How to step out from rumination in depression and take action?

People often find it very difficult for them to ask their closed ones to stop ruminating when their closed ones are depressed.  It is common that no matter how hard one tried, the depressed person cannot step out from thinking about his or her worthlessness or hopelessness.  For instance, a client of mine sufferred from depression and he kept ruminating about others judging him as inadequate after he was being laid off by his boss.  Due to his depression, he withdrew from his family members and friends.  As a result, he had no chance to share about his thinking and get some objective appraisal of the validity of his thinking.  He felt stuck in his life and did not engage in any meaningful activities.  He also had no motivation to start job search and kept thinking his future as hopeless due to his unemployment.  In fact, he felt distressed for his persistent thinking about his subjective inadequacy and worthlessness.  Despite the negative consequences of his rumination, he still could not stop himself from doing this.  He felt very lost and out of control.  Why do people with depression cannot stop themselves from ruminating?

One of the possible reasons for people with depression to ruminate is that it serves as a functional avoidance to escape from adversive experiences.  For example, the client above kept ruminating about his inadequacy so that he procrastinated to start a job search.  In this way, he could avoid possible failure in job interviews and risk of proving that he was incapable in the eyes of employers.  In fact, it might reduce his distress on worrying about being humiliated during job interviews and facing failure in finding another job.  Due to this possible function of rumination, his depression exacerbated and he became even more ruminative.

When people depressed, their rumination might cause them to even further withdraw from social contact and engagement in activities.  This withdrawal might close ones’ life down and lead ones to think in a negative way in all aspects of ones’ life.  This further exacerbated the severity of the depression.  Furthermore, by ruminating, ones limited the exposure to contradicting information of one’s thinking.  This makes it very difficult for ones to disconfirm ones’ negative beliefs and to engage in new learning opportunties.  For instance, the client above got stuck in his life due to rumination.  He kept thinking about he was a failure and no one would hire him.  He closed off himself and did not discuss this with his family and friends.  He did not have a chance to be exposed to other perspectives due to his social withdrawal.  Without trying to attend job interviews by job search, he cannot learn new skills in performing well in job interviews.  This further limited his chance of finding another good job opportunity.

In fact, rumination engaged by depressed people prevented them from facing their actual problems and to solving it with effective strategies.  This way of avoiding to face the actual problems turned the person to only focusing on one’s thoughts and internal states.  Gradually, the persistent depressive mood also paradoxically “proved” that one is inadequate and worthless, because of the avoidance of actual problem-solving and engaging in more positive activities. 

With proper psychotherapy, people with depression are able to reduce or stop ruminating.  When a depressed person is able to replace rumination with alternative constructive behaviors, it is reinforcing for one to face the actual problems and engage in new learning.  In the example above, my client started job search and attended some job interviews.  After repeated attempts in job interviews, he acquired skills in presentation and communication.  In the end, he was able to find a suitable job to have a new start in his career.

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