Tag Archives: Ruminations

Ruminating: The Mental Health Killer


I teach a course on psychopathology. Each week we consider a different family of problems. We explore anxiety disorders, mood disorders (depression, mania), and anger/explosive disorders in the first few weeks in the class. Later on, we look at eating disorders, addictions, trauma, and psychosis.

While each of the presentations of problems vary widely from each other, there is ONE symptom that almost every person with a mental health problem experiences–repetitive, negative thought patterns. Rumination.

The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, hypervigilance, irritability, etc.) but the heart of the problem in most mental health challenges are negative thought patterns leading to an experience of either impulsivity or paralysis. These patterns can look like obsessional worries about germs (triggering ruminative “why” questions as to the root causes of the obsessions). The pattern can look like repeated negative self-attributions for perceived mistakes. Whatever the pattern, the person finds it difficult to break out of the negative thoughts and attempts at distractions seem futile since the thought or feeling returns in seconds to minutes.

Is there anything that helps?

Yes, there are things that you can do to reduce the “noise” level of these repetitive thoughts. It is important, however, to remember two important factors

  • patterns in place for years or decades are harder to change. Give yourself the grace to fail as you work to change them.
  • As with pain management, the goal should not be the complete elimination of negative thoughts and feelings. Realistically, anxious people will have some anxiety. Depressed people will feel darker thoughts. Addicts will have greater temptations. But lest you give up before you start, this does not mean that you must always suffer as you do now.

Consider the following three steps as a plan of action to address the problem of rumination.

  1. Build a solid foundation of health. Every house needs a foundation if it is going to  last. Your mental health foundation starts with your physical body: Exercise, diet, and sleep. Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of prior problems? Will this solve all your problems. No! But failing to get good sleep and eat a balanced diet of proteins will exacerbate your problems. Sleep is especially needed. The lack of it will multiply your problem. Of course, getting sleep is difficult when you are worrying or depressed. Thus, work to develop a different bed-time routine. Shut off your electronics, do mindless activities like Sudoku, develop rituals that help promote sleep. If you are having trouble with this or your diet or exercise, find a trusted person to review your situation. And avoid all/nothing thinking that often leaves us paralyzed when we can’t reach our goals. On this point, read the next step.
  2. Prepare for change by accepting your struggle. What, I thought this was helping me out of my struggle? Acceptance is the beginning of change. Consider this examples. You struggle with intrusive negative thoughts about your belly. You don’t like how it looks. You’ve tried dieting and exercise, but still it is flabby. Every time you look at yourself, every time your hand rests on your belly, you hear (and feel) that negative narrative. The first step in change is to accept the body you have and to find ways to like it, even love it. Sounds impossible but it is necessary to accept all your parts. This does not mean that you won’t continue to exercise and eat well. Marsha Linehan suggests that one part of change is to accept the problem as it is. In her Dialectical Behavior Therapy model she speaks of choosing willingness over willfulness. Willingness opposes the response “I can’t stand this belly” by saying, “my belly is not as I would like but it is not all of who I am.” “I can’t stand it…” becomes a willful and yet paralyzing response. Whereas acceptance acknowledges the reality and chooses goals that are within one’s power to achieve (e.g., healthy eating choices). Acceptance is not giving up but preparing for realistic change.
  3.  Start to move. Consider these action steps as the beginning movements you undertake in a long process towards the goal:
    1. “So what?” Our ruminations are often filled with interpretations and assumptions. There are times we can challenge them by attacking the veracity of the assumptions. But we can also ask, “so what?” So what if I have OCD? So what if have to fight every day to stay sober? So what if I have to manage my schedule so as to not trigger a bipolar episode? Challenge the worst thing that you are afraid of.
    2. Develop a counter narrative. Rumination is a narrative. Begin by writing and rehearsing a counter narrative. It won’t have much power at first compared to your internalized rumination but it will gain power over time. Work to refine it. Choose to repeat it as often as you see the trigger for the rumination. Make sure your counter narrative doesn’t include self-debasing or invalidating comments. If you have trouble writing one, use Scripture passages that speak of God’s narrative, through Christ, for you. Be encouraged that developing alternative storylines has shown capacity to alter chronic nightmares. If nightmares can be changed, then even more thoughts and feelings during the day.
    3. Practice being present. Much of our lives are run on auto-pilot. When we are in that mode, it is easy to fall into rumination. Work to stay present, to be mindful and attuned to your surroundings. Notice ruminations but let them slide on out of view and bring yourself back to the present. Use your senses that God gave you to enjoy the world he made. Smells, sounds, sights, taste, and touch all give you means to enjoy that world. Start practicing staying in tune with it, a few minutes at a time and build your capacity as you go.

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Filed under addiction, christian counseling, christian psychology, Cognitive biases, counseling skills, mental health, Mindfulness, Uncategorized

The danger of “why” questions


Most thoughtful counselees want to ask “why” questions. Why do I do what I do? Why did she do what she did? Why am I the way I am? Why am I so depressed? Why isn’t my life going the way it should or seems to go for others? Counselors too ask “why” questions. Why did you blow up at her? Why is this child afraid of going to school? And closer to home, why did my client drop out of therapy?

On the surface why questions seem to want to get to the bottom of things. We assume that if we understand the nature of the problem, we’ll know how best to respond. And there is much truth in this assumption. 

But consider their danger. Some answers to the “why” are so complex that the answer to the “why” doesn’t really point to any one answer. Further, we frequently prejudge the question with implicit answers (e.g., it is because something is wrong with me…I’m a loser…God doesn’t want me to be happy…I can’t help it that I’m this way…).

Why questions also make us passive. We look for answers; we mull over the “facts.” We are less likely to become active to do something about our situation when we are in a “why…” mode.

Let me suggest a better kind of question: What questions

What is happening? What am I feeling/thinking/doing? What is it that I want? What do others want? What am I doing about my situation? What goals do my behaviors emphasize? (this is a why question that forces us to look at our behaviors and see if they match up with our stated desires) What options are before me? Be descriptive rather than interpretive. Notice that why questions jump to interpretation but seldom activate a person to do what is in their power to do.

Frequently, by asking descriptive “what” questions, we find it easier to activate the will and begin doing something about our situation. In addition, we often come to posthoc understanding of the “why” when we have some distance from the situation.

So, the next time you find yourself stuck in the “why” set of questions, stop and try to ask yourself some what questions instead. Observe the impact of distancing from the passive whys? Does it help?

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Filed under Anxiety, christian counseling, christian psychology, counseling, counseling skills, Psychology