Rumination: A Problem in Anxiety and Depression
Rumination is one of the similarities between an anxiety and depression. Ruminating is simply repetitively going over a thought or a problem without completion. When people are depressed, the themes of rumination are typically about being inadequate or worthless. The repetition and the feelings of inadequacy raise anxiety and anxiety interferes with solving the problem. Then depression deepens.
Brain function plays a role in rumination in several ways, but one significant aspect of brain function relates to memory. People remember things that are related to each other in neural networks. And when people enter a ‘woe is me’ network the brain lights up connections to other times they felt that way. Ruminating is worsened by the another difficulty of the depressed and anxious brain: challenges to flexibly generate solutions. Brain chemistry makes it hard to switch to another perspective to find the way out of problems, so rumination intensifies. Both anxiety and depression are then reinforced.
Rumination can be switched off by two good methods: get out of the negative neural networks and tackle one problem at a time with planning.
End rumination by exiting the negative memory network
Stop ruminating on negatives and activate a neural network of times when everything worked out okay. These might be hard to remember. Neural networks are triggered by mood, and your mood might have connected to other moods when you were afraid of bad outcomes.You can deliberately decide to recall the times when things worked out even though you had been afraid. Those networks of anxiety can lead into remembering positive outcomes. However, ruminating may get you too negative to shift into a network of positive thoughts without a memory jogger. What can shift you into a different network?
- Use family or friends to help you remember. Ask them to help you think of times when things turned out fine. Conversation with encouraging others can shift your attention to a different memory network, and when others point out positive outcomes at your request, you start down a different neural path.
- Interfering with rumination may be helped with a memory jogger for times you were feeling good by going over pictures of happy memories. As you look them over, try to recall not just what you were thinking then but what your body felt like. You might be surprised that joy and happiness are physical sensations. To get in touch with a body memory, scan your senses. What you see? Taste? Touch? Smell? Hear?
- Music holds the power to put us directly back into to a place when we listened to it, usually entering into the mood we were in when we listened and then the pieces of memory fill in with people and situations. As one rather depressed person I know put it, “I like to listen to songs from high school and college, from before things started getting complicated. Maybe life was not perfect, but the music makes me feel good when I hear it.” I there a timeframe or type of music that puts your memory back into a good place?
- Another rumination interrupter is to put yourself literally into a place you connect with things turning out for you – taking a walk in a location that helps you enter a positive frame of mind can only be helpful.
The idea of going into another network is not to get lost in old memories but to find a way into a positive neural network from which you may spring board into a solution to your problem.
Rumination might prevent you from solving the problem or from moving on if you do not have a solution at the moment. Try to unhook problems from each other to see if you have an actual problem you can solve or just a worry to eliminate.
One example of this is a man who was decidedly depressed and anxious about his worklife that was fraught with debt, angry colleagues, and overwhelming reports for expenses and hours put in. He actually knew what to do about the debt, but rather than saying to himself, “I know what I will do,” and setting that problem aside, he tangled it up with a different problem. “I know what to do about the debt, but everyone will find ways to tell me they are angry about it.” Now he was ruminating on what to say to make them be less angry. Then he thought, “I wish I could walk away from them. If I can get caught up with my expenses and reports, I could consider looking for another job,” and he began ruminating about whether he could find a different job. The debt problem had nothing to do with how he wanted everyone happy, and neither affected finding the time to do his paperwork and none connected to how hard it is to find new work. But he connected unrelated problems and now could not let go of any of them. If this kind of rumination sounds like the way you go from one problem to another:
- Make a list of problems on your mind and put them in columns, side by side so you can see if there are any connected parts.
- Identify: Can you make a plan for the first one? If so, write it down, with action steps.
- Do the same thing for each problem.
- Look across the columns. Are any action steps connected to each other? If so, which step comes first? That is where you will direct your first effort. If they are not connected, then pick which action plan you will attend to first.
- See if any one problem in any one column has NO solution. Then write down a date when you might have more information to make it useful to think about it again. This is now jut a worry, and until it is possible to find a solution you do not need to think about it in the meantime.
- When any of these problems comes up, say to yourself, “Stop! I have a plan.” Refusing yourself the permission to re-think a plan is hard, but worth the effort.
The better you get at interrupting rumination, the lighter your depression will become. is possible to stop brain patterns that contribute to anxiety and depression by stopping rumination. It gets easier the more you practice, so stick with it and you will soon be able to do it automatically.
Depression and the Power of Influence
The critical distinction between influence and control makes all the difference to positive self esteem.
Life is not often in our own control. We bemoan this in various ways as we go throughout our day. “Why do I always get the red lights when I leave the house late in the morning?” “I wish I did not have to work such a mundane job.” “I want her to love me the way I love her.” “I want a baby so much. Why can’t I get pregnant?” “I don’t know what I will do if the tests show I have cancer.” From the trivial to the passionately desired wishes we have, it seems so much of our lives are not in our control.
This is truth: No person controls much in life. Yet, we create a great deal of misery in our own lives by the desire to be in control. The very idea that we should be able to control a situation leads to feeling helpless. And if a person has depression, this ‘should’ intensifies a common problematic thought process of this disorder. Depressed thinking is typically ruminative: repetitive, unresolved thoughts. And, when people are depressed, helplessness is a primary theme of their ruminative thinking. “There’s nothing I can do about it,” their brooding brains repeat and repeat until they believe it entirely.
Your brain believes what you tell it. Okay, that is very simplistically stated. But brain science demonstrates that when you repeat a thought, the brain recognizes the repetition and supports it by strengthening the structure of the neural pathway you are lighting up. The brain builds more blood supply (increased vascularization) and provides faster processing (more glial cell support). With such increased speed, that pathway of thought regarding how helpless you are becomes a superhighway of helplessness. It gets easier and easier to fall into the path of “There’s nothing I can do.”
When that is a default thought process, depression gets stronger too. It becomes harder for a person with depression to shake off the sense that they are not effective and will not be effective. Low self-efficacy is a hallmark of this disorder. When you want to climb out of depression, you do have some control, but it is important to be absolutely clear about what control is and what it is not.
12 Step Self-Help provides insight into this and I have learned from the program about the use of the word ‘powerless’ when I think about control vs. influence. The first step of this program is to acknowledge that one is powerless over the addictive substance. It is important that the step does not say helpless because that would be the first step to giving in to addiction. The powerlessness of addiction is that once you use the substance, the substance wins the battle. But an addict is not helpless. Addicts can help themselves by not using. Power is in the choice to refrain, not in controlling how much they use. Much of the 12 Step Self-Help model is focused on living a life of contented sobriety—there is a lot more to that than learning ways to not take the first drink or drug—but from the first step onward, people working a program pay attention to what they can influence as well as what they cannot control in life.
It is so important to make this distinction when the depressed brain is feeling helpless. We are indeed helpless when we want people, life, God or the universe to give us what we want and wait to see if we get it. Taking no action to influence is as unlikely to get us what we want as trying to control others to get it. I talk with people every day in therapy who say things like, “I do everything for her. Why won’t she just do this (thing I want from her)?” Meaning, “I should be in control of what she gives. The more I give to her the more she should give to me.” Or “How can I convince him/her to (stay in school, stop using our credit cards, eat better, stop drinking/gaming/gambling, pay attention to me, etc.) Meaning, “If I just find the right words, I will get what I want. S/he will do what I want.” The fallacy is you can control the other person’s behavior by finding the right words or motivation.
If any of us were indeed that powerful, it would mean we could find a way to be less depressed by exerting our control over others. We would really be effective! But we stay depressed, feeling helpless if others do not comply. Well, we are helpless to control others! So by that definition, we are ineffective, indeed.
This is where the understanding of influence comes to the rescue. You may not have control but you do have influence. I use the analogy of trying to force a baby to sleep. If you have ever been wishing a restless infant would sleep, you know the helpless feeling. That tiny person can keep you up all night and you cannot control the child’s sleeping. However you can influence whether the child sleeps. You can make sure the child is fed, dry and warm and make the environment peaceful, dark and quiet. Rocking and singing might help influence drowsiness.
What Situations Can You Influence Even if You Cannot Control Them?
There are many arenas in life where your actions make a difference.
- You cannot force your boss to give you a good evaluation, but you can influence it by the way you do your work.
- You may be powerless over whether you develop cancer, but you have influence over it by managing diet, stress, exposure to chemicals and so on.
- You cannot force a spouse to want intimacy with you, but you influence intimacy by the kindness, caring or sexual interest you display.
- You cannot guarantee an ‘A’ in a class, but you can influence it by the amount you study or put work into an essay.
- You cannot make someone show up for your birthday party, but you can send an invitation that makes it sound like fun and send a reminder.
- You cannot force another person to give you the statistics you need to complete your report, but you can send a memo reminding that person you need their work on deadline.
Influence Success: Have a Plan B
You can influence getting what you want in any situation involving another person by making plans for how to handle the situation if that person does not come through.
When you are depressed, rigid thinking may cause the failure to see influence as actual power. That rigidity might insist that you must make things go your way or you have failed. But once you see that you do not have power to control and only power to influence, you will feel much better about yourself. It is in your power to exert influence over the consequences in your life and, once you do, you may get more of what you want. And if you do not get what you want, you can evaluate if it was in your control (probably not) and if there are other ways to influence the situation in the future. Start on the path to self-efficacy today: Do the DEEDs that can help you get what you want
- Decide what you can influence about a current situation.
- Evaluate the actions you are able to take that can make a difference.
- Exert that influence: e.g., make that phone call, have that conversation, put in the effort.
- Do not assume failing to get what you want means that your influence was ineffective. It means you did not have complete control of the outcome.
- State your intention for the next time you are in this situation.
You will increase your sense of effectiveness and, thus, your self esteem, banishing the helplessness of depression.
When Is Depression Not Depression? Part 4
You feel sad and the world seems without color or flavor. You do not see the point of getting out of bed, but you have felt like this for several days and there are things that need to be done, so you get moving. This feels a lot like a depression, but there is a good reason to feel this way: you are grieving.
When depression is grief, the feelings can be very similar, and can last for some time. Traci was only 23 when her mother rapidly died from a late stage ovarian cancer. Traci welled with unpredictable tears and found it hard to go to work after her 2 days off for the funeral. After a couple of weeks her doctor wanted to put her on antidepressants. Paul, on the other hand, was ready to jump into marriage with the love of his life when she said she could not do it, she took a job in another city and left home with no notice. He could not eat or sleep, lost 15 pounds in 2 weeks and alarmed his daughter who wanted him to get on medication that would ease his depressed mood. Kimberly went to work and went home and did nothing but sit on the couch, watching some TV, ordering pizza for dinner and spent hours looking at pictures and videos she had taken of her dog who had disappeared from the yard one recent morning.
The biggest, and most common cause of deep grief is losing a loved one: a parent, a spouse or worse, a child. But grieving at the loss of a pet who was part of family life and even grieving the loss through divorce of a relationship or a way of life that was valued, can throw a person into a depression-like state. These behaviors and moods all make sense when put into the context of loss, but in our culture there is tremendous impatience with grieving. It is too often labeled as depression, and too often medicated, thereby blunting the normal process of grieving that allows people to move forward.
There are important differences between depression and grief.
- One obvious one is that the cause of the grief is a distinct and important loss, where depression may not have a distinct beginning.
- Another is that even in grief people’s sadness can be interrupted by joyful moments. Just think of funerals or wakes you may have experienced when people vacillated between tears and laughter as they remembered stories and events from the life of the person who died.
- We know that even when we are in grief, we can think of the future being less sad. We may not feel energy to move toward it at the moment, but we believe we will eventually feel less sad, less alone, less overwhelmed.
- We also know that we can remember a loved person, pet or even life situation with joy once we are done grieving the loss.
Sometimes grief becomes complicated, and it looks even more like depression when the grieving person cannot get out of the pit of sadness, low motivation, and tearfulness. It seems that in this grieving, the person gets stuck in process of moving forward. Among the reasons for getting stuck is the idea that leaving behind the sadness is a betrayal of the relationship that ended. I recall working with Consuela, whose daughter died in a car accident. It became apparent that she did not want to give up her grief because she felt it meant she would no longer love her daughter if she did not feel sad every day. Her grieving in some ways kept her close to her daughter. She warded off every attempt family and friends made to get her to move on, and it seemed as if she was in a deep depression, barely getting herself to work. She was refusing to eat meals with her husband, have a coffee date with a friend and she even got angry when told she would benefit if she got outside for a bike ride, saying, “How can I ride a bike when my daughter cannot?” No one understood she was using her grief to hold on to memory of her daughter or staying actively sad and tearful to demonstrate love. When she began to explain her fear of losing the close connection, we could then talk about other, less debilitating ways to remember and honor the daughter she lost.
The process of resolving grief includes knowing and acting on the following:
- You cannot get over grief without feeling it. This is not depression.
- Allow for the fact that grief comes in waves—a person may be knocked flat by a wave of grief after a day or several of feeling less sad. If you are grieving, expect that you will have moments, then hours, then days, then even weeks when you do not actively feel sad. You are not ‘relapsing’ to feel keenly what you thought was past. Grief can be triggered by so many things that cross your attention – a song, a picture, a sweet smell in the air, even a specific time of year (first holidays without your loved one are especially evocative of grief) but it also passes quickly.
- Try to keep self care in place as much as possible so grief does not negatively affect your health. Lots of people lose weight or have trouble sleeping for a few weeks, but that should subside gradually and without professional help. It is quite common to need a sleep aid for a few or several nights, but once you get back in rhythm of sleep, sleep comes without help and it can become healing.
- Take on the changes in your living environment carefully and attentively. This means removing possessions with attention to what and how. A widow may find it fairly easy to clean out a closet of suits and donate them, but almost a impossible to remove the stack of magazines from the floor next to ‘his’ chair. Being attentive to how it feels to clean a room, sell a car, clean out desk drawers when someone you love is not in the house anymore can help you remember what is good and what is lost in a way that helps you hold on to the good memories.
- Plan how to remember the lost love, appropriate to the relationship, and plan when to remember them. For example, Consuela eventually decided she needed to write her daughter a letter, expressing all of her feelings about how she died, and then she went to the gravesite to read it. After that she decided she would visit the grave on her daughter’s birthday and on New Year’s day but no longer would she stop every day she drove past the cemetery. Traci bought new hymnals for her church and inscribed them, donated in memory of her mother. People can find many opportunities to memorialize a loved person, such as donating bricks in a walk or benches in a park or like many organizations, put up a picture and plaque honoring the founder of their group.
- Find a productive effort you can make to respond to the loss. Consuela founded a cheerleading camp scholarship in her daughter’s name at her high school. Marie decided to walk dogs for the humane society after the death of her beloved pet. Many fund-raising and awareness-raising organizations have started from using productive work to move beyond grief, such as cancer support walks, mothers against drunk driving, efforts to locate missing children, and even new legislation.
Grief is a lot like depression, and while the loss is permanent, the deflated feeling is not. Moving on can be the best way to remember what is lost with joy.