How DBT Mindfulness and Distress Tolerance skills can help with rumination - Center for Evidence Based Treatment Orange County DBT and CBT
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How DBT Mindfulness and Distress Tolerance skills can help with rumination

What is Rumination?

For cows, rumination is when they chew their cud over and over again, which aids in digestion. For humans, it is when we think of something negative that happened over and over and over again, which only aids in feeling bad or stuck. When we ruminate, we focus on the negative, which can contribute to a depressive mood or worsening of depressive symptoms. We feel stuck and reaching out to others proves to be frustrating because they often have good intentioned advice that is already in the ruminative loop in our heads. Rumination leads to avoidance of friends and situations because of hopelessness. Also, when we are around friends we tend to talk about the issue we are ruminating about which reinforces the storyline, contributing to the downward spiral.

How can we stop ruminating?

The first step is to identify when we are ruminating. This requires mindfulness skills – the ability to observe your thoughts and emotions. I often ask myself, “is this thought pattern a problem that can be solved?” If it is not, the solution is to redirect and engage in something present focused. If our mind wanders back to the thought, kindly redirect back to the present.

Mindfulness, as defined by Jon Kabat-Zinn, means “paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally.” The practice of mindfulness in DBT, developed by Marsha Linehan, PhD, teaches individuals allow to access their “wise mind” which is defined as the integration of emotion mind and reasonable mind. You cannot overcome emotions with reason mind and you cannot create emotions with reasonableness. In DBT, we use “what” skills to practice mindfulness and “how” skills to learn to instruct us how to do it. “What” skills are: observe, describe, and participate. “How” skills are: nonjudgmentally, one-mindfully, and effectively. It is important to develop a daily mindfulness practice by using the “how” and “what” skills daily, which can be incorporated in activities, such as walking, eating, and yoga.

For those who are new to mindfulness practice, it may be helpful to use DBT distraction skills from the distress tolerance module. The distractions are not an attempt to completely forget about it the ruminative thoughts, but rather to accept the thoughts as unhelpful and to coexist with them. DBT Distress Tolerance module “ACCEPTS” is an acronym for distraction skills. Activities, contributing, comparisons, emotions (opposite), pushing away, thoughts (e.g. counting, puzzles), and sensations (e.g. holding ice, hot shower).

It is important to remember, ruminating is not a problem that can be solved. The sooner you identify that you are ruminating, the easier it is to redirect. Some people find it helpful to think of their thoughts as a train going by or leaves traveling down a stream. We can choose not to get on the train or pick up the leaf. In Linehan’s latest workbook, there is a worksheet entitled “Mindfulness of Thoughts” which has several examples of noticing, but not attaching to thoughts. As with mindfulness in general, it must be practiced on a regular basis to become skilled.