A to Z Guide to Stress Management for People with Bipolar Disorder, Part 4: Don’t Ruminate

This is the fourth in a series of 26 posts covering a variety of stress management tools and techniques, starting with the letter A. For some background information on stress and bipolar disorder, the blogger recommends reading her three-part series, “Getting a Handle on Stress When You Have Bipolar Disorder,” starting with the first one.

Welcome to the A to Z Guide to Stress Management for People with Bipolar Disorder. In this series I will give you a wide variety of stress management tools and techniques to try. Some go hand and hand, and some may appear contradictory — for example, changing your thoughts and accepting your thoughts can both work. Everyone is different. There will probably be some methods you like and some that don’t work for you. Also, a particular tool or technique may work better in some situations than in others. Keep an open mind, experiment and discover what helps most.

And now for “D”: Don’t Ruminate

As I pointed out in a previous post, ruminating about stressors prolongs the stress response in the body and contributes to depression. It affects emotions, thoughts and behaviors. A powerful way to manage stress and maintain stability is to reduce rumination.

What is rumination?

Rumination involves repetitive thoughts about problems in your life. The word rumination is used to describe the digestive process of cows and other “ruminant” animals like sheep and giraffes. Unlike humans, cows chew things more than once before digesting them. They chew their food once, swallow it, unswallow it and “chew their cud” some more. Cows spend almost eight hours a day chewing!

So rumination, in human terms, refers to “chewing” thoughts or images over and over in your mind. Generally speaking, rumination is used to refer to the type of thinking associated with depression (though different people use the term differently). Similar repetitive thought process, such as worry, play a part in a number of mental disorders.

How do you reduce rumination?

The short answer is, however you can. I think many stress management techniques work in part because they reduce rumination. But in this post I’ll give you some strategies specifically designed to reduce it. These strategies are based on metacognitive therapy (MCT). MCT is a type of cognitive behavior therapy (CBT). However, rather than focusing on the content of thoughts as in traditional CBT (for example, by using thought records or reappraisal), it focuses on the process of thinking. MCT concerns how you relate to your thoughts and what you believe about them.

In MCT, rumination is seen as an attempted coping strategy. People ruminate as a way of dealing with difficult experiences — but it ends up backfiring and making things worse. In MCT, rumination is directly targeted to treat depression.

Here are three things you can do to reduce rumination:

1. Become aware of rumination. For many of us, rumination has become such a habitual process that we don’t even notice we’re doing it. In fact, when you start to pay attention, you may be surprised by how often your mind goes down that road. Once you become aware of rumination, you may find it starts to fade.

2. Challenge your beliefs about rumination. People often have unhelpful beliefs regarding rumination. Here are two of the most common ones:

“Rumination is out of my control”: As anyone who has experienced rumination can attest, it can seemingly take on a life of its own. It may seem like your thoughts are being hijacked and that you are a helpless victim. Although rumination may seem uncontrollable, that doesn’t mean it is.

“Rumination is helpful”: A lot of people swear by the belief that rumination helps them figure things out. But does it, really? It’s important to keep in mind that ruminating isn’t the same as problem solving, planning, journaling or even having a good cry. The point isn’t to deny stressors or problems, it’s simply to ban a particular thinking style that isn’t likely to be productive.

In MCT, these types of beliefs are challenged. If you identify with these beliefs, here are some questions you can ask yourself:

  •  If I’m ruminating and then something urgent or compelling happens that requires my attention, what happens to the rumination? If it stops, what does that say about how uncontrollable it is?
  • How much has rumination actually helped me in the past? If I’ve been ruminating all my life and still have many of the same problems, how helpful can it be?

You can also try experiments to test out your beliefs, for example:

  •  Try to deliberately increase rumination. If you’re able to increase it using your will, what does that say about how uncontrollable it is?
  • Choose to ruminate a lot one day, and then choose to ban rumination the next day. Did you feel better and solve more problems on the day you were ruminating a lot? If not, what does that say about how helpful it is?

3. Postpone rumination. In MCT, thoughts are believed to be the main triggers for rumination. A stressful event may happen, but the event doesn’t directly trigger rumination — rather, your thoughts about the event do. You can be aware of these triggering thoughts without engaging in rumination.

How do you do that? When you notice yourself getting triggered and starting to ruminate, decide to postpone ruminating until a later time. Choose a time later in the day (but not right before bedtime) to spend 10 minutes chewing over the issue. You’re not required to follow through with the rumination — in fact most people find it’s not necessary.

Don’t try to suppress or avoid the triggering thoughts (which probably won’t be effective). Instead, just remain aware of the thoughts and observe them. Take a step back and watch the thoughts from a part of you that is separate from the thoughts. Know they will eventually pass, as clouds eventually pass through the sky. This is called detached mindfulness in MCT.

What about basking and mania/hypomania?

Basking involves repetitive thinking about positive stressors and can potentially lead to mania/hypomania. While the research is clear that MCT helps depression (as well as anxiety and a number of other conditions), to my knowledge, no research has been done on MCT for mania/hypomania.

But in my experience, basking is similar to rumination. It seems to be another type of repetitive thinking style and is likely used as an attempted coping strategy. It seems probable it can be addressed in similar ways (by building awareness, challenging beliefs about it and postponing it). In the case of basking, a key belief that needs to be challenged is that it is harmless. Some people enjoy mania/hypomania, so they may engage in basking without regard for its potential consequences. Basking may seem like an enjoyable process — but if your goal is stability, it’s unlikely to get you there.

My personal experience: I’ve been surprised at the power of noticing rumination and deciding not to engage with it. This idea sounded way too simple when I first heard about it, and I was quite skeptical. But once I gained awareness of rumination and started to change my beliefs about it, it started to lose its hold. It is more difficult with more severe stressors, but even with those I’ve been able to substantially reduce how intense the rumination is and how long it lasts.

How to start: As I mentioned, one of the most important things is to become aware of rumination. The next time you become stressed, stop and notice what is happening with your thoughts. Are you starting to ruminate? You might find that in itself weakens its hold.

Additional resources: Unfortunately, MCT doesn’t seem to be widely available. Its founder, Adrian Wells, is in the United Kingdom and from what I can tell, the therapy is mainly practiced in Europe. According to the MCT Institute’s website they are in the process of developing self-help materials. If you want an in-depth read, you can get Metacognitive Therapy for Anxiety and Depression. It’s geared toward therapists but is very clearly written. You may also be able find a therapist trained in CBT who will work through that book with you.

You can find the rest of Carrie’s IBPF posts here or read additional articles on her Addiction.com blog. You can also visit the website for Counseling and More, her private practice, or Bipolar Beast, a company designed to empower people with bipolar disorder.

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