Obsessive compulsive disorder - OCD treatment and therapy from NOCD
What is OCDOCD SubtypesFear of ruminating

Fear of ruminating

4 min read
Stacy Quick, LPC

By Stacy Quick, LPC

Reviewed by Patrick McGrath, PhD

Oct 11, 2022

Possibly related to:

Mental compulsions like rumination can be present in any theme of OCD, and are often overlooked because they are internal and unseen. They can be sneaky, and often a person with OCD doesn’t even realize that what they’re doing is a compulsion. Nonetheless, mental compulsions 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 all of your thoughts and their outcomes.

The nature of OCD makes it easy for a person to ruminate and 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. Ruminating only strengthens the false alarm system of OCD.

As with any compulsion, the more one engages in compulsive rumination, the more anxiety they feel when future intrusive thoughts, images, or urges—called obsessions—occur, and the stronger the urge gets to engage in compulsions again and again. They are inadvertently teaching their brain that in order to feel less anxious and uncomfortable, they need to take action. The truth is that they do not need to do anything to feel less anxious. Eventually, anxiety fades, since these obsessions do not actually pose any danger.

When one ruminates in response to obsessions, on the other hand, their brain continues to believe that rumination is addressing a real threat. They may feel short-term relief from anxiety, but as obsessions continue to occur, the cycle of anxiety and rumination only becomes stronger.

Rumination can involve any long period in which an individual perseverates on a specific topic in search of an answer or in order to find relief from intrusive fear, doubt, or worry. This can occur in any subtype or theme of OCD.

  • I must solve this immediately
  • I need to know with certainty
  • Did I really say that or do that?
  • I need to replay or rethink what exactly happened or was said

Common triggers

People struggling with compulsive rumination may be triggered by any uncertain situation. They seek to answer a question or solve a problem. Triggers can take any form, because rumination can be a compulsion in any OCD theme or subtype. 

Triggers for people with rumination include:

  • Distress
  • Discomfort
  • Anxiety
  • Stress
  • Uncertainty
  • Doubting one’s memory
  • Intrusive thoughts, feelings, images, or urges
  • Physical sensations
  • Perfectionism
  • Trauma

How can I tell if I’m ruminating, and not something generally stressed or actually problem-solving? 

As a good rule of thumb, rumination is not just the initial thought that pops into your head. It is your engagement with that thought. It is done in response to an urgent desire to solve something with absolute certainty, often done in an effort to decrease feelings of anxiety and distress. 

It is also not an attempt to answer a “real-life” or practical problem. For example, you may confront a choice—even one that brings some anxiety: “Should I go to the upcoming family reunion?” By simply figuring out your decision based on practical concerns like pros and cons, your schedule, financial feasibility, and your own desires, you are not engaging in rumination. Rumination is directed toward thoughts that you find unwanted and distressing, done in an attempt to erase uncertainty and anxiety. 

How to treat fear of rumination

Rumination in any form of OCD can be debilitating and take over people’s lives, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with a specialist who is trained in OCD, you can learn to free yourself of the mental compulsion of rumination. ERP works through the process of habituation. This essentially means that you “get used to” the discomfort you feel when faced with intrusive thoughts, worries, and the uncertainty that comes with them. The more you are exposed to your obsessions without responding by engaging in rumination, the more comfortable you become with them, and the less of a response you have to them. Over time, you can even begin to feel less distress when your obsessions occur

If you are struggling with ruminating on intrusive thoughts, ERP 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 learn to manage intrusive thoughts and mental compulsions is to work with a therapist with training 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

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.

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