Rumination and OCD: Here’s the connection – and how to end compulsive thinking

1 September 2022

A young woman sits on a couch looking pensive. She is staring absently at a pink coffee mug on the table in front of her.

We think of obsessive-compulsive disorder (OCD) as an illness we can see.

A person flicking a light switch on and off. Someone counting obsessively on the tips of their fingers.

But the invisible symptoms of OCD can be just as problematic. Rumination – obsessive, relentless thinking – is one such example.

Dr Peter Kyriakoulis, our co-founder and leading clinical psychologist, explains why people with OCD so often ruminate – and how, finally, to stop.

What is rumination?

It’s happened to us all.

We find ourselves stuck in an endless loop of distressing thoughts with seemingly no way out.

For example, it could look like this: you’re wondering if you accidentally offended a co-worker this morning. Should you apologise? Are you being too sensitive? Was their tone really that sharp, or are you imagining it?

This is rumination. The trigger can range from banal interpersonal conflict to existential questions about ourselves or the world.

But regardless of subject matter, we rarely ruminate on things we enjoy.

“Rumination focuses on negative content, generally past and present, and can cause a lot of emotional distress,” says Peter.

“It can lead to mental health problems – particularly anxiety disorders like generalised anxiety disorder (GAD) and OCD, as well as depression, paranoid ideation and significant stress.”

Problem-solving gone haywire

Though rumination can be profoundly unpleasant, we often begin ruminating with the best of intentions.

Sometimes rumination can be adaptive and lead to problem-solving,” says Peter. “Research has shown that rumination can produce positive outcomes when it’s focused on correcting past mistakes or active goal achievement.

“If we’re using it to reflect in positive ways – and if it is short-lived – then it can be beneficial.”

But as anyone who’s fallen into a rumination hole for days on end knows, rumination is rarely productive. Just as rarely is it short-lived.

This is particularly true for those with OCD – whose rumination is more akin to a compulsion rather than an obsession.

That makes it much harder to reign in rumination when it’s gone too far.

The OCD and rumination connection

OCD is characterised by an extreme reaction to intrusive thoughts. These thoughts might be violent or taboo in nature, causing the person experiencing them to wonder what they mean.

Do I want to hurt my family? Am I secretly gay/straight? Would I ever harm a child?

These are just a few of the questions that a person with OCD might ruminate on following an intrusive thought.

“Rumination is very common in OCD,” says Peter. “Like handwashing or compulsive cleaning, it can bring some relief at first. But it ultimately rewires the brain to become even more obsessive and ruminative.

“This kind of obsessive thinking strengthens our negativity bias. But this is to our detriment – the negativity bias we’ve evolved is already strong enough.”

The key takeaway here is that ruminating is something we do. We have agency. And we must exercise it if we’re ever to recover.

Stopping is simple – but not easy

Ruminating on our intrusive thoughts keeps us stuck on them – even when we’re trying to drive them away. So how can we release these thoughts and stop ruminating?

As is so often the case, the solution is simple in theory and challenging in practice.

“The important thing is to not react to an intrusive thought,” Peter stresses. “We must learn to resist the urge to obsess about a thought.  With practice, we’ll start to feel less distressed.”

It’s understandable that we latch onto intrusive thoughts when they cross our mind. They can stir up such panic that it may feel irresponsible – or just uncomfortable – to release them.

But ruminating over our intrusive thoughts only maintains our distress (or actively worsens it). If peace is our goal, we have to learn to let go.

Peter has a useful metaphor for this idea.

“Picture a glass of fizzy lemonade,” he explains. “Every bubble represents an intrusive thought.

“When we have an intrusive thought, our urge to pop it – and thus get rid of it – will be powerful. But trying to pop one bubble only stirs up more.

“Our best bet is to leave the glass alone. Eventually, the lemonade will just go flat.”

An evidence-based treatment: Exposure and Response Prevention

Everyone struggles to stop ruminating when they’re in the thick of it, regardless of their mental health history. But when a person with OCD stops ruminating, it can feel like they’ve abandoned their only coping mechanism – making stopping seem counter-productive.

To learn to experience and breathe through the distress that our intrusive thoughts cause, we can use Exposure and Response Prevention therapy (ERP).

During ERP, clients are exposed to their fear in a safe, therapeutic environment. They’ll learn to sit with their distress and watch as their anxiety eventually subsides.

This is the go-to approach for OCD, with promising success rates for clients who stick with the treatment.

Another strategy is one that Peter developed during his PhD studies.

“It’s called cold facial immersion,” he explains. “I’ll have a client immerse their face in cold water while they resist the urge to ruminate or engage in mental rituals or compulsions.

“There’s an exposure component to it, but it’s paired with the cold facial immersion as an anxiety management technique. My PhD research showed that it reduces both physiological and cognitive anxiety symptoms.”

Have hope

Our propensity to ruminate might vary depending on the subtype of OCD we have (be it contamination-based, paedophile OCD or one of the many other subtypes).

But regardless of how our OCD manifests, learning how to stop ruminating is a critical skill. Once we’ve mastered it, we’ll be well on our way to a better quality of life.

Struggling with rumination or obsessive thinking?

Call our practice on 1300 995 636 to find a psychologist trained in treating OCD and anxiety disorders. Or enquire here.