Ruminating About Symptoms Can Maintain Distress In Those With OCD

By Emily Reynolds

Rumination is a key feature of Obsessive-Compulsive Disorder. According to the charity OCD UK, rumination is a “train of prolonged thinking about a question or theme that is undirected and unproductive” — worrying incessantly about a particular issue or question, in other words. Those with OCD may also ruminate on their symptoms themselves: rather than just dwelling on their fears of harming someone or on existential worries, for example, they will also worry about having these thoughts in the first place.

It’s this rumination about symptoms that a team of researchers explore in a new study in the Journal of Abnormal Psychology. They find that this kind of rumination can prolong depression in those with OCD, suggesting interventions focusing on ruminative patterns could be one way of addressing the distress of such experiences.

Participants were visitors to inpatient and outpatient clinics specialising in treating OCD, as well as members of a self-help peer support group. First, they completed standardised measures of mood, the severity of their obsessive-compulsive and depressive symptoms, and their baseline level of rumination.

Before the experiment proper started, participants also identified an obsessive thought that would likely cause distress when spoken aloud. They then discussed this with a member of the research team, writing down and reading aloud a few sentences about the potential consequences of the thought. Finally, participants indicated their level of distress and their desire to neutralise that distress.

After “activating” the obsessive thought in this way, participants were asked to think about whatever they wanted in the next five minutes, recording how many times they thought about what they had written down and then again rating their level of distress and urge to neutralise.

Participants were then split into three groups. In each condition, individuals saw 28 statements and questions. In the rumination on OCD condition, these statements included “what would happen if your obsessions and compulsions persisted”; in the rumination on mood condition, “what would happen if your current mental state persisted”; and in the distraction condition more neutral statements such as “think about the shadow of a stop sign”.

Finally, at the end of this phase of the experiment participants again rated their feelings of distress, urge to neutralise, and depressed mood, and then completed another five minute session of monitoring their thoughts and rating themselves again.

Compared to those in the control condition, participants who ruminated on their symptoms or mood saw less of a decrease in distress, urge to neutralise and depressed mood by the end of the experiment. The frequency of obsessive thoughts also declined to a smaller degree in these conditions than in the distraction condition. There was no significant difference between the rumination on OCD and rumination on mood conditions.

So, overall, the results suggest that rumination on symptoms or mood can actually maintain those symptoms. Those who are distracted from rumination, however, may be less likely to experience ongoing levels of distress.

The results are unlikely to reflect the reality of ruminations for those with OCD: because episodes of ruminations are often extremely long, the effects of eight minutes of rumination in this experiment are potentially an underestimation of those someone may experience in real life settings. Looking more closely at a natural setting could provide further insight. The team also used a “counter” technique, with participants indicating how many times they had experienced a obsessive thought: whether this was able to fully capture the obsessive and ongoing nature of such thoughts is also a question worth pondering.

In terms of intervention, the team suggests techniques that supplement the standard CBT many of those with OCD receive, including trying to practise an “observing, non-judgemental and accepting stance” towards the occurrence of obsessive-compulsive symptoms. They also note the questions the results raise about distraction. While distraction is often seen as maladaptive, this study showed it had positive effects — so, while perhaps not a long-term strategy, it could be a short-term balm for those struggling with rumination of any kind.

Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study.

Emily Reynolds is a staff writer at BPS Research Digest