We all worry and ruminate sometimes. When we’re anxious, we tend to worry more. Similarly, when we worry, we tend to feel more anxious! Worry is therefore both a cause of anxiety and a consequence of it. Like many things our brains do, worrying can seem to serve an important function. Perhaps we believe it helps us solve problems, prepare for difficult situations or remain vigilant to potential threats. However, worrying is often quite futile, particularly when it involves dwelling on hypothetical situations. After all, it’s very difficult, if not impossible, to solve a problem that hasn’t actually happened.
What’s more, worrying can distract us from the here and now, making it harder to focus on what’s actually happening around us. And yet, despite its limitations, many of us learn that worrying is somehow helpful. Perhaps this is because so often when we worry, things do actually turn out okay. But was that because we worried, or because things were likely to work out anyway?
So, when does rumination become compulsive?
In OCD, compulsions often feel extremely necessary, and it can be very difficult to resist their pull. There’s frequently a central doubt or question that feels increasingly important to answer. For example:
What if I don’t really love my partner?
What if I’ve done something terrible and forgotten about it?
What if having this thought means I’m a bad person?
What if I’ve overlooked something important?
Someone might spend hours analysing these questions, reviewing past events, examining their feelings or searching for evidence that their fears are unfounded. The more they think about the question, the more important it can seem to find an answer. And yet, the answer rarely feels satisfactory for very long. A new doubt appears, or the person begins questioning the conclusion they’ve just reached. So they start thinking about it all over again.
How is this different from ordinary problem-solving?
I think the most useful distinction is often the function of the thinking. Problem-solving generally involves considering a genuine problem, identifying possible solutions and taking practical action. Compulsive rumination, on the other hand, tends to revolve around trying to resolve uncertainty, reduce distress or obtain reassurance about something hypothetical. The thinking can become repetitive and circular, without leading to any meaningful conclusion. People sometimes describe feeling as though they’re on the verge of finally working something out, if only they could think about it for a little longer. Unfortunately, that sense of being almost there can keep them trapped in the process.
It's also worth recognising that rumination isn't necessarily compulsive simply because it lasts a long time. We might spend considerable time thinking about an important decision or trying to understand a difficult experience. The distinction is whether we're engaging in a useful process of reflection or becoming trapped in an increasingly repetitive attempt to feel certain or safe.
Isn't rumination involuntary?
This is another important question. Intrusive thoughts often appear spontaneously, without us choosing to have them. Rumination can also feel automatic, particularly when we've been engaging in it for a long time. However, there is a difference between an intrusive thought appearing in our awareness and repeatedly engaging with that thought through analysis, mental checking or attempts to resolve it. For example, someone might suddenly experience the thought that they don't really love their partner. That thought may be entirely involuntary. What follows, however, might involve repeatedly checking their feelings, mentally reviewing their relationship or comparing their experiences with those of other couples. These processes can become compulsive attempts to resolve the uncertainty the original thought created. Recognising this distinction can be an important part of treatment. It helps us notice when we're getting caught up in compulsive thinking and practise responding differently.
Of course, this doesn't mean we can simply switch rumination off whenever we choose. Changing established thinking patterns takes time and practice.
How do we stop compulsive rumination?
The aim isn't to force thoughts out of our minds. Trying not to think about something can quickly become another struggle with OCD. Instead, we can practise allowing intrusive thoughts and the uncertainty they bring to remain unresolved. This might involve recognising the urge to analyse a question, choosing not to engage in the usual mental rituals and returning our attention to what matters in the present moment. This is consistent with exposure and response prevention (ERP), a central component of CBT for OCD. In this context, response prevention involves resisting the urge to perform mental compulsions, rather than simply stopping more obvious behaviours such as checking or reassurance seeking.
Initially, this may feel very uncomfortable. OCD can create a powerful sense that we must resolve the question before we're allowed to move on. But over time, resisting compulsive rumination can help weaken that sense of urgency. We gradually learn that we can carry on with our lives without having to find answers to every intrusive doubt.
The important distinction
Thinking isn't inherently a problem. Neither is worrying occasionally or reflecting on difficult experiences. The difficulty arises when thinking becomes a repetitive attempt to achieve certainty, neutralise a perceived threat or relieve anxiety. In OCD, rumination can become just as compulsive as checking, washing or seeking reassurance. And because it happens entirely in our minds, it can be particularly difficult to recognise. Learning to identify these mental compulsions, and gradually changing how we respond to them, can be an important step towards overcoming OCD.