Saturday, May 06, 2006

Ruminations on depression

"It's not what you think but the way you think it."

I have been spending a lot of my time thinking about rumination recently. Rumination can be likened to a mental chewing of the cud, a repetitive thinking about issues or problems without any real progression to action. It's apt then that this is the area underlying my thesis, because it's been a lot of thought and very little action so far.

It is widely accepted that the content of our thoughts can influence the way we feel. However, a growing body of research demonstrates that the way in which we think about things is important in determining the severity and duration of depression.

Work by Dr. Susan Nolen-Hoeksema has examined the role of ruminative thinking in depression: specifically, a repetitive focus by the individual on being depressed, on the symptoms of his or her depression and on the cause, meanings and consequences of those symptoms. (1) Typical contemplations might include questions such as, ‘Why did this happen to me?’ and statements like, ‘I’ll never feel good again.’

How does rumination impact on depression?

The inward-focus inherent in rumination can increase an existent bias towards negative thinking, including distorted interpretations of life events, more negative self-evaluations, a sense of loss of control and more pessimistic predictions about the future. (2) (3) In what could be termed a snowball effect, this can initiate further concerns which then accumulate.

Rumination can affect problem-solving ability. Ruminators often fail to generate solutions to problems. Even when they do, they often express low confidence in their solutions and fail to act on them. (2) While active cognitive coping can be adaptive initially, thinking about ways to improve a situation raises levels of anxiety and depression when it fails to be followed up by subsequent action. (4) As a result, an increasing sense of failure and a general sense of hopelessness can occur, resulting in a further escalation in the severity and duration of depression.

Rumination can also impair social support. Constant rumination can drive others away, which can start off a whole new cycle of rumination. "Why are people abandoning me?" A loss of social support can be critical because social support can act as a distraction and divert attention away from depressed mood and its consequences. (5)

Are you a ruminator?

Assess your own tendency to think about problems.

Are you an obsessive thinker? Would you generally spend more than five minutes thinking about a problem? Ask others what they think.

If so, you are probably likely to ruminate.

Breaking out of the rumination cycle

Distraction techniques can help break the rumination cycle by reducing the tendency to focus on problems. (2) Engaging in activity can help break the stranglehold of obsessive thinking. Go for a walk. Read a book. Watch a movie.

Learn to recognise and reappraise negative perceptions of events and high expectations of others.

Let go of unrealistic goals.

Break down problems into a series of more manageable tasks which can then be acted upon.

For further reading on rumination

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Dr. Susan Nolen-Hoeksema

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Edited by Costas Papageorgiou and Adrian Wells


jumpinginpuddles said...

ok i am a rumination thinker but out or survival more than anything, there isnt a choice for me, at this stage it doesnt get me depressed becasue i have a job to do but thinking about it in the future when i have less of a job it might be interesting.

Anonymous said...

Nice post. I definately have to read it couple of more times (I usually do that with your stuff). Depression is complicated and facinating. I think it all depends too on circumstances. Some people seem to just be prone to depression where others fall into it based on an event and trouble getting back out. Interesting stuff.

healthpsych said...

Hi Jumpinginpuddles,

Rumination in depression is kind of a chicken and egg thing..does the ruminative behaviour exist before the depression or is it part of the depressive process?

The work on depressive rumination does not show that rumination causes depression but it does show a relationship with severity and duration of depression in individuals who already have depressive symptoms.

Rumination is not necessarily a bad thing. Other researchers choose to operationalise it in a more positive light. For example, rumination can help people make sense of things that have happened in the past, allow them to identify the most important elements of their problems, help them to work out how things could have been done better and so on.

It's a very interesting area and there's a lot more to it than I could go into here. :)

Hello Tiesha's Place...
Thanks for your comments. Do you think I need to change the way I write? I'd be interested in feedback.
It is a complex area and, as I said above, it's receiving a lot more interest currently.

Anonymous said...

God no! Your writing is great! The content is good and always warrants more than just one read. Great stuff! Don't change a thing and keep writing. We share a lot of the same professional interests and I learn a lot from your posts.

jumpinginpuddles said...

as everyone learns more they understand more, but looking at what youve written i wonder if perhaps people are trying to find a basis for all human psyche problems and the causes of that could be loss of identity over a labe.
It helps to understand a lot but we wonder is the cost to the individual being able to find thmeselves in the process.
Like all things i hope whatever the result in the understanding of reminations or not we never stop evaluating how a person got to that place in the first place and that means never losing track of a persons individuality and experiences.

healthpsych said...

Hi Jumpinginpuddles,
I know what you mean. Seems that there's such a move to label behaviour that everything becomes about a label rather than the underlying person.
I don't feel the work on depressive rumination is that way. I think it's more about just understanding thinking mechanisms that could aggravate a depression and that thinking style might be important to take into consideration in therapy for some.

Tiesha's place..
thanks for the feedback. I know I'm not the most concise person on this planet! :)

tkj said...

I'm amazed that you manage to put together such thoughtful posts! Seriously, all I ever manage is "I'm hungry" or something inane...ahh for shame!

Dr. Deborah Serani said...

Rumination or any kind of circular thinking can do great damage to a person's psyche. Great info in this post.

:) Deb

Anonymous said...

Hi I just found this site and all I can say is WOW! It hits the nail on the head for me. I've suffered from depression for-ever and am only just beginning to think that maybe, just maybe, my repetitive thinking could have something to do with it!!!! This is very interesting fodder for my brain. Thank you.
Chasegirl said...

my opinion is that to determine the reason why a personality is the way it is, is to attempt to try and understand ones history and consequent devolvement/evolvement of thought processes of past experience. i believe, but in no concrete terms, that this is why people suffer from both over confidence or a lack of confidence, so to speak. thanks for a great read you guys, because bringing to light this subject helps us all to consider our actions and thoughts; to rationalise them somewhat, and thus consequently bring a better understanding between all people we meet who at first we dont connect with, or people that we know, who may change in character, and perhaps more importantly, how we think we behaved or will behave in a situation. humanity should be a progression, and the only way we all can do that is to fully understand ourselves and one another. said...

The rumination caught my eye. I teach a form of minfulness to help with chronic depression. It's been researched (see MBCT under in the US). Any interest? Some details are also on my website,
Sincerely, Donald

think it first said...

Rumination is interesting. Sometimes you can't help but ruminate if you are in a situation that is unpleasant and doesn't seem to have a solution...i.e.crazy in-law. it's definitely taken it's toll on me and led me to ruminate even when she is in another state. It has affected my overall state of mind. I'll try some of your solutions. Thanks!

Anonymous said...

Here's a link to a free video of Dr. Nolen-Hoeksema discussing rumination. It comes from a continuing education website.

Anonymous said...

I'm not sure that rumination causes depression. I had few problems with rumination before a head injury last year. After that I immediately began to dwell on everything. I could let nothing go. I have much more difficulty now, even previously resolved issues are dredged back up.

It seems to me the brain has it's own "stop" setting for negative thoughts and that injury or biochemical changes may short-circuit this. Some people may be neurologically prone to rumination (lacking that "stop" function, and obsessing) which leads to depression, while others may have depressions in which the imbalances also affect that "stop" them the two may occur together as part of the same illness. I'm betting you could find people who rarely ruminate when not depressed but do when they are depressed.

Since most "stop" functions are in the frontal lobe (the brakes of the brain) it would also make sense that other frontal lobe symptoms would show up in these patients. Sure enough, most report difficulty with concentration and focus.

Anonymous said...

You know I have suffered with both, the depression and rumination,, all this rumination in trying to solve my problems has gotten me know where ,, I like to think of myself as a thinker and Ithat is great but when it comes to solving your own problems I think you need the help of someone out side of you to process the problem. I seem to never get anywhere with the rumination,, and like the article said in the end there is no real action and no real change only good intent!!! I am stuck and just now realizing why,,all this time I was thinking that I was getting someone but ended up in the same place.. The only good thing is I have some understanding of life just not how to get going that is the depressive piece...