* Published December 2022
Anatomical Models of Rumination
Rumination as defined in RF-ERP captures all sorts of different thought processes. Taking a closer look at these thought processes can be helpful in various ways.
This article presents a few different anatomical models one might use to organize the content of someone’s rumination. Notably, these models are just that – models – meaning they’re ways of organizing and thinking about something, not objective truths. They’re not exhaustive, meaning both that they don’t cover all rumination and also that there can be other helpful models that aren’t discussed here. Finally, they’re not mutually exclusive, meaning that more than one model can be applied to the same specimen.
Notably, the goal of interpreting rumination is to help a person stop, not to add an additional layer to the rumination. Anyone who walks around analyzing their rumination using these models has missed the point.
Model 1: Two Bad Options (“I’m Damned if I Do and Damned if I Don’t”)
In this model, a person is searching for an ideal option where none exists. They are going back and forth between two (or potentially more) unideal options, discarding each one over and over again because of some problem with it. They may not realize that they are going back and forth between the same options, or may feel like if they think about it enough, they will somehow discover an ideal option.
This type of rumination reflects a pressure to act in an ideal way, and an underlying belief that there must be a way to do so. The goal is to help the person see that their options are limited, that they don’t have a perfect option, and that they therefore have to (and have permission to) pick an imperfect option. In terms of facilitating response-prevention, this interpretation can help the person to see that their rumination is in vain.
This interpretation can also be a jumping-off point for looking at the person’s need to be ideal, the emotional and relational factors driving this need, and their beliefs about ideals in general. It can be helpful to talk about how nothing real is ideal, and to the extent that something is ideal in one way, it is less ideal in another way. It is often also helpful to look for an underlying ‘omnipotent fantasy,’ in which the person believes that if only they were ideal in a given way, they could achieve or prevent an outcome that is not actually subject to their control.
(If a person actually wants to spend time weighing their options, they can schedule time to do so in a constructive way, by making a list of pros and cons for each option to help them see that there are limited options, that there is no perfect option, etc.)
Model 2: Loss Versus Vulnerability to Loss (“Maybe I Should Just Get It Over With”)
In this model, a person is caught between losing attachment and feeling vulnerable to losing attachment.
An example of this is the person who is afraid that they’re in the ‘wrong’ relationship. They are terrified to lose the relationship, but then they also wonder if they should just get the inevitable over with and break up. Another example is the person who is afraid they’re a pedophile: They are terrified to believe this, but then they also wonder if they should just accept it as true and plan accordingly.
When they are engaged in this thought process, the person thinks they might actually come to the conclusion that they should get it over with, and that pushing themselves towards this conclusion might be the way out of their anxiety. But what happens is that the second they go too far in that direction, the competing concern (not wanting to lose attachment) reins them in. They therefore keep on going in circles. The goal is to help the person see that they are going in circles because they are caught between two concerns,and so they shouldn’t bother engaging in this thought process.
(As discussed here, both Type 1’s and Type 2’s may engage in this form of rumination.)
Model 3: Thinking Your Way out of a Feeling
In this model, a person is trying to think themselves out of a natural, healthy feeling that is for some reason threatening to them. Consider someone who feels angry, but tries to convince themselves that whatever happened is really their own fault; someone who is disappointed, but tries to convince themselves that actually it’s all for the best; someone who wants to go somewhere (i.e., act autonomously) but worries about getting into an accident; someone who thinks they are going to accidentally burn down the house, but reassures themselves they will not. In all of these examples, the person is engaged in a thought process that aims to neutralize a natural, healthy feeling. In some, the feeling is conscious, while in others it is disguised symbolically. The rumination reflects a tug-of-war between the natural feeling and the defense against it.
This model is based on the idea of emotional conflict and defense discussed here, and can be helpful in identifying and addressing emotional and relational dynamics driving symptoms. This type of interpretation can yield many different clinical interventions. Perhaps the person needs to acknowledge a (natural, healthy) feeling they’ve never acknowledged before. Perhaps they need to validate that feeling for themselves. Perhaps they need to realize that while in the past that feeling threatened their attachments, in the present it doesn’t. All of these things can facilitate the decision to refrain from rumination, while also attenuating the emotional forces driving the rumination in the first place. For example, if someone’s rumination is talking themselves out of being angry, and they can acknowledge that they’re angry, validate that anger for themselves, and recognize that that anger doesn’t pose a threat in the present, they might not need to ruminate about it anymore.
I’ll issue the same warning here as I have elsewhere:
None of the above means that a person’s obsessions are true. For example, it does not mean that the person with OCD about killing their baby actually wants to kill their baby. Rather, it means that the symptom reflects a natural, healthy feeling that the person is unable or afraid to feel or acknowledge. For example, ruminating about whether one might kill their baby or might want to kill their baby might reflect anger towards the baby, which every parent feels, and is not only unconcerning but actually perfectly healthy (Winnicott, 1994).
Model 4: Thinking Your Way out of What Happened
This model is very similar to Model 3, but in this case, instead of trying to think their way out of a feeling, the person is trying to think their way out of something that happened or their understanding of something that happened.
Please note: Some people with OCD ruminate about whether or not something happened. This model isn’t about that. Rather, it describes cases where the person knows what happened (i.e., there’s no question about the facts), but is searching for a way around it or around their understanding of it.
For example, someone who sees something upsetting but tells themselves they must have misunderstood; someone who searches for a way to undo something (i.e., to make it as if something never happened); someone who searches for a way they could have controlled something that in reality they had no ability to control.
In this model, the rumination reflects a tug-of-war between what happened, or the person’s understanding of what happened, and the defense against it. As you can see, this model is extremely similar to Model 3, especially because a person who tries to think their way out of something that happened, or their understanding of it, does so in order to defend themselves against certain feelings. Returning to one of the examples above, if someone is searching for a way they could have controlled something they couldn’t have, they may be doing so to avoid feelings of helplessness about what happened.
This model doesn’t indicate that the person’s understanding of what happened is or is not accurate. For example, let’s say someone saw someone else do something ethically wrong, and is trying to convince themselves that there is some additional context that justifies the behavior. That could very well be true! Nonetheless, the person’s rumination would fit this model, because they have an understanding of what happened, and they are compulsively trying to think their way out of it.
The goal of this interpretation is to obviate the person’s need to ruminate their way out of what happened by helping them come to terms with it and/or their understanding of it.
Implementation
Sometimes, and to some people, it may be obvious what model can be applied to a certain specimen of rumination. When this is not the case, I recommend the following line of questioning:
- What is going through your mind when you are ruminating? Tell me your stream-of-consciousness thoughts.
- What are you trying to figure out? What question are you trying to answer?
- What are the two possible answers or options? (1) (E.g., is it true or false? Is it me or them? Should I do it or not? Should I do this or that?)
- How do these two* possible answers map onto one of the models (2)?
A worksheet to help with this can be found here.
Conclusion
I hope these models will be helpful on both a cognitive-behavioral and a psychodynamic/psychoanalytic level, facilitating response-prevention of compulsive rumination and also helping patients and therapists to connect with underlying emotional and relational factors. Addressing the latter can provide so much additional relief.
Notes
1. Model 1 may involve more than two unideal options.
2. To reiterate, these models are neither exhaustive nor mutually exclusive. Not every specimen of rumination will fit into one of them, and some specimens might fit into multiple ones at the same time.
Works Cited
Winnicott, D. W. (1994). Hate in the counter-transference. Journal of Psychotherapy Practice & Research, 3(4), 350–356.