At the Cognitive Health Group we have treated hundreds of cases of emotional disorders – problems like panic, phobias, generalized anxiety, depression, OCD, and the emotional distress associated with tinnitus & hyperacusis. While many factors converge to produce these debilitating symptoms, it is clear that obsessive thought processes are often at their root. The information that follows will help you understand two important forms of obsessive thinking – worry and rumination – and provide some practical tools to address them.
Healthy Worry. Worry is an anxious preoccupation with an anticipated negative event. Worry helps us adapt by directing attention to true problems that once identified can then be addressed. In this way worry is effective in managing the many, real challenges of life.
Unhealthy Worry. For some people the adaptive process of worry breaks down. Their worries no longer motivate effective problem solving and instead they become stuck in thinking about everything that could go wrong. They are plagued with thoughts and images of disastrous outcomes that in reality may never come to be.
Dwelling on the Past. While obsessive worry is focused on future outcomes, rumination is an uncontrolled preoccupation with the past. Rumination is experienced as guilt, regret, anger, over perceived mistakes, losses, slights, actions taken or not taken, opportunities forever lost. Rumination is often accompanied by excessively harsh criticism and the overwhelming belief that if things had only been different then existing and future misery could have been avoided.
The Damage Done. Worry and rumination intensify and prolong distressing emotional states. Worry reinforces anxious feelings – you literally scare yourself – which, in turn, only leads to more worry. The process can extend into anxious periods lasting hours, days, weeks, even years, at times spiraling into panic attacks and emotional “spikes” of anger, guilt and shame. Rumination reinforces feelings of sadness, hopelessness and anger, and if left unchecked, can sink into depression and withdrawal.
“Stopping” the Thoughts. Unfortunately, breaking the cycle isn’t as easy as just snapping out of it. There’s no/off switch for obsessive worry and rumination. Simply telling yourself to stop is like pushing a beach ball under the water. The harder you push, the farther it will pop up! But there are a few strategies that, when applied with patience, can keep over-thinking from overtaking your life.
Cognitive Behavior Therapy (CBT)
Cognitive-Behavior Therapy is an evidence-based, practical treatment for obsessive worry and rumination. CBT is as an action-focused form of psychotherapy that seeks to reduce the intensity and emotional impact of destructive thought patterns like worry and rumination. CBT works by 1) changing the beliefs underlying worry and rumination, 2) minimizing engagement in the obsessive process, and 3) committing to the hard work of developing true sources of emotional reward.
Cognitive Restructuring is a core CBT skill that helps you step back from emotional thinking, to nurture a balanced, “wise” mind that is both informed by emotions and grounded in reason. Cognitive restructuring “puts your thoughts on trial,” separating the facts from the fictional spin your mind has come to place on them. The goal is to develop a supportive inner voice, better manage strong emotions, and more effectively guide you toward your goals.
Acceptance & Mindfulness: Rather than battling and bracing against unwanted realities – like an unchangeable past and uncertain future – acceptance strategies help conserve precious emotional resources, and redirect these resources toward practical, achievable goals. Mindfulness, the experiential practice of acceptance, helps build emotional muscle to better tolerate the inevitable challenging emotions that arise as you activate toward your goals.
Behavioral Activation: The ultimate aim of CBT is to help you get out of your head, i.e., disengage from obsessive worry and rumination, and into the process of living a full, meaningful life. The process of working toward specific, achievable goals creates opportunities to practice and master CBT skills and to obtain valuable emotional rewards. In this way, through determination and hard work, one may truly create a life worth living, a life in which worries and regrets take a back seat to the value inherent in each, present moment.