Rumination-Focused Case Conceptualization

Please note that Rumination-Focused ERP is a new and evolving approach to ERP. It has not yet been researched, and therefore to the extent that it differs from classical ERP, it is not evidence-based.

An effective treatment plan starts with an accurate understanding of what’s causing the problem, also known as a case conceptualization.  RF-ERP views rumination as the cornerstone of OCD, and therefore starts with a case conceptualization that includes the role of rumination.  Here are some examples:

Contamination: As discussed here, ruminating about (paying attention to; keeping track of) what is contaminated generates the subjective experience of contamination.

Intrusive thoughts’ (e.g., in ‘Pure O’): As discussed here, when people say they’re struggling with intrusive thoughts, they are actually struggling with rumination. (1) Ruminating about (trying to solve) a problem keeps the problem in mind. (2) If a person gets stuck ruminating (and consequently feeling anxious) every time they’re reminded of the problem, they become afraid to be reminded of it.

Hyperawareness (e.g., in sensorimotor OCD): As discussed here, ruminating about a sensation or experience (directing attention towards it, trying to figure out how to stop noticing it) keeps it in awareness.

A persistent urge (e.g., in BFRBs, rituals, ‘just right’ OCD, and other compulsive behaviors): As discussed here, ruminating about (struggling with) whether or not to fulfill an urge perpetuates the urge.  Not knowing how to stop ruminating thus makes fulfillment of the urge the only way out.

Manufactured emotions, such as guilt and regret: Ruminating about potential sources of these feelings manufactures the experience of them.

Fear of anxiety itself: A fear of being unable to stop ruminating later may be a reason for avoidance or compulsion.

And on the most basic level:

Anxiety:  As a general rule, if someone is anxious, they’re ruminating (trying to figure something out or directing attention towards something).   For further discussion, see here.

Please note that this article is for your information only and does not constitute clinical advice or establish a patient-psychologist relationship.