How Does Rumination Affect Obsessive-Compulsive Symptoms and Mood?

What you need to know

• Rumination, or repetitive negative thinking, can maintain obsessive-compulsive (OC) symptoms and depressed mood in people with OCD.
• Both rumination about OC symptoms and rumination about mood had similar immediate effects on maintaining distress, urge to neutralize, and depressed mood.
• Rumination about OC symptoms had longer-lasting effects on OC symptom severity compared to rumination about mood.
• Distraction was more effective than rumination for reducing symptoms in the short-term.

What is rumination and how does it relate to OCD?

Rumination refers to repetitive negative thinking about one’s symptoms, their causes, and consequences. It is common in many mental health conditions, including obsessive-compulsive disorder (OCD).

In OCD, a person may experience unwanted, intrusive thoughts, images or impulses (called obsessions) that cause significant distress. To cope with these obsessions, the person may engage in repetitive behaviors or mental acts (called compulsions).

Rumination in OCD can take different forms:

1. Mental compulsions - For example, mentally reviewing a situation over and over to make sure nothing bad happened.

2. Rumination about OC symptoms - Repeatedly thinking about why one has OCD, what the symptoms mean, and their impact.

3. Rumination about mood - Focusing on feelings of distress, anxiety or depression related to OCD.

While rumination is meant to help resolve uncertainty or distress, research suggests it may actually maintain or worsen symptoms over time. This study aimed to clarify how different types of rumination impact OC symptoms and mood.

How was the study conducted?

The researchers recruited 145 people diagnosed with OCD. Participants were randomly assigned to one of three groups:

1. Rumination about OC symptoms
2. Rumination about mood
3. Distraction (control group)

The experiment proceeded as follows:

1. Participants identified their most distressing obsessive thought.
2. They read this thought aloud and rated their distress, urge to neutralize (engage in compulsions), and depressed mood.
3. They monitored occurrences of the obsessive thought for 5 minutes.
4. Depending on their assigned group, participants then spent 8 minutes:
   • Ruminating about their OC symptoms
   • Ruminating about their mood
   • Thinking about neutral topics (distraction)
5. Participants again rated their symptoms and monitored thought occurrences.
6. Follow-up ratings were collected 2, 4, and 24 hours later.

This design allowed the researchers to examine both the immediate and longer-term effects of different types of rumination compared to distraction.

What were the key findings?

Immediate effects of rumination

Both types of rumination (about OC symptoms and about mood) had similar immediate effects compared to distraction:

• Smaller decrease in distress
• Smaller decrease in urge to neutralize
• Smaller decrease in depressed mood
• Smaller decrease in frequency of obsessive thoughts

In other words, while symptoms tended to naturally decrease over time, rumination maintained higher symptom levels compared to distraction.

The effects were particularly strong for distress and depressed mood. This suggests rumination may play an important role in prolonging the emotional impact of obsessive thoughts.

Importantly, there were no significant differences between ruminating about OC symptoms versus ruminating about mood in the immediate term. This indicates that any form of repetitive negative thinking can maintain symptoms in the short-term.

Longer-term effects of rumination

When looking at effects 24 hours later:

• Rumination about OC symptoms led to higher OC symptom severity compared to rumination about mood.
• Rumination about OC symptoms reduced positive affect more than rumination about mood.
• Both types of rumination had similar effects on negative affect.

This suggests that while both types of rumination have similar immediate impacts, repeatedly thinking about one’s OC symptoms may have more lasting negative effects compared to thinking about mood alone.

Why are these findings important?

These results provide experimental evidence that rumination plays a causal role in maintaining OC symptoms and depressed mood in people with OCD. Some key implications include:

1. Rumination may help explain why OC symptoms and depressed mood often persist or worsen over time.

2. The strong effects on depressed mood highlight how rumination may contribute to the high rates of depression seen in people with OCD.

3. While ruminating about OC symptoms didn’t have stronger immediate effects, its longer-lasting impact suggests it may be particularly problematic if done habitually.

4. Distraction was more effective than rumination for reducing symptoms in the short-term. This challenges the idea that distraction is always maladaptive in OCD.

5. Targeting rumination in treatment may help improve outcomes for people with OCD, particularly those who experience a lot of mental rumination.

How might these findings impact treatment?

The results suggest several potential ways to enhance treatment for OCD:

1. Educating patients about how rumination maintains symptoms could help motivate them to reduce this habit.

2. Teaching alternative strategies to replace rumination when faced with obsessions or low mood.

3. Incorporating focused techniques to reduce rumination, such as:

   • Practicing more concrete, experiential thinking rather than abstract rumination
   • Mindfulness-based approaches to observe thoughts non-judgmentally
   • Cognitive restructuring to modify beliefs that drive rumination

4. Using moderate distraction as a short-term coping tool, while still engaging in exposure therapy.

5. Addressing both OC-focused and mood-focused rumination, given their similar short-term impacts.

Conclusions

• Rumination plays a causal role in maintaining OC symptoms and depressed mood in people with OCD.
• Both rumination about OC symptoms and about mood have similar immediate effects, but OC-focused rumination may have more lasting negative impacts.
• Targeting rumination in treatment may help improve outcomes for people with OCD, particularly those prone to mental rumination.
• Distraction can be helpful in the short-term, challenging the idea that it is always maladaptive in OCD.

While more research is needed, these findings highlight the importance of addressing rumination as part of comprehensive treatment for OCD. By breaking the cycle of repetitive negative thinking, people with OCD may experience greater symptom relief and improved mood over time.