Is Rumination a Form of OCD?
Obsessive-compulsive disorder (OCD) is an incredibly common mental health disorder, affecting millions in the United States alone. OCD features a cycle of unwanted, intrusive thoughts known as obsessions and ritualistic behaviors referred to as compulsions.
Often, people are familiar with OCD because of stereotypes portrayed on television or in movies, such as someone constantly checking that doors are locked or being a “clean freak.” In reality, there are many subtypes of OCD, and symptoms can vary widely from individual to individual.
Each individual with OCD faces specific triggers that launch their cycle of obsessions and compulsions. While the cycle is present among all manifestations of OCD, an individual can experience obsessions on a wide range of subjects, such as contamination fears, worries of harming someone, uncertainty about their sexual orientation and more.Similarly, compulsions can vary from person to person as the behaviors are done in an effort to bring a someone a sense of relief from their obsessions and the accompanying distress. Here are some common compulsions:
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- Seeking reassurance that nothing bad will happen
- Avoiding certain people or places
- Excessively checking that the oven is off
- Counting or tapping to a certain number
What is rumination?
Rumination is the process of continuously thinking about the same thoughts and feelings, often to a much more extensive level than warranted. Since rumination centers on thoughts, this may seem like a form of obsession. However, this is not the case.
Obsessions simply occur, hence why they are often referred to as intrusive thoughts. If you have OCD, you have likely experienced the sensation of an obsession seemingly popping in your head out of nowhere. With obsessive thoughts, you don’t feel like you have a choice in thinking about them.
On the contrary, rumination is typically viewed as a choice. It’s done to try to figure out where your fears are coming from, what you should believe or what you should do to prevent something bad from happening. To this extent, rumination would then be considered a compulsion.Rumination can often feel like a form of obsession, as you may feel like you have no choice in following the train of thought. However, this is because of the negative feelings associated with your obsessions, which often lead you to feel you must engage in a compulsion (like rumination) in order to ease your distress. In short, your obsessive thoughts occur in an instant, and any further mental engagement with them is considered to be compulsive rumination.
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How do I stop ruminating?
Since rumination is a compulsive behavior, you can treat it as you would any other compulsion. One of the most effective ways to help people resist engaging in compulsions is a form of cognitive-behavioral therapy called exposure and response prevention (ERP) therapy.
ERP therapy is known as the gold-standard treatment for all forms of OCD, as it helps people better tolerate the uncertainty caused by obsessions, which subsequently lessens the urge to enact compulsions. In ERP sessions, your therapist will work with you to expose yourself to the things that trigger your OCD cycle and work with you to allow your intrusive thoughts to simply exist — without acting on them. The more you experience your obsessions without engaging in compulsions, the more you’ll learn to endure the uncertainty and uncomfortable feelings. Over time, you’ll feel less and less inclined to ruminate or act on any of your other compulsions.
One of the most important things associated with ERP therapy is the response prevention element. If you engage in compulsions following an exposure, it undermines the learning you are trying to acquire (e.g., that nothing bad will really happen or that you can handle your discomfort). In your daily life, when you feel your obsessions begin, it’s crucial to continue resisting your compulsions to refrain from reinforcing the OCD cycle. Specifically, you will want to work on letting your intrusive thoughts pass without beginning a rumination cycle. This will likely feel very difficult — or even impossible — at first, but the more you work on it the easier it will get.
How can I begin ERP therapy?When seeking a therapist to work alongside you in ERP therapy, it’s important to find someone who has experience in the treatment of OCD and ERP. Luckily, all NOCD therapists specialize in the treatment of OCD and have received specific training in ERP therapy.
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To begin working with a NOCD therapist, you start by scheduling a free call with our clinical team. Our team will help match you with the right therapist and, shortly after, you can begin ERP from the comfort of your home through video sessions or phone calls.
While it may feel like you will never be able to stop ruminating on your obsessive thoughts, change is possible. ERP can help you refrain from compulsive responses allowing you to find freedom from the seemingly endless cycle of obsessions and compulsions.
Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.
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Licensed Therapist, MA
I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.
Licensed Therapist, LCMHC
When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.
Licensed Therapist, MA
I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.