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3 Questions to Help Clients Interrupt the Depression-Rumination Loop

31 Comments

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.

 

Click here for full transcript
When you catch yourself thinking about something, I want you to ask yourself a couple of questions. The first thing I want you to ask, “Is this the right time to be thinking about this?” Now, I asked that question because a lot of people, when they’re depressed or anxious, they ruminate a lot in the middle of the night. They wake up and they start to ruminate about something.Even if it’s good problem solving, 3:00 AM is rarely the best time to do problem solving. So the first question is, is this the time to be thinking about it? If it’s not, I’m going to do something else. I’m going to read, listen to music, do something else.The second question I ask is, “Am I avoiding anything?” Because avoidance is quite common in both depression and anxiety. A lot of times, our rumination kind of tricks us into thinking we’re doing something useful and meaningful, when in fact we should be doing something else. Maybe I am supposed to be working on writing a paper and I’m really dragging my feet on doing it, I don’t feel like writing that paper.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.

 

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31 Comments

  1. Diane Rejman, Other, Phoenix, AZ, USA says

    I went through extensive neurofeedback which helped me on this.
    The first thing they did was map my brain to test my alpha, beta, delta, and theta waves. A doctor who I had never met, and knew nothing about me, reviewed my test results. He saw that my brain was “racing.” He wondered how I was able to function at all, since it never stopped. He said I was probably ruminating a lot. I hadn’t heard that term in ages, and never about me. However – he nailed it. I had been spending an extraordinary amount of time doing this. There was no way I could stop it. One time I was driving through gorgeous Colorado, and couldn’t stop my mind from ruminating on stupid issues. I was so angry, but I couldn’t stop it. I also couldn’t enjoy the drive at all.
    So anyway – the doctor identified my symptoms, and I was shocked.
    I then went through multiple neuro feedback sessions.
    My brain was mapped again. The neurofeedback did exactly what we needed it to do. My brainwaves had calmed down.
    The neurofeedback changed my life in many ways. Some I still don’t understand. I can now stop myself if I start ruminating. The neurofeedback helped me more than any of the many other trauma therapies I had gone through over a period of ten years.

    Reply
  2. Annette Shobika Surendran, Psychotherapy, LK says

    Am going to try this on me first to stop my rumination. Most of my clients say 5 senses grounding technique helps them much better than any other relaxation. Now coming from an expert its time for me to practice.
    Thank you Christine

    Love from Sri Lanka

    Reply
  3. Kate O'Halloran, Psychotherapy, IE says

    Really helpful and every client has different choices they can make.I might give examples…
    Think of three things you’re goanna do ( action) NOW, or later.
    Take 3 really deep breaths.letting out them out slowly.
    or what worked fora client was
    Say 3 Hail Mary’s ..as by the time she had finished them she had stopped ruminating.

    3 being a spiritual holy number .
    thanx Christine

    Reply
  4. Jan West, Nursing, Rougemont, NC, USA says

    I often suggest that the client jump up two times and move to a different position.

    Reply
  5. Liz Hampson, Other, GB says

    huh! CBT…not for everyone, everything, especially not for complex trauma

    Reply
    • Christine Riederer, Other, DE says

      Thank you Liz. That is also my own experience. Complex trauma need complex thinking helpers, which are rare from my point of view. They are fixed in their methods and concepts and are not able to see what is really going on in their clients.

      Reply
      • Christine Riederer, Other, DE says

        Let me add: Recognizing a person’s real needs can take more time than quick fixes allow. It requires developing strong listening skills, getting to know the people we want to serve, and being honest with ourselves about our motivations and hidden agendas.

        Reply
  6. Susan Servin, Social Work, Stratford , CT, USA says

    Well, said and practical for the most part. Only issue is as you stated, ruminating is common at night, but the sensory exercise is more for daytime. The nighttime exercise would be helpful here.

    Reply
  7. E, Other, CA says

    I think it’s a DBT skill called Distract.

    Reply
  8. Maria Wood, Other, AU says

    Hi Lisa,

    I’m interested o hear your recommendations. Insights and tips for working with autistic people? Thanks

    Reply
  9. Emma Clout, Counseling, GB says

    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.

    Reply
  10. Stephanie Frank, Social Work, Denver, CO, USA says

    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.

    Reply
    • Brooke West, Another Field, South Lake Tahoe, CA, USA says

      I practice this too, adding mantra. It backs up the mantra with power!

      Reply
  11. Stephanie Frank, Social Work, Denver, CO, USA says

    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!

    Reply
  12. Jackie Y, Coach, NYC, NY, USA says

    This was very helpful. I can relate to each of your examples. Thank you!

    Reply
  13. Warwick Baird, Other, AU says

    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.

    Reply
    • Jenn J, Coach, CA says

      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.

      Reply
  14. Warwick Baird, Other, AU says

    Very succinct, practical and useful. Thanks.

    Reply
  15. Anonymous says

    Thank you! very helpful!

    Reply
  16. Anonymous says

    Great ideas. This is very helpful. Thanks so much ❤️

    Reply
  17. Iiris Bjornberg, Coach, FI says

    Many many thanks for this!

    Reply
  18. Sheila Murray, Counseling, Choteau, MT, USA says

    Excellent and straightforward, thank you!!

    Reply
  19. Linda Tiro, Counseling, NZ says

    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

    Reply
  20. Ute Vollmer-Conna, Psychology, AU says

    This was a wonderful bite to help you think about such a common problem. Thank you!! x Ute

    Reply
  21. DEBORAH KALUZA, Counseling, Lewisville, TX, USA says

    That was fabulous, thank you!

    Reply
  22. Lou Lipsitz, Psychotherapy, Chapel Hill, NC, USA says

    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.

    Reply
  23. Irma Santiag, Medicine, Toledo, OH, USA says

    Thank you,I found this very helpful.

    Reply
  24. Christine Givens, Psychotherapy, USA says

    Thank you! Very helpful. I appreciate the free content.

    Reply
  25. Jordan Hendin, Maplewood , NJ, USA says

    Thank you! Easy and helpful

    Reply
  26. Michelle Lily, Counseling, NZ says

    So simple and clear. Thank you

    Reply
  27. Kim Butler, Providence , RI, USA says

    Thank you

    Reply

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