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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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Rumination Diary (Archived Version)

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). The Rumination Diary helps clients to ...


Rumination Self-Monitoring Record (Edition 1)

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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 ...

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Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ...


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Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ...


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Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are ...


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What Is Worry?

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Worry Decision Tree

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  • 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.


  • 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.