OCD Schoolhouse Rock: Rumination Station
Rumination is the trickiest compulsion. It leaves no physical evidence, and it’s hard to distinguish from ‘normal’ thinking. This means we need to get crafty in fighting it.
Let’s back up and answer... What is rumination? Within Obsessive-Compulsive Disorder (OCD), there are two key concepts: obsessions and compulsions. Obsessions are intrusive thoughts, images, or urges that bring up anxiety, disgust, or other strong emotions. For example, someone might have the obsessive thought, “What if my mom gets injured?”. Compulsions are the brain’s response to the obsessive thought: They serve to decrease the distress and increase the certainty around the thought or image. In response to the obsessive thought, “What if my mom gets injured?” someone with OCD might engage in a compulsion designed to keep their mother “safe.” For these sorts of fears, the compulsions are often ‘magical,’ such as having a repeat a phrase or count to a certain number. For someone with OCD, they use their compulsion, feel less anxious for a moment, and then (usually) the fear creeps back up.
Rumination is an unseen compulsion, because it is a mental process. Rumination usually involves thinking about something A LOT trying to ‘churn through,’ find the answer, or get more clarity/certainty. For example, let’s say we had someone with OCD who is having doubts about dating. They might get in a loop of thoughts while on a date such as:
“What if I don’t like him as much as I thought?”
“What if I’m not as attracted to him as I should be?”
“Am I feeling a connection right now?”
“What if Brad Pitt is my soul mate and not this guy?”
Engaging in trying to answer these questions would be rumination. And what would be the result? Probably, this person would not have the best date, because they’d be stuck in their head the whole time! (Also, they’d probably never find the “perfect” answer to these questions.)
This is why I said rumination is so tricky. It seems like ‘normal’ thoughts, but it’s actually a compulsive process that keeps you stuck in OCD and not enjoying the moment. Now, for the person on the date, are these all normal questions to ask yourself on a date? Potentially. But, for someone with OCD, they will get stuck in trying to answer them. And that’s why we want to learn to cut off rumination.
For lot of people with OCD, once they learn this concept of rumination, they realize they are doing it almost constantly throughout the day! It can be really hard to stop it, and it’s very difficult to recognize when a regular stream of thoughts is starting to turn into rumination. It can take a lot of trial-and-error to find a strategy that works.
So, here I am, just presenting one possible strategy, which some patients have found very helpful. The first thing we need to do is even recognize that we are engaging in rumination, or we won’t be able to stop it. This is a tool to call ourselves out for ruminating, hopefully find some humor in it, and then use other tools to mindfully disengage from this compulsion.
Remember Schoolhouse Rock? They had that catchy song with the line, “Conjunction Junction, what’s your function?” (If this isn’t flooding in a memory, please watch the video here.) I like to take that line and change it to, “Rumination Station, what’s your expectation?”. This is just a silly way to call attention to the compulsion, ask ourselves how we got here, and try to move on.
So how would we use this? Let’s go back to the person on the date. Hopefully, at some point, they would catch themselves hardcore ruminating. Then, they’d sing to themselves in their mind, “Rumination Station, what’s your expectation?”. Hopefully this would call attention to what’s happening and produce a laugh. Now, “What’s your expectation?” is a reasonable question to ask in this situation. What are you trying to get out of answering all these questions? Do you really expect to figure out if this person is your soul mate on date #1? And will you ever know if you’re interested in them if you stay stuck in your head for the whole date?
Then, it’s this person’s job to use their other therapy skills (mindfulness, response prevention, etc.) to see if they can disengage from rumination, actively engage in their date, and decide later whether they want to ghost or go for date #2.
Sometimes we just need to try something cutesy and silly to see if we can help ourselves get unstuck from OCD. Is this trick the cure to OCD? Of course not. Might it be helpful to try to decrease rumination? I sure hope so!
P.S. If you read this and thought, “OMG is she reading my mind!?” and haven’t engaged in an evidence-based treatment for OCD before, consider these tips for finding an OCD specialist or visit iocdf.org for more information.
Comment: What are your other go-to tricks for tackling rumination?