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Worry and Rumination

Worry and rumination are forms of persistent negative thinking. They involve a predominance of verbal thoughts, and can be likened to a negative inner-speech. Worry is concerned with the possibility of threats in the future and ways to effectively avoid or deal with them whilst rumination is concerned more with things that happened in the past.

Worrying contains chains of thoughts and questions in the form of “what if•?• statements (e.g. “What if my partner has an accident?• “What if I can’t cope with my job?• “What if I become ill?•). Episodes of worry can be recurrent, persistent and last for relatively short or longer periods of time. It can interfere with concentration and sleep and it can be difficult to control.

A key difference between worry and rumination is that worry is concerned with danger whilst rumination is concerned with loss, hopelessness and failure. Rumination occurs in the context of sadness, disappointment, loss and depression. If persistent and chronic both worry and rumination can prolong and intensify emotional suffering.

Worrying is often associated with anxious symptoms such as muscle tension and feeling on-edge, feelings of dread and an inability to relax. When it is persistent occurring most of the time over a period of 6 months and it causes significant impairment and distress this may constitute a psychological disorder. Excessive and difficult to control worry is a central feature of Generalised Anxiety Disorder, but worry occurs in most types of mental health suffering. In other anxiety disorders the content of worry has a more specific focus. For example, in health anxiety it focuses on the possibility of having a serious disease, whilst in social anxiety it focuses on concerns about humiliating oneself and in panic disorder it focuses on anticipation of future panic attacks.
In contrast, rumination tends to occur in the context of depression and low mood and often people suffering from depression reduce their level of activity and this gives more time for unhelpful rumination. It can help to increase activity levels and give less time to rumination.

The ubiquity of worry and rumination has not escaped our attention at MCT-I and we believe they are part of a very important process in the development and persistence of most types of psychological disorder. Metacognitive therapy consists of many new strategies for reducing worry and rumination and regaining control over them. These techniques find a place in treating psychological disorders but they can also be used as more general strategies for learning about worry and rumination and new effective ways of relating to and reducing them. Return to the website regularly or sign-up for out newsletter to be kept informed of developments in our worry and rumination-focused research and treatment. For a comprehensive summary of research on worry and rumination the books by Davey and Wells (1), and Papageorgiou and Wells (2) are recommended. For treatment see Wells (2008).

Suggested references for academic reading

Davey, G.C.L. & Wells A. (2006). Worry and its psychological disorders: Theory, assessment and treatment. Chichester, UK: Wiley

Papageorgiou, C. & Wells, A (2004). Depressive rumination: Nature, theory and treatment. Chichester, UK: Wiley.

Papageorgiou C. & Wells, A (2003). An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research, 27, 261-273.

Wells A. & Papageorgiou C. (1995). Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy, 33, 579-583.

Wells A. (2005). Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23, 337-355.

Wells A. (2008). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press.