Breaking Free from Overthinking: How to Master Your Mind (even as a teen!)
Learn about rumination, its impact on our well-being, and how to break the cycle with the ASK technique.
Have you ever found yourself trapped in a loop of negative thoughts, unable to break free? If so, you've experienced rumination. This habit tends to make us feel bad and can contribute to ongoing depression. The good news is scientists are exploring ways to overcome rumination and replace it with healthier mental habits.
Overthinking (or rumination) is when we repeatedly dwell on negative thoughts or experiences, which often makes us feel stuck and helpless. It can be a major roadblock on the path to happiness. One of the pioneers in understanding this mental habit, Susan Nolen-Hoeksema, discovered that women tend to engage in overthinking more than men. She even wrote a book about it called "Women Who Think Too Much." Overthinking can make us feel stuck and unproductive, but the key to overcoming it is developing new, healthier ways of thinking.
A helpful approach to reducing overthinking is called RF-CBT, developed by another expert, Ed Watkins at the University of Exeter. His treatment uses the acronym ASK to remind us to be Active, Specific, and Kind as alternatives to overthinking. First, we have to build awareness of when we are caught in the trap of overthinking. Then we can choose to toggle into another mental mode (kind of like what software or app you are using on a computer).
Breaking the Cycle: The ASK Technique
Practicing being Active, Specific, and Kind can create positive habits to use in the place of rumination. Let’s look at these alternatives more closely:
Active: Instead of continuing to just think about a problem, is there something you can do? Could you ask someone to help? Could you take a break and move your body if you’re feeling stuck and come back and problem-solve later? Can you take a small step to solve the problem?
Specific: To replace ruminative thoughts, try to pinpoint specific problems and possible solutions. For example, instead of thinking, "Why does this always happen to me?" focus on a specific issue, such as, "I missed an assignment in math class last Monday." By identifying the specific problem, you make it more likely you can take a specific action step like Tuesday at 4 pm I will spend 20 minutes completing the late assignment.
Kind: Lastly, practice self-compassion. Treat yourself as you would a friend, with understanding and kindness. Remember, everyone makes mistakes, and it's okay to feel disappointed or frustrated. Beating ourselves up about our mistakes only makes us feel worse and doesn’t motivate us to move forward in a positive way.
Research Evidence for Success
Research by Watkins’ team in England has shown that RF-CBT can be effective in helping adults shrink their rumination habits. We explored whether RF-CBT could help earlier in life, specifically among teenagers with a history of depression.
Our pilot research was conducted at the University of Illinois at Chicago where we recruited 33 teenagers, ages 12-18, who had a history of depression but were not currently depressed. These teens were divided into two groups: one group received RF-CBT while the other group received Assessment Only (AO). We measured self-report of overthinking (rumination) and fMRI brain scans before and after treatment. The results were promising: teens who participated in the RF-CBT intervention showed a significant reduction in rumination scores compared to the treatment-as-usual group. The fMRI scans illustrated shifts in brain connectivity, suggesting that RF-CBT might influence the mental habit of rumination at the level of the brain.
More specifically, we observed a reduction in connectivity between the left posterior cingulate cortex (PCC) and the right inferior temporal gyrus. The PCC is a key node in the Default Mode Network (DMN) and plays a crucial role in self-referential thinking, while the right inferior temporal gyrus is involved in cognitive control and processing of emotional stimuli. Reducing the connectivity between these regions may result in a better balance between self-referential thoughts and cognitive control, allowing individuals to shift their attention more easily away from negative thoughts.
Figure 1. Change in connectivity of the left posterior cingulate cortex across eight weeks of Rumination-Focused Cognitive Behavior Therapy.
Panel a displays significant connectivity of the left posterior cingulate seed with the whole brain among all participants at baseline. Panel b illustrates reduced connectivity with the right inferior frontal gyrus. Panel c illustrates reduced connectivity with the bilateral inferior temporal gyri. Panel d illustrates reduced connectivity with the middle frontal gyrus. Panel e illustrates reduced connectivity with the caudate body. Panel f illustrates reduced connectivity with the middle cingulate. z denotes z coordinates for axial slices and statistical maps are illustrated to the right of relevant images.
https://doi.org/10.1371/journal.pone.0163952.g003
We also found that stronger connections between the left dlPFC and left inferior frontal gyrus, was associated with lower levels of mindfulness (Peters et al., 2016).
When we followed these adolescents for two additional years of monitoring their depressive symptoms, we found that teens who learned RF-CBT skills maintained lower depression scores, relapsed into full depression more slowly, and were hospitalized less frequently for suicidality than their peers who did not learn RF-CBT (Bessette et al 2020).
Figure 2. Survival plot of percent well (any mood disorder relapse) over study intervention and two-year post-intervention follow-up.
RFCBT = Rumination-focused Cognitive Behavior Therapy, AO = Assessment Only, AMD = Any Mood Disorder. Percent of adolescents in each group not meeting criteria for AMD at each assessment point; at two-year study endpoint, all AO adolescents experienced a relapse, whereas 26.7% of RFCBT youth remained well.
https://doi.org/10.1371/journal.pone.0233539.g003
Why this is important
The take-home message is that we are hopeful that reducing rumination and increasing the skills of ASK could alleviate some of the negative symptoms associated with rumination and depression. Since teenagers’ brains are still developing and the habit may not be as entrenched, we want them to learn healthy habits that will help them transition to a healthy adulthood free from depression.
What you can do
If you find yourself struggling with rumination, remember the ASK technique: Active, Specific, and Kind. By cultivating healthier thinking habits and treating yourself with compassion, you can break the cycle of negative thoughts and work towards a happier, more resilient mind. If you see a teenager in your life stuck in their head or struggling with depression, get them help as soon as you can. Remember there is hope and we have treatments that can help.
Funding:
The research was supported by the Mind and Life Institute, the Klingenstein Third Generation Fund, the University of Illinois at Chicago Campus Research Board, and the National Center for Advancing Translational Sciences to Rachel Jacobs.
Ongoing research is supported by the National Institute of Mental Health (MH116080) to Scott Langenecker and Ed Watkins. Recruitment is ongoing: https://medicine.utah.edu/psychiatry/research/labs/mend2/rumechange
https://clinicaltrials.gov/ct2/show/NCT03859297
References:
Bessette KL, Jacobs RH, Heleniak C, Peters AT, Welsh RC, Watkins ER, Langenecker SA. Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. PLOS ONE. 2020;15:e0233539.
Jacobs RH, Watkins ER, Peters AT, Feldhaus C, Barba A, Carbray J, Langenecker SA:
Targeting Ruminative Thinking in Adolescents at Risk for Depressive Relapse: Rumination-Focused Cognitive Behavior Therapy in a Pilot Randomized Controlled Trial with Resting State fMRI. PLoS ONE, 11(11): e0163952. Nolen-Hoeksema, S. Women Who Think Too Much: How to break free of overthinking and reclaim your life. Henry Holt and Co; 2003.
Peters A, Burkhouse KL, Feldhaus C, Langenecker SA, Jacobs RH. Aberrant resting-state functional connectivity in limbic and cognitive control networks relates to depressive rumination and mindfulness: A pilot study among adolescents with a history of depression Journal of Affective Disorders. 2016;200:178-181.
Watkins ER: Rumination-Focused Cognitive-Behavioral Therapy for Depression. London, Guilford; 2016.
Watkins, E.R., Mullan, E., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., et al. (2011). Rumination-focused cognitive-behavioural therapy for residual depression: Phase II randomized controlled trial. The British Journal of Psychiatry, 199, 317-322.