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Lessons Learned on Rumination

Rumination (i.e., the compulsion that tries to “figure it out”) is such a difficult compulsion to manage, I’ve already written about it twice (here and here). Individuals with Obsessive-Compulsive Disorder (OCD) might spend hours per day ruminating. In treatment, they often have to try out a few different techniques before learning how to reduce this compulsion.

I’ve compiled a few more ideas that have worked for my patients with OCD. Sometimes you just hit on the right metaphor and it clicks.

Note: Some OCD experts would argue that you should never delve into the “content” (i.e., specific fear/theme) of OCD. Through some of these strategies, you might dive into the content in order to come to the conclusion that it is irrelevant.

Validate and Turn Away

Sometimes people ruminate because the thing they’re thinking about is really important to them and related to their values. For example, Angel, who highly values her religion, may believe that the answer to the obsessive question “Am I going to Heaven or Hell?” is extremely important. However, her rumination on this question likely leads to excessive distress and never a 100% answer.

Validation is a skill that involves showing someone that we understand their thoughts, feelings, or actions in context. For example, you might say to someone, “I understand how worried you must be about your surgery next week.” Validation helps others feel heard and understood.

Someone with OCD could validate their own urge to ruminate.

But wait, if I validate, am I saying it’s okay??

No, validation can show understanding without approval.

If Angel noticed herself caught in rumination, she might validate herself by saying something like this: “I know it feels really important to answer this question, because my salvation is very important to me. I also know that the longer I allow myself to ruminate and try to answer this question, the worse I will feel. So, I’m not going to try to answer this any longer today.”

After validating herself, hopefully Angel would more easily be able to shift her attention to a mindful or values-based activity, moving away from rumination.

Leave the Slot Machine

Sometimes people with OCD report that rumination feels good. They feel like they’re problem solving or getting close to finding the answer to their obsessive question.

Think about playing the slot machines. Pull the lever, hear the bells, win! Pull the lever, hear the bells, win! Feel the positive reinforcement! Repeat until... you’ve lost all your money.

It’s the same with rumination. It’s good until it’s bad. You will almost always go down the rabbit hole until you feel worse than when you started. It may just be better to not start at all (or quit very very soon, while you’re still ahead).

Be Coy with the Reporters

Have you ever seen a politician or celebrity who’s an expert at answering a question without... actually answering the question? Maybe they were asked about a personal scandal and somehow they’ve moved on to an unrelated political issue. If they don’t have to answer every question they’re asked, why do you?

Picture OCD as a crowd of reporters. It’s asking all these questions that you feel the need to answer:

Is my life like The Truman Show?

Are we living in The Matrix?

Does life have purpose?

Instead of trying to answer these questions (through rumination), what if you just didn’t answer at all? You could say, “Next question” or provide a totally unrelated answer like a politician.

Does the Answer Matter as I’m Living Toward My Values?

Sometimes a specific question does not need an answer (through rumination) when taking into account someone’s values. Let’s take the following example...

Elizabeth is in a monogamous relationship with her fiancé, Todd. She was diagnosed with OCD as a teenager and it has rotated through several themes. Elizabeth and Todd plan to get married next year. Elizabeth starts to have the obsessive thought, “What if I’m bisexual?”. She feels she must find the answer to this question before her marriage, or she will be a fraud to herself and unfair to Todd. She engages in several compulsions, including rumination, trying to find the answer to this question.

Elizabeth highly values her romantic relationship and the concept of marriage. She and Todd, being that they practice monogamy, would not be engaging in romantic or sexual relationships with other people. Rumination never leads to certainty, so Elizabeth will never know with 100% certainty if she is bisexual or not. Eventually, Elizabeth realizes that, even if she were bisexual, she would still be engaged in this relationship with Todd. So, while the goal of rumination is to answer “yes” or “no” to the question of her sexuality, the answer is actually irrelevant when taking into consideration her value as a whole.

So, how does this help in the moment of trying to prevent compulsions? The next time that Elizabeth is tempted to engage in rumination to answer this question, she can more confidently respond, “Actually, the answer doesn’t matter” and try to mindfully move away from this compulsion.

[Note: This example is specific to Sexual Orientation OCD; these strategies are not what would be recommended for someone exploring their sexual identity.]

Another example: Let’s say I’m trying to answer the question, “Am I doing a good enough job as a therapist for my patient, Timmy?” by ruminating on everything that has ever happened in our sessions. Assuming my value is something like, “I want to be the best psychologist I can be,” this again makes the answer irrelevant. If I’m doing a great job with Timmy, go me. If I’m doing a terrible job with Timmy, I might be learning something really valuable that helps 10 other patients in the future. Whether the answer is “yes” or “no,” I am still working toward my value of being the best I can at my job.

Translate What OCD is Really Saying

Imagine if your friend came to you every day asking you questions such as:

“Is my outfit alright?”

“Does my hair look okay?”

“Should I post this picture on Instagram?”

Let’s say they were just seeking reassurance on these things constantly. How might you feel? Maybe annoyed.

Now let’s say that your friend came to you one day and said, “I’m sure I annoy you all the time with my questions. I have a fear deep down that I’m ugly, so I’m always trying to make sure I look okay.”

How would you feel in that moment? You’d probably have a deep outpouring of compassion for your friend. If every time she asks, “How do I look?” you could translate it to “Help! Am I ugly??” you’d probably never feel that annoyance and have a huge urge to help your friend (even if helping her means not answering this question directly).

With OCD, often the core fear could be translated either to “You’re bad” or “You’re unsafe.”

Imagine if you had a bully following you around all day saying, “You’d bad! You’re bad!” How terrible would that be?? You might start to believe it after a while. Well, with OCD, sometimes it is like being told “You’re bad” all day long. Realizing that, you might have that deep outpouring of compassion for yourself. This is HARD and no wonder you’re reacting so strongly and feeling a need to do compulsions!

Now, what if someone followed you throughout your daily activities and said, “You’re unsafe!!” constantly? You might actually think it’s funny at times. You’d probably want to respond, “I’m totally fine. I’m just unloading the dishwasher. You don’t have to try so hard to protect me.” Maybe OCD is just a little overeager about keeping you safe. If you realized what it’s saying, you might want to reassure it that you’re okay.

In translating what OCD is truly saying, you might be able to prevent even having an urge to ruminate, because you know the underlying message is faulty.

I hope you’ll find some of these metaphors and strategies helpful. Please let me know your thoughts in the comments below.

To learn more about OCD, go here.

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