3 Questions to Help Clients Interrupt the Depression-Rumination Loop

Clients who ruminate often think of it as a helpful problem-solving tool – that if they dwell on a problem long enough, they’ll gain new insight into how to fix it.

But as we know, rumination can keep clients stuck in cycles of depression and self-doubt.

So, in the video below, Christine Padesky, PhD will share 3 specific questions that can help clients ease patterns of obsessive negative thoughts. She’ll also walk us through a mindfulness exercise that’s intended specifically to replace rumination.

[marcieuzomah]

As a person who experienced a traumatic childhood, I found that I ruminate in an effort to determine if I am making good decisions, can I trust a person, why this happened or didn’t happen as a way to validate if I’m worthy or worthless. The rumination for me is a trauma response in hopes that nothing bad will happen to me or how I can prevent a crisis. The problem though is it manifests as a glitch and my emotions glitch and thoughts glitch like a record player that’s skipping except it’s my thoughts and not music replaying over and over. I read where natural lithium supplements can help with this.

[TheAaronJP]

I would add the question "have I learned anything new about the problem that I didn't know before." This helps check whether it is rumination or reflection.

[Nyx]

THANK YOU for the video. My notes:
0:10 Is this the RIGHT TIME to be thinking about this? 3 AM is not a good time
0:42 Am I AVOIDING anything? If so, then go do it
2:08 How LONG have I been thinking about this?
2:16 Set a TIMER for 2-3 minutes for rumination, then stop and do something else
3:29 MINDFULNESS exercise = 5 SENSES game, note and focus on:
Sight, Smell, Touch, Taste, Sound
Using going for a walk was a great example for me. I often start to ruminate during my walks and sometimes come home more anxious/sad/angry/etc than when I started. I will try to focus on my surroundings more.

[florissaful]

Some of us with MDD and GAD know:
1) Rumination, even while it is happening, is not productive, and we will actively and repeatedly remind ourselves of that.
2) It’s not a good time for it, because no time is good to ruminate, weather it’s 3am or 3pm.
3) We should and do purposefully try to stop and/or distract ourselves and/or refocus. Though I would not recommend anyone, especially many of us who live in less than safe neighborhoods, go on a walk at 3am (and in some areas I’ve lived not even at 3pm).
4) Are not avoiding mundane task or deadlines. In fact such and avoidance would suggest rumination is a distraction from a project, which I’ve never experienced personally as it would require an indulgence of rumination that actively requires my participation(consciously or not). Given the mindfulness of some, particularly if we have come across this video in our efforts to consciously impede rumination, avoidance of tasks seems highly unlikely and almost dismissive of the deeper underlying cause of one’s rumination.

Even awareness and mindfulness does not stop the thoughts, which are persistent much more than most in the mental health field realize. Sure you may distract or refocus on physical, sensory, or thought exercises, but those ruminating thoughts are only pushed to the background for mere moments, continually popping back into the forefront. No amount of CBT or DBT in OPs IPs, or private treatment (alone or in combination with medication) has ever effectively helped to subside my rumination. The current information on rumination along with the mental health field’s primary focus on CBT has not only been ineffective for me, it has put far too much of the onus on patients, struggling with a problem that has not adequately been studied or understood, to resolve it. This in turn becomes demoralizing and frustrating for those seeking help as well as weakening patient trust and confidence in providers (something I ruminate quite a bit about).

[Poemeloentje]

Great advice, I am ready for the Olympics on ruminating anytime. 🙈

[lofatmat]

I have avoided injustices against me then my dreams would help me automatically as I am stuck in the harm they done!

My brain has helped me sort out the analysis of what has been going on because of what this was soing to my body regardless of daily pain and psychological chaos I have been left with since car crash 2020 and my work using that car crash instead of their duty of care and now cover up that has led to my termination!

Having suffered what I thought was my ending then covid my work threw me back into another place of danger whilst I was suffering undiagnosed ptsd at the time but was waiting in a queue of backlogs to be seen for my state of mental health issues after the crash! My boss having told me not to worry that I won't be doing my own role for a long time then go and throw me back in to covid areas after only 4 hours different job having just returned from shielding!

[bridaw]

I struggle with OCD tendencies( everyone isID label nowadays 😂)

Hard to break but this is exactly what has helped me. Thank you for reminding me. Planning so you don’t ruminate doing mindless things like walking is brilliant ❤

[rafaelribeiro]

Awesome....btw I think mindfulness has an incredible benefits to help people to stop ruminating, stress management and self regulation too.

[susielyle]

This was very helpful. It's one of the tools I will be adding to my toolbox. Very practical and sound advice. Thank you for sharing.

[kristinamarcisauskiene]

These questions can be helpful in mild or moderate depression..but not for severe depression, especially severe Bipolar depression.. the first goal for people to not ruminate at night is to help to restore sleep. And most of the time medication are required.not cbt techniques..to ask a severely depressed person to go for a walk when he lost weight from size 12 to 8 because of decreased appetite...can be very unhelpful. When that person has not energy even to get up and take shower. ..to remind you people with severe depression lose pleasure in all areas.- dopamine pleasure neurotransmitter is depleted..and to read...I would love to see that PhD therapist being able to focus your mind and be able to read in severe depression. So questions and suggestions in video for severely depressed person can do more harm than good..I can elaborate on it more extensively...CBT is very limited for severe depression especially if the therapist has good techniques but not trying enough to deeply understand what suffering that person experiences from minute to minute, days, weeks or months

[amypola]

3am is a great time, but constructively. Get some paper and brain dump, then treat the problem like a project, if none of it is in your control, or if it is and you have identified what you can do, note when and how the tasks and steps for that and then pray and go over your thoughts with Heavenly Father, then meditate. I like The Practice from The Crappy Childhood Fairy, she teaches it for free. Its meditation preceeded by a writing practice to purge current fears and resentments. The early morning hours are a great quiet space to constructively work something out, or reregulate especially if the issue is not at all in your control. A great time to pray for them, and identify what can be done. I also recommend a hot bath. Shut the shower curtain. Make a little think tank, or decompression tank. Put some epsom salts, essential oils, ground oatmeal in a nylon. Might help you get back to sleep too.

[chinookvalley]

For 12+ years, I've been ruminating about the terrifying, deadly experience I had 12+ years ago. I can't get it to stop. It's ruining my life. *I will try these exercises*. My freeze response ruled what happened back then, and it still has control over me now. I like to think I've moved on, but I haven't. It seems to be getting worse the older I get.

[tuxedoneko]

Great tips! Practical and simple. Will be trying these questions/exercises. Ty

[gabrielmello]

This is really good. Thank you, Dr. Padesky.

[donnasmith]

This is so me...
I do my own head in.

[shahilagh]

I didnt like your example about the “paper” .. it reflects your own struggle. I think therapists should be careful to speak less of themselves and think of their patients.
Also these questions work for most people, when you are dealing with shallow stuff in life, like just you said: writing your paper!