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Repetitive Thought (Rumination and Worry)

Human beings experience a wide variety of repetitive thoughts about themselves and their lives, not all of them negative. Reminiscing, savoring, anticipating, problem-solving, and emotional processing are positive examples of repetitive thinking, and go some way to explaining why we have the propensity to engage in repetitive thought. Some types of repetitive thought are unhelpful, though—even harmful. Rumination and worry are two key forms of unhelpful repetitive thought and use of these can predict anxiety and depression (Watkins, 2016). We can conceptualize repetitive thinking about the future as ‘worry,’ and repetitive thinking about the past as ‘rumination.’ They are maintenance factors in conditions such as generalized anxiety disorder and depression (Harvey et al, 2004). Read more
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Catching Your Thoughts (CYP)

Before thoughts can be examined or challenged they must be ‘caught’ – they must be noticed and distinguished from events and feelings. The Catch ... https://www.psychologytools.com/resource/catching-your-thoughts-cyp/

Worksheet

Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)

Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Numer ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-generalized-anxiety-disorder-gad-dugas-gagnon-ladouceur-freeston-1998/

Information Handout

How Trauma Can Affect You (CYP)

Trauma can result in a wide variety of symptoms, experiences, and behaviors. As well as post-traumatic stress disorder (PTSD), prevalence rates of oth ... https://www.psychologytools.com/resource/how-trauma-can-affect-you-cyp/

Information Handout

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record/

Worksheet

Intrusive Thoughts Images And Impulses

Intrusive Thoughts, Images, And Impulses that are experienced as distressing are a feature of obsessive compulsive disorder (OCD). They are also a com ... https://www.psychologytools.com/resource/intrusive-thoughts-images-and-impulses/

Exercise

Living With Worry And Anxiety Amidst Global Uncertainty

This free guide was published in March 2020 in response to the coronavirus pandemic. It is designed for anyone who is experiencing anxiety or worry. ... https://www.psychologytools.com/resource/living-with-worry-and-anxiety-amidst-global-uncertainty/

Free Guide

Problem Solving (CYP)

Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide children and adolescents through steps wh ... https://www.psychologytools.com/resource/problem-solving-cyp/

Exercise

Process Focused Case Formulation

The Process-Focused Case Formulation encourages clinicians to make hypotheses regarding mechanisms or processes which they believe may be maintainin ... https://www.psychologytools.com/resource/process-focused-case-formulation/

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Properties Of Trauma Memories

Important properties of trauma memories include involuntary recall, ‘nowness’, vividness, and immutability. People who have experienced t ... https://www.psychologytools.com/resource/properties-of-trauma-memories/

Information Handout

Rumination Diary

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). The Rumination Diary helps clients to ... https://www.psychologytools.com/resource/rumination-diary/

Worksheet

Rumination Self-Monitoring Record

Rumination-Focused CBT (RF-CBT) takes a functional-analytic approach to rumination and aims to help depressed clients to identify the contexts in whic ... https://www.psychologytools.com/resource/rumination-self-monitoring-record/

Worksheet

Stages Of Social Anxiety

Stages of Social Anxiety is a CBT worksheet to explore maintaining factors with a client and then to explore possible treatment strategies. ... https://www.psychologytools.com/resource/stages-of-social-anxiety/

Worksheet

Thought Suppression And Intrusive Thoughts

Suppression is a common approach to unwanted thoughts, worriers, doubts, or urges. Unfortunately, there are good reasons why this strategy fails. This ... https://www.psychologytools.com/resource/thought-suppression-and-intrusive-thoughts/

Information Handout

Transdiagnostic Processes

A ‘transdiagnostic process’ is the label given to a mechanism which is present across disorders and which is either a risk or maintaining factor f ... https://www.psychologytools.com/resource/transdiagnostic-processes/

Information Handout

Understanding Depression

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-depression/

Guide

Understanding Generalized Anxiety And Worry

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-generalized-anxiety-and-worry/

Guide

Understanding Health Anxiety

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-health-anxiety/

Guide

Understanding Obsessive Compulsive Disorder (OCD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are ... https://www.psychologytools.com/resource/understanding-obsessive-compulsive-disorder-ocd/

Guide

What If

“What if…?” questions are a powerful way in which anxious individuals generate or maintain anxious states, particularly in generaliz ... https://www.psychologytools.com/resource/what-if/

Exercise

What Is Rumination?

Rumination and repetitive thought is a transdiagnostic maintenance process underpinning a range of difficulties. This information sheet explores the c ... https://www.psychologytools.com/resource/what-is-rumination/

Information Handout

What Is Worry?

Worrying is a form of thinking about the future, defined as thinking about future events in a way that leaves you feeling anxious or apprehensive. Cli ... https://www.psychologytools.com/resource/what-is-worry/

Information Handout

What Keeps Depression Going?

Our “What Keeps Disorder Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Frien ... https://www.psychologytools.com/resource/what-keeps-depression-going/

Information Handout

Worry Decision Tree

Worry is a cognitive process that involves thinking about problems that might happen in a way that can leave you feeling anxious or apprehensive. Not ... https://www.psychologytools.com/resource/worry-decision-tree/

Exercise

Worry Diary

In the initial stages of treatment for GAD it is helpful to orient clients to observing their worries as a process rather than focus on their content. ... https://www.psychologytools.com/resource/worry-diary/

Worksheet

Worry Postponement

Worry postponement is often prescribed as an exploratory or standalone intervention relatively early in the treatment of GAD, but ‘worry postponeme ... https://www.psychologytools.com/resource/worry-postponement/

Exercise

Worry Thought Record

Anxiety stems from negative predictions about the future (and also from assumptions that one will not be able to cope with the magnitude of the threat ... https://www.psychologytools.com/resource/worry-thought-record/

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Intervention

Presentation

  • The how and why of rumination and worry | Watkins | 2012 download archived copy
  • Targeting rumination by changing processing style: experiential and Imagery exercises | Watkins | 2011 download   archived copy
  • Unwanted intrusive thoughts | David Clark | 2019 view

Recommended Reading

  • Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163-206  download
  • Watkins, E. R. (2009). Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process. Journal of Rational-Emotive Cognitive Behaviour Therapy, 27, 160-175  download
  • Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. Guilford Publications.

What Are Rumination And Worry?

Disorders That Are Associated with Rumination and Worry

  • generalized anxiety disorder (GAD)
  • depression
  • social anxiety
  • post-traumatic stress disorder (PTSD)
  • pain
  • eating disorders
  • insomnia
  • psychosis

Helpful Questions for Assessing Rumination and Worry

  • How often do you find yourself ruminating or dwelling on your problems?
  • When do you tend to do most of your worrying or ruminating?
  • What are the consequences of ruminating and worrying for you? How does it make you feel?
  • Are there any particular feelings that are warning signs that you might worry?
  • What tends to stop your ruminating?

Treatment Approaches That Target Rumination and Worry

A variety of treatment approaches have been identified that target rumination and worry. These include:

  • approaching uncomfortable thoughts and feelings rather than avoiding them;
  • imaginal exposure to a ‘worry script’ or ‘worry story’;
  • problem-solving training;
  • processing information at a more concrete and less abstract level;
  • identifying and challenging positive and negative metacognitive beliefs that may contribute to repetitive thinking.

References

  • Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. New York: Oxford University Press.
  • Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford Press.