Clients who ruminate often think of it as a helpful problem-solving tool – that if they dwell on a problem long enough, they’ll gain new insight into how to fix it.
But as we know, rumination can keep clients stuck in cycles of depression and self-doubt.
So, in the video below, Christine Padesky, PhD will share 3 specific questions that can help clients ease patterns of obsessive negative thoughts. She’ll also walk us through a mindfulness exercise that’s intended specifically to replace rumination.
Have a look.
Instead, I’ll start ruminating about something that has recently happened or that’s coming up, “Oh, what am I gonna say when I do this interview for the practitioner series.” I’ll have to think about that and maybe I just start ruminating about it, and I’m not really making any forward progress. I’m not writing anything down, I’m not taking any steps. Really what I’m doing is I’m avoiding working on writing my paper. We want to find out, am I avoiding something? If I’m avoiding something, I want to put my energy into doing something about the thing that I’m avoiding.
The answer to these questions about rumination are – Is it time to be thinking about this? Am I avoiding something? How long have I been thinking about this?
In general, once we establish that someone is doing unhelpful rumination, I generally give them like a two to three minute. I let them choose, “Do you want to have two minutes, three minutes? How much rumination do you want to do before you stop?” We literally give it a time limit and say, “At the end of three minutes, if you’re not actively problem solving, coming up with steps that are useful, then I want you to stop thinking about this and go do something. It can be something very mundane and practical like go do the dishes, or it can be something like take a walk, or it can be tuned into your sensory experiences.”
Because getting people out of their heads and into the world around them is really one of the best antidotes to rumination. I want people to get engaged with something and really pay attention to that thing. If they say, “I’m going to go for a walk,” then I’m going to say to them, “Now, how are you going to make sure you’re not ruminating when you’re walking? ‘Cause I can walk and ruminate at the same time and I’m sure you can too.” Then we’ll talk about what else could you do.
An experience I often give people is a mindfulness exercise where I’ll say to them, “Okay, while you’re out walking, I want you to play the five senses game. So I want you to notice one visual sight that you really like, and then I want you to look at that and really enjoy seeing it for a minute or two. And then I want you to go to another sense, you know, maybe find one smell you really enjoy, get up close to that smell, enjoy it. Then I want you to get one sensation. Is it the sun on your cheeks, or the breeze on your face, or is it the feel of your feet crunching on leaves or snow? And I want you to really pay attention to that and really enjoy it. And we can go tastes.” I’ll always take myself to an ice cream store if I can.”
We’ll go through the different senses and get people focusing on their sensory experiences rather than ruminating about something in their head. Usually about 10 minutes of doing some kind of activity with sensory focus is enough to get people engaged in something else.
For more expert strategies on working with depression, check out this training featuring Marsha Linehan, PhD; Pat Ogden, PhD; Richard Schwartz, PhD; Bessel van der Kolk, MD; and other leaders in the field.
Now we’d like to hear from you. How have you helped a client with depression break a rumination habit? Let us know in the comments below.
This idea of “just go do something else” completely ignores the fact that depression often makes that impossible. An inability to do the dishes or take a walk are real manifestations of depression that simple will-power is not capable of overcoming, and not recognizing this amounts to stigma.
Ruminating thoughts can be extremely hard to disrupt! One technique I suggest is that the client memorize an affirming piece of some kind; for example a prayer, passage from a religious text, poem, or lyrics from a life-affirming song (“I am woman hear me roar….”). Every time they notice the rumination happening, begin to play the mental tape of the affirmative piece. It should be at least a few sentences long and require some concentration in order to make it harder to slip back into the rumination. Repeat all day – and night – long if necessary.
This was very helpful. I can relate to each of your examples. Thank you!
Very succinct, practical and useful. Thanks.
Thank you! very helpful!
Great ideas. This is very helpful. Thanks so much ❤️
In the Mindfulness exercise, “I want” Christine to be aware of how many times she tells her client “I Want You to..whatever!” This is control freak directives ordering a person to do another’s will. Obedience is the core of this strategy. Perhaps wording it in a way that puts focus on the patient’s own cognition rather than doing what he/she/them is told would be less offensive. Don’t tell me it is just a way of expressing a thought, please.
I find it more useful to focus on the important information contained in the content rather than be entangled in the form in which the content is conveyed.
This reply is dismissive to the max. How will we ever change the systemic barriers if we refuse to hear when people tell us how things impact them? If you are trying to empower someone, then this change in language is essential.
I agree, that language could be triggering for some clients. A good reminder to be mindful of how the client is reacting to our words!
I agree that the use of “I want” could be quite triggering for some clients, although exploring the “why is it so triggering” could also be useful! However, I think using “I invite you to……” might be a better phrase than “I want you to….” in this scenario. There is an invitation to do something, thereby suggesting that the client has a choice.
Many many thanks for this!
Excellent and straightforward, thank you!!
I found this very useful and will be utilising these questions with clients where rumination is an ongoing “go to” place for them. Thank you
This was a wonderful bite to help you think about such a common problem. Thank you!! x Ute
That was fabulous, thank you!
Working with either depression or anxiety depends on whether there is trauma somewhere in the clients background. Then it’s a different task and a therapy that might require 10 years versus 3 years. I think we have many useful methods for usual cases
but where is the guidebook for truly long term work. Please – I’d love to read it.
Thank you,I found this very helpful.
I suffered from depression myself, from as young as twelve years old. The house we lived in did n’t have mains gas, we had to have bottles, which we stored in the downstairs toilet.
This particular day, I felt really down and decided I was going to commit suicide. I went and sat on the toilet and I was crying when I turned on the gas. Then the smell hit me!!!.
Needless to say, I did n’t go ahead with it but from then, I suffered terribly but never once, did I go to the doctors. I did go when I was in my twenties and was given some tablets to help me.
Thank you! Very helpful. I appreciate the free content.
Thank you! Easy and helpful
So simple and clear. Thank you
Thank you
There are a lot of hurting autistic adults out there that these trainings miss. Please let me help you help us (autistic adults). The suicide rate for autistic adults is 7 times higher than the general public and we are gravely misunderstood by mental health professionals.
Please reach out to me to learn how to help this population of hurting people. Your trainings are excellent- for non autistic people. They can be for autistic people too, with modifications.
Thank you,
Lisa Morgan M.Ed., CAS
Hi Lisa,
I’m interested o hear your recommendations. Insights and tips for working with autistic people? Thanks