an obsession in OCD differ from worrying, generally?
Usually, worrying makes people 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, such as harm coming to oneself or others. Intrusive thoughts are often referred to as having obsessive-compulsive disorder (OCD) that has two components (obsessions and compulsions). Ruminating is a type of mental compulsion that increases anxiety. Subsequently, it strengthens one’s fears about about what has or will happen.
How we resolve worry
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. Even with pervasive concerns, such as those linked with a generalised anxiety disorder (GAD), problems can be worked on by generating helpful strategies.
Searching for answers
However, when people who have OCD ruminate about an obsession, they tend to search for answers in their heads where there are none. They dwell on lost opportunities, disappointments, if-only statements and regrets. Also negative 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 themselves or others, and fear about the future and what it holds, all add to the problem.
So what’s the solution?
First, and before someone can start to put helpful strategies into place, it’s important to recognise when ruminating is actually happening. It helps to identify that while obsessions and ruminating both take place in the mind not to confuse the latter as the obsession. As noted already, ruminating is a thinking behaviour, a corresponding mental compulsion related to the obsession.
To clarify, if the obsessive thoughts are that harm might come to themselves or someone else, then the thinking behaviour will usually be going over the “what-if” scenarios and fearing the worst. By identifying that they are ruminating about their fear, people can learn to resist it like any other compulsion, which helps to reduce the intrusive thoughts.
How can people resist ruminating?
People can learn to be in the present and use their five senses as they move mind and body to something else, or being mindful of what we’re already doing. For instance, if your someone who likes the outdoors, you might choose to spend time in the garden, or the park. You would purposely practice being mindful of the scents around you, what you can touch, the sounds you can hear, and what you can see. Having a packet of strongly flavoured sweets in your pocket can be useful because you can pop one in your mouth and mindfully direct your attention to the taste.
But isn’t mindfulness like blocking obsessional thoughts, won’t ruminating start up again?
No, because intrusive 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 compulsive response when you shift state, not an obsession. In other words, you would Acknowledge the obsessive thoughts are there, Accept they are there and Allow them to come and go while staying in the present and continuing to do what you’re doing.
But what about anxiety?
Leaning into raised anxiety while practising mindfulness is essential. It’s because it teaches people that they have the stamina to work through a mindful exposure until anxiety reduces in its own time. By bearing with associated distress, they can build a tolerance for it, and this is what leads to resilience and becoming less sensitised to the obsessional fear.
How can someone resist going back to ruminating?
One useful tip is persuading oneself that any further ruminating will be given attention to in one hour. After an hour has passed, it might be that they’ll have forgotten to come back and ruminate. However, when the hour passes and they’re hard-pressed to fall back into mental review, they can ask themself, “Where will it lead”? They can then persuade themself to come back in another hour.
How else can Mindfulness help?
It can help enhance exposure-response prevention. First, and as we’ve seen already, ruminating happens when we deliberate at length about a problem. This circular thinking usually involves self-questioning. For example, “How do I know something terrible won’t happen, if I don’t do X, Y or Z?” When someone has gone through all the questions, they tend to start over again. Mindfulness works well with exposure-response prevention. It helps people face their fears step by step (exposure) and resist all compulsions (response prevention) towards recovery.
© Carol Edwards 2018 Updated 2019.
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My colleague, Sunil Punjabi, is a confident therapist and highly recommended for his expert approach in delivering exposure-response prevention for ruminations among other obsessional problems. He does call and skype and offers a sliding scale. Ask me for details here.