Obsessive compulsive disorder - OCD treatment and therapy from NOCD

The Rumination Trap

6 min read
Stacy Quick, LPC

One of the questions I get asked most by people starting OCD treatment is “how do I stop ruminating?” The answer seems straightforward enough: you can make a choice to stop. In reality, learning to stop ruminating is one of the most difficult things a person with OCD will do. It’s one thing to know something must be done and another to do something. This is a tremendous burden people with OCD often face. 

What is rumination?

Rumination occurs when you have constant and repetitive thoughts about something; it may involve making repeated attempts to solve a perceived problem you’re having. When you ruminate, you are directing a lot of your attention to a particular thought. It’s the difference between having a thought which can go away as quickly as it appeared, and being actively focused on a thought that you’re fixated on and that may be interfering with daily functioning

Rumination is a mental compulsion. For people struggling with OCD, rumination can look like engaging with an intrusive thought in an effort to figure it out. It can involve searching for an answer – specifically, needing to feel certain about it. You attempt to make sense of the intrusive thought or try to rationalize it. It may even look like trying to reverse the thought or move on from it with a feeling of assurance or peace. I would describe it as going down a rabbit hole, or being caught up in an endless loop. 

Mental compulsions are often overlooked because they are internal and unseen. They can be sneaky, and often the person with OCD doesn’t even realize that what they’re doing is a compulsion. Yet mental compulsions, after all, do what any other compulsion does: they reinforce the idea that an intrusive thought is dangerous, and deceive your brain into believing that it controls the outcome of the thought. 

One member I worked with would have the repeated intrusive thought that his partner would become ill if he didn’t properly prepare their food. In an effort to feel less anxious about this and to convince himself that his partner would not become ill, he would replay in his mind every step he had taken to prepare the food. He would picture it in his mind and walk through it repeatedly. He would do this several times until he felt convinced that he had taken the proper precautions. Some days, this could take hours, but he could not move forward with his day until he felt that this had been resolved. 

Why do people with OCD ruminate?

OCD is called the “doubting disorder” for many reasons: people with this illness often doubt their memories, the meaning of their thoughts, their values, etc. OCD distorts how they see things and the experiences they have. OCD often leaves them feeling unsure and forces them to seek comfort or reassurance. 

The nature of OCD makes it easy for a person to ruminate and to focus on justifying what they’re doing. After all, many people ruminate on problems they think they’re having in an attempt to solve them. The issue here is that with OCD, there is not necessarily any real problem or danger. Choosing to ruminate only strengthens the false alarm system OCD creates. 

As with any compulsion, the more you do it, the more the alarm continues to go off. You are inadvertently teaching your brain that in order to feel less anxious and uncomfortable, you need to take action. The truth is that you do not need to do anything to feel less anxious. Eventually anxiety fades. 

Even more pleasant emotions, such as joy, fade on their own. There’s nothing you have to do to stop feeling those emotions; the feeling simply moves on after a while. When something is funny, you don’t laugh forever – eventually you stop, without having to do anything. 

But when feelings of discomfort occur for people with OCD, the brain can send off a signal that there is a danger when there is not. This signal tends to create a high level of intolerance for feeling uncomfortable and causes people with OCD to try to avoid this feeling as much as possible. In order to overcome this, your brain must relearn the signals, which can occur through habituation. 

What is habituation?

Habituation occurs when a person stops responding or paying attention to a stimulus – such as a thought, object, place, person or action – with repeated exposure to that stimulus. This essentially means getting used to something that you don’t like or that doesn’t feel comfortable. 

A personal example of habituation is that I grew up with a train track in my backyard. The train would always go over the tracks around 1am each day and would shake the entire house, that’s how close it was. Though I was acutely aware of it at first, after living there for a few weeks, I no longer paid attention to it. It didn’t wake me up in the middle of the night or cause me to get scared. I habituated and adjusted to it. I no longer noticed it or was bothered by it. The more I experienced it and saw that it was not dangerous, and that nothing bad happened, the less I even thought about it. I eventually stopped thinking about it altogether. 

The same is true for feared stimuli: the more someone is exposed to them, the more comfortable they become with them, and the less of a response they have to them. They began to build a tolerance to the thing that was once very distressing.  

Addressing rumination, since it’s a mental compulsion, works in the same manner. Once you stop ruminating or engaging with the thought, the “false alarm” goes off less and less. The more you do this, the more it becomes habitual. Initially you may find yourself starting to ruminate and catch it. It’s important in these moments that you give yourself compassion and try again. It requires dedication and practice. Guidance from a specialty-trained professional will help.

Learn to stop ruminating

If you are struggling with ruminating on intrusive thoughts, exposure and response prevention (ERP) therapy can teach you how to stop engaging with the thoughts causing your distress. You will learn how to sit with uncomfortable feelings and resist the urge to do compulsions. You will see that anxiety, like any other feeling, eventually passes, and you don’t have to do anything to make this happen.

The best way to practice ERP and manage intrusive thoughts and mental compulsions is to work with a therapist trained in ERP. At NOCD, our therapists specialize in OCD and ERP, and they will provide you with a personalized treatment plan designed to meet your unique needs. Your therapist will teach you the skills needed to begin your OCD recovery journey and will support you every step of the way. They will guide you in taking small steps to reach your goals.

Our team of therapists at NOCD are passionate about the treatment of this debilitating disorder and are trained by world-renowned experts. To learn more about working with an NOCD therapist, schedule a free call with our care team.

Stacy Quick, LPC

Stacy Quick LPC, is a therapist at NOCD, specializing in the treatment of OCD. She has been working in the mental health field for nearly 20 years. Her goal is to help members achieve skills to help them live a more fulfilling life without letting OCD be in control. Ms. Quick uses ERP and her lived experiences to help her members understand it is possible to live a life in recovery. She is a mother of 3 children, 2 of whom are also diagnosed with OCD. Ms. Quick is also a writer and content creator. Learn more about Stacy Quick on Instagram: @stacyquick.undone

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

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.

Madina Alam

Madina Alam

Director of Therapist Engagement

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.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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