# Rumination, depression, and anxiety



## David Baxter PhD

On rumination, depression, and anxiety
By Eric Wilinski 
June 22, 2007

Most of those with panic, anxiety, or depression know exactly what obsessive thinking is like. "Something's wrong with my heart. My heart's not beating right. It's skipping beats. Didn't that basketball player collapse on the court and die because his heart was skipping beats? What if I get to the supermarket, and collapse right their in the frozen foods aisle? I'll be so far from home! And what if nobody helps me? I know that's not really going to happen. But my heart's skipping beats -- what if it does? What if I have a heart attack, and collapse, and die?"

That kind of thing.

This blog post, which discusses the correlation between depression and obsessive thinking (a correlation that is, of course, just as strong between obsessive thinking and panic and anxiety), opens with a wonderful description by Sylvia Plath of depressive rumination: 

"I am terrified by this dark thing
That sleeps in me; 
All day I feel its soft, feathery turnings, its malignity."​
It goes on to say:

One theory is that ruminators have a particular cognitive style, a neuronal inflexibility that distorts the normal executive functioning of the brain. Two psychologists at the University of Colorado, Boulder, decided to explore this idea in the laboratory, to see if they could identify the specific deficit underlying such perseveration. Anson Whitmer and Marie Banich gave several hundred young adults a widely used test to measure their ruminative tendencies. The ones who scored high were not clinically depressed, but they did display this signature cognitive style.

Then the psychologists gave both the ruminators and those who scored very low on this trait a complicated mental test in which they were required to pay attention to certain stimuli, switch their attention elsewhere, suppress thoughts and replace them with new ones, and so forth. The idea was to sort out two ways that normal attention can malfunction. Sometimes we simply can?t shake an unwanted thought, hard as we try. At other times we cannot switch from one way of thinking to a newer, fresher way. These sound similar, but to the brain?s executive neurons they are distinct. The subjects were required to respond as rapidly as they could, in order to tap into these fundamental, unconscious processes.

The results, as reported in the June issue of Psychological Science, were plain. The ruminators, when compared to normal thinkers, had much more difficulty suppressing unwanted thoughts. Imagine trying as hard as you can not to think of the death of a loved one or a failed relationship--or trying to expel the embodiment of your melancholy--and failing; that?s the clinical equivalent of these lab results.

But Whitmer and Banich went one step further. They studied the same two cognitive processes in two other kinds of rumination, namely angry rumination and intellectual reflection. Angry rumination is, well, think of the rude guy who just cut you off in traffic?and the visceral feelings you still have, hours later. Reflection, as the word conveys, is good rumination; it?s peaceful and creative focus on an idea.

It turns out that, as different as they are emotionally, angry rumination and intellectual reflection are cognitively similar?and cognitively distinct from the distorted thinking of depression. Both involve difficulty switching to a new topic, rather than difficulty inhibiting a negative thought. In a sense, depressive rumination is an avoidance problem, while angry rumination and reflection are characterized by uncommon persistence in a way of thinking.​


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## Gwen67

> Most of those with panic, anxiety, or depression know exactly what obsessive thinking is like. "Something's wrong with my heart. My heart's not beating right. It's skipping beats. Didn't that basketball player collapse on the court and die because his heart was skipping beats? What if I get to the supermarket, and collapse right their in the frozen foods aisle? I'll be so far from home! And what if nobody helps me? I know that's not really going to happen. But my heart's skipping beats -- what if it does? What if I have a heart attack, and collapse, and die?"



Wow, I have literally had these _exact_ thoughts before...that my heart didn't feel like it was beating right and that I had some undiagnosed heart problem and about the basketball player that just dropped dead with the heart problem.

I came on here tonight because I needed to talk about an anxiety attack I just had....so I don't know if this is the appropriate thread to post this in, but I'm just going to since I'm already here. (Maybe a mod can move it if it's not right here?)

Over the last 6 months or so (could be longer, I'm really not sure) I've been having occasional anxiety attacks.  I didn't classify them as anxiety attacks before, because I didn't really have a lot "symptoms" for them.....they were basically just like, an awful feeling I would get.  Most often it would happen late at night and would basically involve my or someone in my family's imminent death or one of us being diagnosed with some fatal medical problem (like cancer).

Lately I've been getting this feeling more and more often....like that one of my parents will be in a car accident on their way home from work.  A couple of weeks ago I was driving to visit some friends 4 hours away and I was just terrified that I would be in a car accident and die.  It is really scary to have these feelings and thoughts about death all the time.  I hate it....I really think I need some actual help now.  I know exactly how I bring these thoughts on too.  Basically I think about the future (it has been short term and long term) and if I can't "imagine" myself or my mom or something there, I start having these awful feelings about death.  The reason this scares me so much is because I normally have very good intuition about things....not all things, but sometimes I just "know" things before they happen.  I definately would not call this psychic ability or anything, but it scares me when I can't "imagine" something because often times my intuition has been very accurate when I _have_ imagined something. (However never about something terrible...as yet)

Tonight's attack was different than I've felt before and that scared me even more.  My mom went to Florida today and is supposed to be coming back next week.  I felt like I couldn't "imagine" her coming back and I started getting upset like she was going to die in a plane crash or something on the way home.  Except today I didn't have that horrible awful feeling in my stomach that I normally do when this happens.  My stomach had been feeling weird all night and I started having like nauseous hunger pains, but different.  I actually was hungry, but whenever I thought about eating something, I didn't feel sick, I felt nervous.  And I didn't have that awful feeling, but I had a more "neutral" feeling and scared and nervous feeling.  This *really* frightened me because the other day I determined that my intuition was good when I felt "neutral" about something rather than afraid (but I was obviously very upset to be thinking about my mother dying).  Does any of this make any sense?  I've calmed myself down, but I know if I start thinking about it again it will come back.  I'm still scared about the intuition thing.

Anyway, I realize this is really long so if you've made it this far, thanks.  I don't know what else to say right now, but I really just don't want to be scared anymore and I really want these feelings to be wrong!

Any advice, comments, and especially REASSURANCE would be wonderful. Thanks so much!


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## David Baxter PhD

I think that many or most people with anxiety disorders have a certain "OCD  style" of worrying (I call it that because it's also characteristic of obsessive-compulsive disorder, which is also an anxiety disorder at its foundation).

Part of that is "runaway worrying", where the very existence of a thought or worry takes on a life of its own. There's a kind of internal dialogue going on that says "if I'm having this thought or worry it must have significance - it must mean that it's telling me it's going to happen", so that the thought or worry takes on predictive powers for the individual.

In reality, the only significance it has is that it's something the individual fears or worries about. When my children are out driving in bad weather or are later than expected arriving home, I worry about them - I have fleeting thoughts about something happening to them or worries that they may be ill or injured, but I am able to push those thoughts away as irrational. Someone with this "OCD-style" of worrying has much greater difficulty in dismissing the thought, even where it is recognized as irrational. But it's the same worry - just experienced differently.

When I'm working with clients with this characertistic, what I help them to do is to accept the thought or worry for what it is, to learn to resist giving it special significance, to understand that "this is just how I worry - I don't want this thing to happen so I worry about it - the fact that I worry about it doesn't mean it's going to happen".

I don't doubt that some of your past worries have "come true". But I am also certain that many of them have not, that many more than you remember have not come true. It's that superstitious thinking based on OCD-style worrying and selective memory that drives the anxiety to such levels.


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## Gwen67

So do you believe that what I described above are anxiety attacks?  Yes they are worries that I have, but they are not constant.  I always know they are irrational, but sometimes I get an awful feeling for a little bit and then it passes.  Most of the time if I have a thought about something scary, I am able to push it away because it's ridiculous and not worry about it....just sometimes I get a really bad feeling -- that's when it's harder to push away.  It's not the thoughts I have a problem with -- it's the feeling.  I have never been diagnosed with any kind of anxiety disorder; in fact I've never even talked to anyone about any of this.   

The problem that I have with all of this is that I haven't always been like this.  I mean, I'm sure to an extent I have, but I never used to have so many morbid worries about things.  This is more something that has increasingly developed.  Increased worries.

I don't doubt that I have an obsessive style of thinking.  In my daily life, I am a very calm, rational, level-headed person...I just don't get frazzled about things.  When I face a problem, I think through it and come up with a solution.  Thinking is just what I do.  Thinking is what makes me able to stay calm in sticky situations.  But I'm sure all my thinking brings up more worries than if I just didn't think so much.

When I was talking about my intuition coming true, it has never been about worries....just random things.  Like I knew what kind of car my parents were going to buy before they decided; I knew the other day that I wouldn't have to go to a scheduled appointment before it was cancelled.  Sometimes I just "feel" things like that.  This is why I feel like maybe the thought/worry has significance like you mentioned and this is why they scare me so much even though i am fully aware of how irrational they are.  This is the scariest part about all of this.  What can i do about this?

Like I said earlier, it's not a random thought that scares me -- it's the bad feeling accompanied with the thought.  Is this an anxiety disorder?  What can I do to manage this?

Thanks


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## David Baxter PhD

Gwen67 said:


> So do you believe that what I described above are anxiety attacks?  Yes they are worries that I have, but they are not constant.  I always know they are irrational, but sometimes I get an awful feeling for a little bit and then it passes.  Most of the time if I have a thought about something scary, I am able to push it away because it's ridiculous and not worry about it....just sometimes I get a really bad feeling -- that's when it's harder to push away.  It's not the thoughts I have a problem with -- it's the feeling.  I have never been diagnosed with any kind of anxiety disorder; in fact I've never even talked to anyone about any of this.



I won't try to diagnose anyone from a distance. However, with anxiety disorders, symptoms typically do tend to wax and wane, depending on (1) how much general stress you're experiencing; (2) how much things in your life feel out of your control; (3) hormonal variations; or even (4) how well you are sleeping.



Gwen67 said:


> The problem that I have with all of this is that I haven't always been like this.  I mean, I'm sure to an extent I have, but I never used to have so many morbid worries about things.  This is more something that has increasingly developed.  Increased worries.



That's also not unusual. What has changed in your life recently?



Gwen67 said:


> I don't doubt that I have an obsessive style of thinking.  In my daily life, I am a very calm, rational, level-headed person...I just don't get frazzled about things.  When I face a problem, I think through it and come up with a solution.  Thinking is just what I do.  Thinking is what makes me able to stay calm in sticky situations.  But I'm sure all my thinking brings up more worries than if I just didn't think so much.



Almost certainly. Your reliance on cognition rather than feelings to make decisions or solve problems is what gives you confidence. But when you're facing a situation where logic doesn't seem to work, your anxiety rises sharply because you're much less comfortable with emotional decision-making.



Gwen67 said:


> When I was talking about my intuition coming true, it has never been about worries....just random things.  Like I knew what kind of car my parents were going to buy before they decided; I knew the other day that I wouldn't have to go to a scheduled appointment before it was cancelled.  Sometimes I just "feel" things like that.  This is why I feel like maybe the thought/worry has significance like you mentioned and this is why they scare me so much even though i am fully aware of how irrational they are.  This is the scariest part about all of this.  What can i do about this?



Those "hunches" or "intuitions" aren't magical. They're not even purely "guesses". They're based on either (1) information you have (or believe you have) about the other people involved or about the circumstances; or (2) based on fears about those people or circumstances.

You also need to take ninto account the number of times that you "knew" something was going to happen and it didn't happen. Those times tend not to be remembered nearly as often as the times where your "hunch" turned out to be correct.



Gwen67 said:


> Like I said earlier, it's not a random thought that scares me -- it's the bad feeling accompanied with the thought.  Is this an anxiety disorder?  What can I do to manage this?



See my previous comments. It's largely about challenging the thoughts and using cognitive restructuring (CBT, or cognitive behavior therapy) to change your self-talk and the significance you allow your worries to take on.


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## Gwen67

Nothing has changed in my life recently and it is a huge problem for me.  I'm just stuck in this rut with nothing changing or advancing.  I hate it.  I actually think I might be falling into some sort of depression.  I haven't felt like myself in a long time.  I've lost a lot of self confidence and I feel disappointed in myself and like I haven't accomplished anything and I feel lonely.  Nobody else can tell though because when I'm around other people I'm able to pretend to be myself.

The morbid worries have been coming more and more frequently and I don't want this to become debilitating where I'm afraid to do things because of irrational worries.  I really want to improve my relationship with my family, but nothing has been changing.  We don't have bad relationships....just empty - like none of us really know each other.  I don't know how to fix things, so I fear that I won't have enough time with them (not daily, just total - like before someone dies).  Like I'm always just wasting time with them.  Could this be what is stemming the morbid worries about them and myself?

What you said about the emotional decision-making made a lot of sense.  Thinking _is_ what gives me confidence and emotions make me feel like i'm weak.  So anything dealing with emotional issues probably does increase my anxiety a lot.

All of this is getting a little intense.. Do you advise that I seek professional help?  Right now I deal with everything independently....I never talk about my personal issues with others.  I see you are in Ottawa...I go to university in Ottawa.  Do you actually have a practice?  If so, maybe you could PM me with some information about it.

I really appreciate your responses thus far.  Thanks!


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## David Baxter PhD

Gwen67 said:


> I really want to improve my relationship with my family, but nothing has been changing.  We don't have bad relationships....just empty - like none of us really know each other.  I don't know how to fix things, so I fear that I won't have enough time with them (not daily, just total - like before someone dies).  Like I'm always just wasting time with them.  Could this be what is stemming the morbid worries about them and myself?



That sounds very likely to me. It almost sounds like a family where one of the parents was an alcoholic or highly critical or aggressive/prone to rages.



Gwen67 said:


> All of this is getting a little intense.. Do you advise that I seek professional help?  Right now I deal with everything independently....I never talk about my personal issues with others.  I see you are in Ottawa...I go to university in Ottawa.  Do you actually have a practice?  If so, maybe you could PM me with some information about it.



Actually, you can view more about my practice at the main website: http://www.psychlinks.ca/pages/baxter.htm. I suspect that some counseling or psychotherapy could be helpful.


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## ThatLady

> I don't know how to fix things, so I fear that I won't have enough time with them (not daily, just total - like before someone dies). Like I'm always just wasting time with them. Could this be what is stemming the morbid worries about them and myself?
> 
> What you said about the emotional decision-making made a lot of sense. Thinking is what gives me confidence and emotions make me feel like i'm weak. So anything dealing with emotional issues probably does increase my anxiety a lot.



I sorta cherry-picked these comments out of your post because they struck me as something to which I can relate.

One thing I've learned that has helped me tremendously is that no one person can "fix" things gone wrong between two or more people, family or otherwise. It takes a cooperative effort on the part of everyone involved. Without that cooperation, the one person who wants to "fix" things will find him/herself spinning his/her wheels. It's frustrating, and it's discouraging. It leads only to disappointment. If all the people involved aren't willing to work at repairing the broken parts of a relationship, the relationship is going to stay broken. As hard as it is, sometimes we just have to face that fact and either work around the broken parts, or let the relationship go.

Emotions are difficult; especially, if you've been the type to subjugate them and try to work from logic alone. I think this kind of thinking can come about for many reasons. For me, it happened because I was always accused (by family, mostly) of being "too" emotional, "too" sensitive, "too" dramatic. It took therapy to bring me to the realization that I'm not "too" anything. I'm me, and that's a fine thing to be!

Therapy can help you work through the difficulties you're having. I'm sure of it. I know it did wonders for me.


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## Gwen67

I totally forgot about this thread!  Thanks for your post ThatLady .  It really made a lot of sense to me.  First thing that would be helpful is if all of them would actually realize that our relationships need fixing and actually want to help them ... they're not stupid; they know we're not as close as we should be, but I think for all of them (and what used to be for me) it's more like, 'oh well, sucks but nothing i can do' type thing, or 'oh well, this is just the way our family is'.  except I don't want this to be the way our family is anymore...

The second part of what you said is interesting because that's definately how I feel I'm perceived by my family -- too emotional, sensitive, dramatic.. But the funny thing is that is like the complete opposite of me outside of my family.  It's something that all of my friends acknowledge about me, that I'm not one to get emotional or upset about things or create drama, and that I'm not like most other girls in that sense.  But I also feel like my family is completely emotionally-stunted, so any display of emotion other than anger or neutral is like SUPER emotional, SUPER sensitive, SUPER dramatic...



David Baxter said:


> Part of that is "runaway worrying", where the very existence of a thought or worry takes on a life of its own. There's a kind of internal dialogue going on that says "if I'm having this thought or worry it must have significance - it must mean that it's telling me it's going to happen", so that the thought or worry takes on predictive powers for the individual.



I keep coming back to this -- that the presence of my worry is significant...because I believe everything happens for a reason ... how can I tell myself then that I have this worry for no reason??


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## ThatLady

I don't think you should tell yourself you have this worry for no reason, Gwen. There is a reason. You'd like to see relationships improve within your family setting. However, I think what Dr. Baxter is trying to point out is that we can't let these concerns take over our lives. While it's a worthwhile effort on your part to try to get your family to be closer and more involved with one another, it should take up all your time and energy. It shouldn't become the only thing on your mind, or the only thing of importance. You've got to go on living life and enjoying it.


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## Vinton

I believe that rumination and impulsion are part of OCD.

Am I right?


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## David Baxter PhD

Vinton said:


> I believe that rumination and impulsion are part of OCD.
> 
> Am I right?



Rumination can be part of OCD.

I'm not sure what you mean by "impulsion", though. If you mean "impulsivity" or "impulsiveness", then no, not typically. If you meant "compulsions", then yes, for certain types of OCD.


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## Vinton

I'm French so I translated directly. Yes it is compulsion.


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## Apocalipser

I've read the post and I was thinking It was exactly one "mental trait" I have.
Except that my ruminations continues for years, and it only decreases to a certain point, from which it do not decreases anymore, no matter how much time passes from the events that caused the rumination. It still causes deep hurt or rage everytime I think about it.

Sometimes, these ruminations, combined with other "psychyatry problems" I have, create this tornado inside my head, ever spinning, the only way I can get out of it is if I take like half a dozen lexotans so that I crash and sleep.

Sometimes this tornado engulfs me in situations I must stay awake, like in a work break, or in the way back from work. That's kinda worse, since I feel like putting a gun to my head and shoot, or take the seat belt and drive as fast as I can into a concrete wall.

Pretty weird for a 26-yo who drives a Porsche, if you know what I mean, success is so subjective....
To say that every single day is a struggle is a big understatement. Of course somedays are better than others, but it's like walking over a rope every single day of your life and trying not to fall to the abyss under your feet.

So, by this article, is it it's kinda genetic? You are born with pre-disposed brain mechanisms to these ruminations? Great... absolutely fantastic.
I also have personality disorders and othello syndrome, by the way.

Sometimes I wish I would just develop a disease that removed my contact with reality, like schizo or alzheimer... It's kinda weird wanting that, but I cant live like this the rest of my life... no matter what it takes.


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## ladylore

Welcome Apocalipser :hello:

Fortunately, ruminations don't happen nearly as often as they use to for me. Good old distraction helps (art work, visit a friend) with a far bit of grounding. My therapist has taught me to refraim my thinking and it usually helps.

What can still send me into an emotional spin is if there is actually something going on but I don't have all the control over the situation to handle it, for instance, rules and process you are "suppose" to follow to correct the problem. I usually ask myself if there is anything I can do to change the problem...if no, then the self talk, and talking to friends come into play. And recognizing that I am being triggered and deal with it in therapy. Not as easy as it sounds.

My therapist does Cathartic Therapy which really does eleviate much of the discomfort and much of the times calms the anxiety.


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