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Free patients from the rumination trap

November 12, 2015
by Edward Hoffman, PhD
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Thoughts are powerful, and especially when habitual they strongly affect our well-being. Certainly, this view has become well-accepted in today’s field of positive psychology. Under the banner of self-regulation, researchers are increasingly focusing on our ability to manage our moods effectively. From both clinical and experimental studies, it is now clear that this ability comprises two different—but perhaps equally important—skills necessary for everyday flourishing: minimizing negative feelings such as anger, sadness, jealousy and worry, and amplifying happiness.1

People prone to destructive habits involving alcohol or drugs typically lack proficiency in one or both of these arenas. To put it simply, they either don’t know how to avoid bad moods or how to elevate themselves into good moods. Or worse, they lack both kinds of proficiencies.

Why does this matter? Because scientific evidence is mounting that such difficulties are linked to a variety of behavioral health problems, including depression, anxiety disorders and substance abuse. This article focuses on a particularly debilitating weakness in self-regulation—namely, rumination—and its role in addictive disorders.

Brooding and rumination

That brooding is psychologically unhealthy has been known for more than a century. In Sigmund Freud’s famous “Rat Man” case in 1909, he treated a young lawyer with multiple anxieties and a fear of rats. Freud termed the man’s chief problem as “obsessional brooding” and saw his fixation on negative thoughts as a form of self-punishment caused by guilt feelings about early sexual behavior.2 In other cases, Freud saw brooding as a way that people avoided acting on mainly sexual impulses by over-focusing on their thoughts.

Today, clinical researchers use the term “rumination” to describe the repetitive replay of unhappy thoughts or memories, and have found it predictive of depression and alcohol/drug dependence. While viewing sexual issues as only one potential contributor to ruminative behavior, they share Freud’s insight that it originates during childhood and takes hold by the time we’re adults. For cognitive psychologists, rumination is a type of “self-talk” that is both negative and repetitive.3

Of course, not everyone ruminates, so what family dynamics are likely to set it in motion? The consensus is that it is induced by a parenting style that is intrusive or controlling, and cold rather than nurturing.4 Think of the “helicopter parent” as the mass media likes to call it, but one whose constant hovering also lacks warmth. Children exposed to this parenting style grow into anxious teens with meager self-efficacy (confidence in handling life’s challenges) and are prone to ruminate. As adults, they typically believe that their replay of unhappy thoughts is somehow beneficial, but it almost never is. Studies show that females generally dwell on sadness-producing memories, while males fixate more on those involving anger.5

Consider these hypothetical examples. Karla is a timid 13-year-old with no close friends. During lunchtime at school, she was ridiculed about her dress and burst into tears. Nobody defended her. Since then, Karla finds herself recalling the event throughout each day and feeling worse about her loneliness. Yet she takes no concrete action to make friends, or to view the event in a less important or different way.

Devin is a burly 15-year-old. He loves playing tennis, and was scheduled to try out for his high school team. Unfortunately, the night before, Devin sprained his hand while wrestling with his cousin, and the coach canceled the tryout without offering a makeup. “Good luck next year!” he snapped, and walked away. Several times a day, Devin angrily replays his coach’s abrupt remark, feeling both furious and helpless. The repetitive scene never gets better or goes away.

Teens such as Karla and Devin have the illusion that their rumination is somehow helpful. But as research led by the late Susan Nolen-Hoeksema, PhD, of Yale University and colleagues consistently showed, ruminators rarely problem-solve their troubling thoughts away or even distance them effectively.6 It is as though they’re wearily running on a treadmill while believing that they’re reaching a destination.

Nolen-Hoeksema’s team found that these teens are at greater risk than low-ruminating peers for developing depressive symptoms—and eventually for becoming dependent on alcohol or drugs. Indeed, the risk is so high that researchers have suggested that youthful ruminators be targeted for prevention programs.7

In this light, Tony Bevacqua, author of Rethinking Excessive Habits & Addictive Behaviors, has offered a cogent explanation for the connection between rumination and substance abuse. He comments that “self-critical people experience chronic stress, depression and anxiety because they live with the voice inside their heads repeatedly telling them they’re inadequate or worthless. At the same time, family and friends contribute to this negative mindset through criticism and judgmentalism. Further compounding this dynamic are the treatment professionals who use deficit-based, emotionally charged, and negatively connoted words—such as `alcoholic’ and `addict.’”8 In Bevacqua’s view, this tripartite system sustains excessive, destructive habits.

Treatment considerations

How can you detect rumination? Simply ask your client, “Do you often find yourself having the same, unhappy or troubling thoughts day after day? If so, about what?”

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