Trying to suppress my panic, I would describe to my therapist how I’d spend hours on end trying to piece together fragments of long forgotten memories, getting increasingly worked up when I couldn’t remember some random detail before starting again. This would repeat, over and over, eventually morphing into some other imagined transgression or forgotten detail. The thing I had originally panicked about now meant nothing to me but this new thought, the one that infused my whole skeleton with a sense of terror, became inescapable.
I thought my inability to shake the distress meant I had done something which was so horribly wrong that I couldn’t remember it. But it turns out that wasn’t it. According to my therapist, it was a particularly pernicious pattern of rumination.
Rumination in a literal sense is the act of reprocessing or reworking something over. If you google the term, it comes up as "the act of bringing up food from the stomach and chewing it again". Ew. Psychologically, though, it is our brains acting like cow stomachs: processing the same piece of information/cud over and over again until it is digestible. But unlike cows and their built-for-purpose digestion, there is no clear end point for when we can stop processing that thought.
Dr Sheri Jacobson, clinical director and founder of Harley Therapy, says that the thoughts must be tinged with negativity for them to constitute rumination.
"[The thoughts] in rumination are more problematic, more troublesome usually. For example, if you were thinking about a happy time at the beach and you kept thinking over and over, we wouldn't necessarily call that rumination. It's usually got an edge of negativity – it's something that's troublesome and causes us upset." While 'intrusive thought' is the term for the distressing and upsetting thought in itself, rumination is the process of cycling through that thought over and over.
According to a huge study on stress in 2013 by the BBC’s Lab UK and the University of Liverpool, rumination is the biggest predictor of the most common mental health problems in the country. Although there is no data to determine the prevalence of rumination in and of itself, the study shows that it is not only a key factor in conditions like OCD and eating disorders but is also linked to anxiety and depression. As Professor Peter Kinderman said at the time of the study’s publication: "Dwelling on negative thoughts and self blame have previously been recognised as important when it comes to mental health, but not to the extent this study has shown. The findings suggest both are crucial psychological pathways to depression and anxiety."
The reason why rumination is so absorbing is that, in many ways, we have evolved and adapted to it. We are habit-forming creatures who tend to repeat the same actions again and again unless we deliberately direct our attention to changing those habits. Applying this to our thinking patterns, it’s important to note that "of the thousands of thoughts that we have in a day, most of them are repetitive," as Sheri tells R29, "and the majority of thoughts we've already had before."
On top of that, we have evolved to mostly think negative thoughts. "Our mind tends to be problem hunting," says Sheri, "and that's really what's got us through all these millennia: basically hunting for difficulty to survive." Surviving has relied on risk awareness, with some of the adaptive fears (like a fear of spiders) lasting far beyond their immediate usefulness.
This is where rumination comes in. While negative thinking is not only natural and useful, our brain’s habit-forming ability to get stuck in a cycle can lead to a downward spiral.
Like all mental health problems, the question of who can be plagued by rumination is not a clear-cut case of cause and effect. Some people do have more of a tendency towards overthinking and staying in thinking loops thanks to childhood experiences (often in the form of trauma) but there are others who experience no overt harm or distress and can still be liable to negative thinking loops. Unsurprisingly, like literally everything else, propensity to ruminate has been exacerbated by the pandemic.
"Many of us are ruminating more than ever," says Charlotte Fox Weber, psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP). "This may well be a response to how restricted and stuck we feel externally. We can’t travel or socialise or live exactly as we want to, and so our minds look backwards. We don’t know how to envisage the future or feel the sense of potential we are used to feeling, so we tilt back in time instead, focusing on particular moments where perhaps we had choices."
The genuine sense of chaos and stress that comes with living through a global pandemic, among other things, has led many of us to try and make sense of reality by reminding ourselves of where things went wrong. "I think rumination is a kind of hyperbolic sense of responsibility," Charlotte adds. "We think we can explain our pain by looking at one moment in time and lamenting."
This is what happened to Georgia, 28. While she’s always been anxious and prone to huge amounts of worry, something shifted for her in the pandemic. "Something a friend said triggered my first panic attack in four years and I then experienced around five months of intense intrusive thoughts, rumination, anxiety and panic attacks. I'd never had ruminations to the extent I did last year before." While certain trigger points were personal to her, others were directly linked to the global pandemic. "I'd coped so well with the pandemic up until then, so I think it was a gross cocktail of many things: the pandemic finally getting to me, the specific situation my friend brought up, being at home without outside stimulus, a lack of community and social interaction to help me ground myself in reality, and the time to obsess and spiral uninterrupted."
With only your household (if you don’t live alone) and your internet for company, the clear markers that break up your day, encourage you to pause or just take you out of your head for a few minutes have fallen away. In their place is your brain’s ability to loop, and a steady stream of terrifying news stories and other people's emotions on social media. No wonder people ruminate.
With the end of lockdown an impossibly optimistic idea right now, the question becomes how you can break out of thinking the same few terrifying thoughts over and over. For those whose rumination is a part of or develops into OCD, the methods of self-soothing can often become part of the cycle – such as the compulsion to repeatedly wash your hands or turn off the lights.
These are the better known compulsions associated with OCD; people also reach for far less obvious instances of self-soothing, like drinking or distracting yourself with social media. Many coping mechanisms are soothing only in theory or in the moment, and the long-term effects can create more harm. "For example, most of us don't realise that when we drink to try and blank out the thoughts, it makes us worse," says Sheri. "Physiologically, our bodies had a dose of toxins and this ends up triggering thoughts about ourselves. That's not really conducive to good self-esteem – and so the cycle continues."
There is hope, though. Unlike genetics or childhood trauma, we have the capacity to change our thought cycles and behaviours, which means that you can learn to manage rumination. Therapy, if you can access it, can be a godsend. Georgia had been diagnosed with depression and anxiety on and off since she was 21 but never found a therapist who worked for her or brought up rumination. However after seeking CBT (cognitive behavioural therapy) last year, she found real release. "My new therapist was incredible. She taught me about ruminations, gave me tools to cope and made me feel less of a terrible monster."
Other than the obvious route of talking therapies – and many people find CBT particularly helpful in reframing their thought patterns – Sheri points to exercise and meditation as key practices to take up, especially in lockdown. "[Exercise and meditation] are research-backed, they’re free and they’ve got immense health benefits on the physical and mental level."
Additionally, Charlotte recommends several thought exercises. One focuses on identifying when ruminating is taking place. From there you could potentially accept the trigger at the heart of that rumination. "Acceptance is the best tool we have. It’s not the same as defeat but it’s a kind way of acknowledging that something has happened. Ruminating is a kind of arm wrestle with what’s happened, so acceptance helps resolve this."
Another useful exercise is to work on centring yourself in your physical reality. "Bring yourself to the here and now," says Charlotte. "As tricky as it may feel, coax yourself to notice your surroundings, feel yourself in your own skin, and just be where you are. If your mind continues to fixate, gather your thoughts and remember that you have a degree of agency. You don’t have to be enslaved by the ruminations. This doesn’t mean that you can just talk yourself out of them— but you can, to a large degree, encourage yourself to keep moving."
Combining these thought exercises with healthy habits can help to achieve a balance. Now I, like Georgia, rely on a combination of tools to keep my body and brain in check.
"For me it's always a combination of tools that have to be employed together," says Georgia. "Doing one alone feels like slapping a plaster over a gaping wound. It varies for everyone of course but for me it's implementing rigid structures made up of daily exercise, nourishing food, stepping away from social media, journalling, walking in green spaces and less booze – all the classics!"
None of these would work on their own or without working through other thought exercises. Nor do they protect you from struggling again. But they can help you get through it.
"I still have some bad moments," says Georgia. "I see ruminations as a needle getting stuck on a record and just buffering continuously. When I'm in a bad place, they feel like the same three seconds of a frightening song playing over and over, getting louder and louder; when I'm good, I can hear the record play out and just observe without judgement or attachment.
"While I accept this won't be the last time I experience this, I feel pretty well prepared to work through it now."