RUMINATION


 

CHAPTER 5

RUMINATION

Picking at Emotional Scabs


When we encounter painful experiences we typically reflect on them, hoping to reach the kinds of insights and epiphanies that reduce our distress and allow us to move on. Yet for many of us who engage in this process of self-reflection, things go awry. Instead of attaining an emotional release we get caught in a vicious cycle of rumination in which we replay the same distressing scenes, memories, and feelings over and over again, feeling worse every time we do. We become like hamsters trapped in a wheel of emotional pain, running endlessly but going nowhere. What makes rumination a form of psychological injury is that it provides no new understandings that could heal our wounds and instead serves only to pick at our scabs and infect them anew.


Unfortunately, our tendency to ruminate is set off almost solely by painful feelings and experiences and rarely by positive or joyful ones. Few of us stay up nights on end replaying how we had everyone in stitches at a dinner party. Nor do we feel the need to go over every nuance of how our boss complimented our latest efforts at work. But if everyone at the dinner party was laughing at us rather than with us, or if our boss criticized our performance and yelled at us in front of our colleagues, we can stew over it for weeks.


The danger of rumination is not only that it deepens whatever emotional distress we already feel about the events, but that it is linked to a wide range of threats to our psychological and physical health. Specifically, rumination increases our likelihood of becoming depressed and prolongs the duration of depressive episodes when we have them; it is associated with greater risk of alcohol abuse and eating disorders, it fosters negative thinking and impaired problem solving, and it increases our psychological and physiological stress responses and puts us at greater risk for cardiovascular disease.


Despite being aware of these dangers for decades, many psychotherapists struggle when it comes to treating rumination in their patients because their approaches are based on the assumption that the best way to purge ourselves of our preoccupations is to talk them through. But when we have ruminative tendencies, revisiting the same feelings and problems over and over again, even with a therapist, only increases our drive to ruminate and makes matters worse.


To be clear, not every attempt to analyze emotionally painful experiences is doomed to cause us more harm than good. Certainly there are many forms of self-reflection that are perfectly useful and adaptive. The question is, what distinguishes these adaptive forms of self-reflection from the maladaptive ones? Further, can those of us with ruminative tendencies find ways to think about our feelings and problems more productively so that we don’t end up picking at our emotional scabs and preventing them from healing?


These questions have been occupying and preoccupying the thoughts of a new generation of researchers. Fortunately, their ruminations about rumination have yielded fascinating studies and promising new approaches. As a result, we’ve finally begun to pull back the veil on the mechanisms that underlie both maladaptive rumination and helpful self-reflection and we’ve begun to learn how we can modify our ruminative tendencies to make them less damaging and more psychologically beneficial. In order to utilize these new discoveries we first need a better understanding of the psychological wounds rumination inflicts.

The Psychological Wounds Rumination Inflicts

Ruminating on our problems and feelings scratches at our emotional scabs and causes four primary psychological wounds: it intensifies our sadness and allows it to persist for far longer than it might have otherwise; likewise, it intensifies and prolongs our anger; it hogs substantial amounts of emotional and intellectual resources, inhibiting motivation, initiative, and our ability to focus and think productively; and our need to discuss the same events or feelings repeatedly for weeks, months, and sometimes years on end taxes the patience and compassion of our social support systems and puts our relationships at risk. Let’s examine each of these wounds in greater detail.

1. Supersizing Our Misery: Why Rumination and Sadness Are Best Friends Forever

One of the reasons rumination is so difficult to treat is its self-reinforcing nature. Ruminating about problems tends to make us even more upset about them, and the more upset we are the stronger the urge to ruminate becomes. This dynamic represents the primary reason rumination puts us at risk for developing clinical depression: hyper-focusing on painful emotions and experiences can damage our mood, distort our perceptions so we view our lives more negatively, and make us feel helpless and hopeless as a result. Further, once we have a tendency to ruminate, it becomes easy to trigger a ruminative cycle whenever we self-reflect, even if there is nothing necessarily distressing going on in our lives at that moment.


A simple experiment demonstrates this dynamic beautifully. Scientists asked regular people on a regular day to reflect on their feelings for eight minutes. Many of us can do this without it having any impact on our mood whatsoever, and indeed, we might struggle to fathom why it should. But people who were a little sad to begin with, and those with a tendency to ruminate, reported feeling significantly sadder after this eight-minute exercise than they had been previously. Again, people’s emotions were not manipulated in any way in these experiments, they were simply asked to think about their feelings.


My work with Linda, a corporate attorney, provides a good illustration of how persistent ruminations can be. Linda graduated at the top of her class at an excellent law school and was quickly snatched up by one of the best law firms in New York City. A few years later, one of the firm’s senior partners requested she transfer to his department and join his team. It was the most exciting moment of Linda’s professional career to date. It was also the start of her downfall. Her new boss turned out to be a nightmare. He was critical, dismissive, patronizing, passive-aggressive, and condescending while at the same time incredibly demanding of her time and efforts. He was also a screamer, something to which Linda had not been exposed previously.


A year passed and Linda was utterly despondent. She considered transferring back to her old department, but her new boss made sure to dangle the carrot of partnership in front of her, hinting that if she improved her efforts and worked harder, he would nominate her for the promotion within a few years. He did give Linda above-average yearly reviews, but at the same time he also continually put her down, diminished her contributions, and embarrassed her by publicly belittling her efforts and yelling at her in meetings. Linda found herself regularly crying in the bathroom. With the encouragement of her husband, she decided to confront her boss about when she would be nominated for partnership. He promised that if she continued to perform as she had, he would nominate her by the end of the following year. Linda asked him to put his promise in writing and, much to her delight, he did.


Linda doubled her efforts. When her boss finally invited her to his office to discuss her future she could barely contain her anticipation. But instead of announcing her promotion, he handed her a terrible yearly review, chastised her for “slacking off” (despite her having worked harder than ever before), and told her she had no chance of making partner at the firm. Linda was devastated. She transferred to another firm soon thereafter, taking a large pay cut in the process.


Linda came to see me a full year after starting her new job because although she liked her new boss, she simply could not stop ruminating about her experiences with her old one. “I’m just miserable all the time,” she explained. “I keep thinking about how he rolled his eyes whenever I spoke in meetings, the expression of disgust he had when he criticized my work, how angry he looked when he yelled at me in front of my colleagues.” The emotional pain these and other experiences evoked was etched plainly on Linda’s face. Linda had sought out psychotherapy previously, but doing so had done little to reduce her ruminations and sadness.


Many traditional therapies involve patients examining their experiences in great detail and from every angle, something that can actually increase ruminative tendencies. Other approaches, such as cognitive therapy, involve less heavy pondering and instead teach people to identify negative thoughts so they can dispute them. However, this approach can also be problematic where rumination is concerned because in order to practice refuting such thoughts one has to keep bringing them to mind.


Illustrating this problem, in a recent study, researchers gave college students at risk for depression either a cognitive therapy workbook or an academic skills workbook. The participants’ levels of depression were measured immediately after they completed the workbook and again four months later. Subjects with high ruminative tendencies felt significantly more depressed after completing the cognitive therapy workbook than those who completed the academic skills workbook. Asking people with ruminative tendencies to identify their negative thoughts and feelings, even if for the purpose of learning to refute them, caused them to ruminate about their feelings even more and to become sadder as a result. That their sad feelings persisted even four months later is a testament to the tenacity of ruminative urges once they become entrenched.

2. Anger Inflation: How Rumination and Venting Fan the Flames of Fury

Another emotion that tends to elicit powerful ruminative urges is anger. Many of us replay experiences that elicit our ire over and over in our heads. As with the self-reinforcing cycle that gets triggered with sadness, the more we ruminate about our anger and the more we discuss anger-provoking thoughts and experiences with others, the angrier we feel as a result and the stronger our urge to ruminate about these feelings and problems becomes.


Carlton, a young man I worked with a few years ago, fell prey to this very dynamic. Carlton’s father had come from modest means, but after making a fortune in the stock market he insisted his son want for nothing. For example, after graduating from college, Carlton expressed an interest in moving to New York. His father promptly put him up in a newly purchased penthouse apartment and gave him a generous monthly allowance because, as he told Carlton many times over the years, “Nothing but the best for my son!”


Carlton tried his hand at several careers, landing one plum job after another with the aid of his father’s connections. However, since he had neither the experience nor the qualifications to succeed in these positions, Carlton usually spent less than a year in each of them before being gently advised by his superiors to “try something else” or to “move on.” The suggestion that he wasn’t performing adequately caught him by surprise more than once.


“I kept assuming these companies would never offer me a job I was unqualified for. But they were just doing my dad a favor,” Carlton explained when we first met. “Since they figured I wouldn’t be there for long, they never told me what I wasn’t doing well or what I could do to improve. They’d just ask me to leave. You have no idea how humiliating it was each time it happened!” Carlton’s nostrils flared at the memory. “I didn’t ask my dad for the apartment, I didn’t ask for the allowance, and I never asked for help getting a job, not once. I’d just mention I was interested in something and the next thing I knew I’d get a call about a possible opening. No one told me these positions were over my head. Good ol’ Dad just kept setting me up for failure. Nothing but the best for my son!” Carlton added in a bitter imitation of what I assumed was his father’s voice.


When Carlton was twenty-five he met Solana, a marketing professional. They married a year later. In the fall of 2008, a few months after their wedding, the world entered a global recession and Carlton’s father was hit hard. He was forced to sell the apartment in which Carlton and Solana were living and to cut off every penny of his allowance. Carlton was between jobs at the time and he and Solana found themselves having to manage with Solana’s salary and the small sum of money Carlton had left in the bank.


“I started looking for work like crazy,” Carlton explained. “I applied to hundreds of jobs over the next six months and got rejected by all of them. No surprise there, my resume looked like one failed career choice after another. My dad was so into being the hero, he didn’t care if it made me totally financially dependent. He didn’t care if it screwed up my professional life. He didn’t care that it could leave me with no chance of getting anywhere!” Carlton’s face was red with anger. “I’m twenty-seven years old and I have no skills, no qualifications, and no prospects! He ruined my life! I’m angry all the time and poor Solana gets the brunt of it. She tells me to stop obsessing about my father, but each time I get rejected from a job I hear his voice in my head: Nothing but the best for my son! It’s making me crazy! If I don’t stop yelling at Solana she’ll leave me. She’s even said as much. And then I’ll really have nothing!”


Getting stuck in an angry ruminative loop can leave us awash in fury and resentment and make us feel irritable and on edge much of the time. Angry feelings activate our stress responses and our cardiovascular systems such that over the long term, having consistent and intense anger ruminations can place us at greater risk for developing cardiovascular disease.


An even more insidious consequence of anger ruminations is that the general irritability they cause can make us overreact to the mildest provocations. As a result we often end up taking out our frustrations on our friends and family members. We snap at them, jump down their throats, and respond in exaggerated ways to minor and everyday irritations.


As an illustration of how easily we displace our anger onto innocent people, one study put people through a frustrating experience and then induced some of them to ruminate about it. Participants who ruminated after the frustrating experience were far more likely to display aggressive behavior toward an inept but innocent confederate compared to those who had been through the same frustrating experience but had not been induced to ruminate about it afterward. Even though the confederate had nothing to do with the situation that caused their frustration, the angry ruminators went as far as to sabotage the confederate’s chances of getting a job they knew was hugely important to his livelihood and career.


Although it is no treat for our partners and family members when we get caught in a depressive ruminative loop, their quality of life (as well as ours) tends to take a much greater hit when the ruminative cycle holding us hostage is one of anger and irritability.

3. Cognitive Leakage: How Rumination Saps Our Intellectual Resources

Rumination involves such intense brooding it consumes huge amounts of our mental energies. By doing so it impairs our attention and concentration, our problem-solving abilities, and our motivation and initiative. Further, the faulty decision-making we employ in its wake often proves incredibly costly to our physical and mental health. For example, women with strong ruminative tendencies were found to wait two months longer than women without ruminative tendencies to see a physician after discovering a lump in their breast—a potentially life-threatening difference. Other studies found that cancer and coronary patients with ruminative tendencies had poorer compliance with their medical regimens than people with similar disease profiles who were not ruminators.


Rumination causes us to stew in our negative feelings until we become so consumed with them that we begin to see our entire lives, histories, and futures more bleakly. Our negative outlook then causes us to view our problems as less manageable, to come up with fewer solutions to them, and to avoid implementing the solutions we do find. We might be able to recognize that certain mood-enhancing activities would be helpful to us but we are far less willing to pursue such activities nonetheless.


This leads some of us to soothe our pain with alcohol or other substances. Many of the ruminators I’ve worked with over the years claimed that drinking eases their irritability and makes life more manageable for those around them. While having a drink might take the edge off our irritability and make us more agreeable to others, the question is whether someone can stick with one drink or whether they tend to go for two, three, or more. When we use alcohol to manage our mood, our consumption is unlikely to remain at moderate levels for long. The more inebriated we get the less impulse control we have and the more likely we are to express our anger and aggression in destructive ways.


Our first steps onto the path toward alcohol abuse or dependence are often prompted by a misguided effort to manage the emotional distress and anger our ruminations cause. Some of us might turn to binge eating or purging instead. But whether we turn to food or to alcohol or other substances to manage such feelings, the ruminations causing them remain unaddressed and we only increase the risk of sustaining long-lasting psychological damage.

4. Strained Relationships: How Our Loved Ones Pay a Price for Our Ruminations

Our ruminations are often so consuming, we fail to consider how our need to constantly discuss them can impact our friends and families and put a strain on our most important relationships. In addition, we usually fail to spread our efforts evenly and prefer to share our feelings with those who have been most supportive and compassionate in the past, making them shoulder a disproportionate load of supportive duties. Even if these individuals care for us tremendously, repeating the same discussions over and over will eventually tax their patience and compassion and risk making them feel resentful and angry toward us as well. When I point out these risks to my patients they grudgingly acknowledge why someone might lose patience but not why that person might become resentful or angry.


To understand why this might happen we need to consider that lending emotional support and assistance to people who are close to our hearts is one of the most rewarding aspects of close friendships and relationships. Helping others we care about makes us feel better about ourselves, it fosters stronger relationship bonds, it increases trust and loyalty for both parties, and it allows us to feel valuable and meaningful in the world.


Consider, then, that by bringing up the same thoughts and feelings we’ve discussed many times before we cannot help but communicate to those around us that their previous efforts to help us were ultimately lacking because here we are asking them to do so all over again. At best they were able to provide us with a measure of relief but it clearly didn’t last long if we’re expecting them to repeat their efforts. Our supportive friends and family members might not pick up on this embedded “insult” consciously but they are likely to find themselves feeling vaguely angry and resentful nonetheless.


Further, we each have an internal statute of limitations when it comes to how long we feel it’s fair for someone to be distressed about certain events. Once that period has expired and we’re asked to listen and be supportive again nonetheless, we might offer our support and compassion out of duty, obligation, or guilt but we’ll probably feel somewhat resentful and angry about having to do so.


I once worked with a young man whose fiancΓ©e had left him only weeks before their wedding, and he spoke about little else with his buddies for over a year. From what I gleaned, his friends were showing every sign of losing patience with his constant obsessions and soliloquies about his ex. They started changing the nature of their get-togethers with him so that instead of activities that fostered conversation, like golf, dinners, or meeting at bars, they suggested movies and activities such as basketball or football. Unfortunately, the young man did not heed any of his friends’ hints nor my own warnings about their rising resentment. When he broached the subject for the umpteenth time during a game of basketball, one of his friends became so exasperated he stopped the game and yelled, “Come on, dude! Just man up already!” and punctuated his statement by throwing the basketball straight into my patient’s face, breaking his nose in the process.


Clearly the friend’s resentment had been building up over many months and had reached a boiling point. But he hadn’t said a word about feeling burdened by my patient’s incessant ruminations. Indeed, none of his friends had. The assaultive friend did receive his comeuppance, however, as he spent the next five hours in the emergency room, listening to my patient replay nasal renditions of the breakup while avoiding sprays of bloody gauze from his nose.


Of course, few of our friends throw things at us in exasperation when we chew their ears off, but that doesn’t mean they don’t feel like doing so. Intense ruminations can often make us so focused on our own emotional needs that we become blind to those of the people around us and our relationships often suffer as a result.

How to Treat the Psychological Wounds Rumination Inflicts

It is natural to reflect on upsetting events after they occur and to mull them over in our minds. The intensity and frequency of normative preoccupations should decrease with time and as such they do not usually require treatment. But when time has passed and the frequency and emotional intensity of our preoccupations continue unabated, we should make efforts to break the cycle of rumination and apply emotional first aid. Let’s open our psychological medicine cabinet and examine the treatment options available to us.

General Treatment Guidelines

In order to break the self-reinforcing nature of ruminative thoughts and allow our wounds to heal we must interrupt the cycle of rumination once it gets triggered, and we should weaken the urge to ruminate at the source by diminishing the intensity of the feelings that fuel it. We must also make efforts to monitor our relationships and to ease the emotional burden we might be placing on our loved ones.


The following treatments are listed in the order in which they should be administered. Treatment A (changing perspective) is focused on reducing the intensity of the urge that compels us to ruminate, and Treatment B (distraction from emotional pain) is focused on reducing the frequency of ruminative thoughts (which is easier to do once the urge to ruminate is less intense). Treatment C (reframing anger) targets the anger and aggressive impulses ruminations can evoke, and Treatment D (managing friendships) is useful for monitoring our relationships with those who provide emotional support.

Treatment A: Change Your Perspective

When scientists began investigating the mechanics of how we self-reflect on painful feelings and experiences in an effort to understand what distinguishes adaptive from maladaptive forms of self-reflection, one factor emerged as hugely significant—the visual perspective we use when going over painful experiences in our minds.


Our natural tendency when analyzing painful experiences is to do so from a self-immersed perspective in which we see the scene through our own eyes (also known as a first-person perspective). Analyzing our feelings in such a way tends to allow our memories to unfold in a narrative form (i.e., the play-by-play of how things happened) and to elicit emotions at a level of intensity similar to when the events occurred.


But when the researchers asked people to analyze a painful experience from a self- distanced perspective (a third-person perspective) and actually see themselves within the scene from the point of view of an outside observer, they found something quite remarkable. Instead of merely recounting the events and how they felt about them at the time, people tended to reconstruct their understanding of their experience and to reinterpret it in ways that promoted new insights and feelings of closure. This result was amplified even further when they suggested people employ a self-distanced perspective while reflecting not onhow things happened but on why they happened.


In numerous studies, subjects who were asked to analyze painful experiences this way experienced significantly less emotional pain than those using self-immersive perspectives. In addition, their blood pressure was less reactive (it rose less and it returned to normal baseline more quickly), indicating that using self-distanced perspectives lowers our stress responses and causes less activation of our cardiovascular systems. The good news didn’t end there. Follow-ups one week later indicated that people using self-distanced perspectives reported thinking about their painful experiences significantly less often, and they felt less emotional pain when they did ruminate about them than people who used self-immersed perspectives. These findings held true for both depressive and anger ruminations.


When I first read about these findings I immediately thought of Linda, the lawyer who ruminated about her abusive ex-boss. Linda’s descriptions of how she saw her boss’s face (e.g., “I keep thinking about how he rolled his eyes whenever I spoke in meetings”) clearly indicated she reflected on her experiences using a self-immersed as opposed to a self-distanced perspective. I was curious as to whether changing her perspective would impact her ruminations. I told Linda how to tweak her ruminative thoughts so she was using a self-distanced perspective and suggested she be as judicious as possible in doing so until we met next two weeks later.


Linda walked into our next session with a huge smile on her face. “It worked!” she announced before she even got to the couch. Linda reported that for the week following our session she had been diligent about employing a self-distanced perspective whenever she thought about her ex-boss; then she added, “But soon after that something shifted. It took me a few days to realize it, but I was thinking about him far less than usual.” Even better, when Linda did think about her ex-boss, she reported feeling much less upset than she had before and she was able to put such thoughts aside more easily. She also found it easier to use distraction (Treatment B) when the thoughts did persist. The combination of the two approaches, perspective change and distraction, helped significantly reduce her ruminations in a short amount of time.

EXERCISE FOR CHANGING PERSPECTIVES

Switching visual perspectives to ones that afford us greater psychological distance from the topics of our ruminations requires practice. Complete this exercise when you have the time and space to do so without interruption and practice the technique for each topic or experience that elicits unproductive ruminations.


Sit or lie comfortably, close your eyes, and recall the opening snapshot of the scene or the experience in question. Zoom out so you see yourself within the scene, or if the scene involved two locations (e.g., if you were on the phone) imagine a split screen so you see both yourself and the other person or locale. Once you see yourself within the scene, zoom out even further so you can watch the scene unfold from an even greater distance. Allow the scene to unfold as you observe it from afar, as if you were a stranger who happened to pass by as it occurred.


Make sure to use this same perspective every time you find yourself thinking about the events in question.

TREATMENT SUMMARY: CHANGE YOUR PERSPECTIVE
Dosage: Practice the technique in this treatment when you can do so without interruption and then apply it consistently whenever you ruminate. Once the intensity of the feelings the rumination elicits and the urge to ruminate subsides, focus on using Treatment B to cut off any ruminative thoughts as soon as they appear.

Effective for: Reducing depressive and angry ruminations, and restoring impaired intellectual and mental functioning.

Secondary benefits: Reducing physiological stress responses.

Treatment B: Look at the Birdie! Distract Yourself from Emotional Pain

Even once our urge to ruminate is weaker, cutting off a ruminative train of thought once it begins is still quite challenging. The main reason we tend to indulge the urge to ruminate even once we’re fully aware of how damaging it can be is that we often catch ourselves ruminating only once our emotions are already churning. Trying to simply suppress our ruminative thoughts is not only difficult, it is inadvisable too. Decades of research on thought suppression demonstrates that nothing compels us to think of something more than trying desperately not to think of it.


In now-classic experiments, people were instructed to see if they could avoid thinking of a white bear for five minutes and to ring a bell if they caught themselves thinking of one (the choice of white bear had no significance other than it was assumed that white bears were not something the subjects thought about often—maybe because the study was done in Texas). Less than a few seconds passed before the average participant rang the bell, and it was usually rung repeatedly thereafter. The more interesting finding was that once the five minutes were over and the subjects were “permitted” to think of whatever they liked, they experienced a rebound effect and found themselves thinking about more white bears than the average Klondike ice-cream truck driver. Since the original white bear experiments, many studies have demonstrated that efforts to suppress unwanted thoughts are likely to cause similar rebound effects, such that the very thoughts we try to banish return with a vengeance the moment our concentration wavers.


While suppression is a dud as far as our war on rumination goes, distraction has proven to be a far more effective weapon. Dozens of studies have demonstrated that distracting ourselves by engaging in tasks we find absorbing or ones that demand our concentration, such as moderate to intense cardiovascular activity, socializing, doing puzzles, or playing computer games, will disrupt a ruminative thought process. Distraction has also been found to restore the quality of our thinking and of our problem-solving abilities because once we cease ruminating, we recover our ability to apply our intellectual skills effectively rather quickly.


While socializing or going to the movies can take our mind off our ruminations, it is not always practical to engage in such time-consuming activities. However, brief and less labor-intensive distractions can also be effective in cutting off ruminative thoughts. For example, spending a few minutes engaging in a brief mental exercise like completing a quick Sudoku puzzle on our phone or imagining the layout of our local supermarket (e.g.,aisle two—cleaning supplies and toiletries, aisle five—Klondike bars) was found not only to interrupt people’s ruminations but to improve their mood as well.


Identifying which distractions work best, given the specifics of our situation (i.e., whether we are at home or at work, trying to study or sitting on the subway) and the nature of our ruminations, can require trial and error, as our assessments of how absorbing various activities or thought exercises will be are not always accurate. Whenever possible, we should test out our arsenal of potential distractions ahead of time so we can identify which work best for the settings in which we tend to ruminate most. The more distractions we have from which to choose, the more effectively we will be able to derail the ruminative train of thoughts that plague us.

EXERCISE FOR IDENTIFYING POTENTIAL DISTRACTIONS

Complete this writing exercise for each topic or experience about which you tend to ruminate unproductively.

  1. List the places and situations in which you tend to ruminate most often.
  2. For each place and situation, list as many distractions as possible of both short durations (e.g., a game of Sudoku or supermarket layouts) and longer ones (e.g., a cardiovascular workout or catching a movie).

Once your list is complete carry it with you so you can refer to it when the need arises even if you’re convinced you won’t have trouble recalling the distractions you chose. Remember, our thinking is not as clear as it could be when we’re in the midst of an intense rumination.

TREATMENT SUMMARY: DISTRACTION
Dosage: Create a list of distractions that work for you and apply the treatment as soon as possible whenever you catch yourself entering a ruminative cycle.

Effective for: Minimizing the impact of depressive and/or angry ruminations, and restoring impaired intellectual and mental functioning.

Treatment C: Reframe the Anger

In the film Analyze This a psychiatrist (played by Billy Crystal) encourages a patient who has anger issues to “hit a pillow” in order to let off steam. The patient (Robert De Niro), who also happens to be a mobster, pulls out a gun and fires a round of bullets into the pillow. The alarmed psychiatrist recovers his composure enough to ask, “Feel better?” The mobster thinks for a moment and then replies, “Yeah, I do!”


The notion that venting our anger produces a cathartic experience that will reduce our rage and improve our psychological state is widespread even among mental health professionals. Decades ago, therapists like the one played by Billy Crystal began advocating we vent our anger by assaulting benign objects and nary a couch pillow has felt safe ever since.


Indeed, the “catharsis model” of venting anger has spawned entire product lines with numerous forms of “therapeutic” toys for both children and adults. For example, one line of lifelike plastic figures comes with firm plastic bats children can use to express their anger “productively”— by smashing the humanlike figures in the face and head. The last time I observed a session in which the therapist used one of these figures it featured a seven-year-old bruiser who pummeled the figure mercilessly while the therapist stood to the side, saying, “Yes, you’re very angry at Daddy, aren’t you?” Not exactly a recipe for domestic tranquility, if you ask me.


The effectiveness of venting anger by letting off steam has been studied extensively and the verdict of all such studies has been virtually unanimous—the catharsis model is not only wrong, it is actually harmful! In one recent study angered participants were placed into one of three groups. They were instructed either to hit a punching bag while thinking of the person who angered them, to hit the bag while thinking of a neutral subject, or to do nothing at all. Subjects who hit the punching bag while thinking of the person who angered them felt significantly angrier afterward and displayed significantly more aggressive and vengeful behavior than those in the other two groups (bad news indeed for the “daddy” of the bruiser). In fact, it was the participants in the group that took no action at all who felt least angry and who displayed the least aggressive behavior.


Venting our anger by assaulting benign objects only serves to reinforce our aggressive urges in response to anger. These issues should be of special concern for the innumerable parents whose children’s aggressive impulses are unwittingly being strengthened with every swing of the bat and every pound of the pillow.


So how should we manage our anger?


The most effective strategy for regulating emotions such as anger involves reframing the event in our minds so that we change its meaning to one that is less infuriating. By formulating a new interpretation of the events to one that is more positive we change our underlying feeling about the situation to one that is less enraging. For example, Michael Phelps, the most decorated swimmer in history, was often subjected to his competitors’ taunts in the press before major competitions. Phelps gave several interviews in which he discussed how he dealt with the anger he felt in those situations. Rather than pounding the lane divider in the pool while his coach whispered, “Yes, you’re very angry at that German swimmer, aren’t you?” Phelps would reframe the situation as one in which he envisioned his rivals’ taunts as motivational fuel that spurred him to train harder and to focus even more intently in his actual races.


Despite the effectiveness of reframing, many of us struggle to use the technique because it is not always easy to reinterpret upsetting events in benign ways. For example, Carlton, the man whose father went bankrupt and left him without financial support, was so angry at his father’s previous meddling in his career that it was all he could think about. His constant ruminations exacerbated his anger to such a point that he had trouble tolerating even minor frustrations, leaving his wife, Solana, to bear the brunt of his irritability and aggression. Carlton needed to find a less enraging way of thinking about his situation, but even after I explained why it was crucial he do so, he struggled to reframe his situation in positive or more benign terms. I tried pointing him in the right direction.


“Carlton, you have a college degree from a great university and you spent the last five years working in every field in which you expressed an interest. Even if you did so for only brief periods of time, you did get a taste of these fields. Surely those experiences helped you figure out which of those directions holds the most appeal as a career choice.”


“Sure. But what’s the point? I’ll never get the kind of job I really want without my father pulling strings.”


“No, you won’t. But that’s exactly why you’re angry with your father. He got you jobs you weren’t qualified for instead of allowing you to get the kind of experience you needed. In the real world people don’t start where you did, they start at the bottom and work their way up.”


“But then these past five years were entirely wasted! That’s what kills me!”


“Well, not exactly. They helped you identify what you want to pursue. If you thought of your previous experiences as internships that helped you figure that out, you might be able to see them as time well spent. Now that you know what you want you can start at the bottom and work your way up.”


“Don’t you get it?” Carlton snapped. “I don’t want to start at the bottom!”

“I know,” I responded softly, “and your dad didn’t want you to either. Was it so terrible of him to want to spare you what you now wish you could spare yourself?”


The color drained from Carlton’s face. He looked as if he had been struck. He had never considered that his father’s hopes and intentions mirrored his own so closely. But once he was able to reframe his father’s meddling as well-intentioned as opposed to controlling, and his professional experiences as instructive as opposed to wasteful, it had a huge impact on him. His ruminations diminished rapidly, as did his anger and irritability. He began searching for positions more suited to his training and lack of experience, and within a few months he landed his first job entirely on his own merit—it was an entry-level position at the bottom rung of the ladder, and Carlton could not have been happier about it.


Reframing requires us to switch our perspective and to perceive the situation in ways that change its meaning and, consequently, how we feel about it. Although the focus here is on reducing anger, reframing can also help us feel less sad, less disappointed, or less victimized. For example, had Linda been promoted in her old law firm she would still be working for her abusive boss. Distraught as she was about taking a step back professionally, doing so did wonders for her quality of life. Reframing her boss’s behavior as “useful” rather than as “destructive” allowed her to feel less victimized by her experience.

EXERCISE FOR PRACTICING REFRAMING

Although your ruminations are unique to your specific circumstance, certain themes and principles are common to many reframing situations. Use the following four suggestions to help identify ways to reframe your situation so that it elicits less anger (or sadness).

  1. Find the positive intention. Much as Carlton’s father had good intentions, most people who cause us to ruminate in anger have some redeeming qualities and might mean well regardless of how their words or actions impact us. Identifying these kernels of good can help us view the situation differently and modify the intensity of our emotions as a result.
  2. Identify the opportunities. Today, many companies insist their managers reframe areas of weakness as “opportunities” when giving employees feedback. Doing so makes negative feedback easier for the employee to absorb without becoming demoralized. What makes this technique so successful is the universal truth it embodies. Many distressing situations might also provide opportunities for us to improve ourselves, to reevaluate things, to change direction, or to address problems that needed fixing anyway.
  3. Embrace the learning moment. There is usually much we can learn from the situations that elicit our ruminations. Identifying mistakes we’ve made and ones we wish to avoid in the future, viewing negative situations as strategic puzzles that require creative solutions, learning who we can count on and who we cannot, and discovering our strengths, weaknesses, and vulnerabilities can provide valuable lessons that will boost our confidence and spare us future heartache and emotional distress.
  4. View the offending person as needing spiritual help. Those of us with strong religious beliefs can reframe many situations as ones in which the person who caused us emotional distress is in obvious need of spiritual help. As such they deserve not our anger but our prayers. A series of recent studies examined the power of prayer to alleviate anger (using sound scientific principles and blind peer-review processes) and found that it can be an effective way to regulate our emotions, as long as the nature of our prayer is positive. Tempting as it may be to do so, praying that the person who angered us gets hit by a Mack truck will not make us less angry, as it is the spiritual equivalent of shooting a couch pillow.
A secular version of this approach (albeit an untested one scientifically) would be to view the offending person as someone who might be troubled and in need of psychological help or psychotherapy.
TREATMENT SUMMARY: REFRAME THE ANGER
Dosage: Apply to situations, memories, or events that elicit anger or sadness and are the subject of repeated ruminations. Write down the reframed formulations you construct so you can revisit them whenever the rumination occurs.

Effective for: Reducing anger and anger-focused ruminations (as well as the intensity of other emotionally painful ruminations), restoring impaired intellectual and mental functioning, and reducing physiological stress responses.

Treatment D: Go Easy on Your Friends

When we repeatedly discuss the same problems with friends and family members we risk taxing their patience and compassion and we also risk making them feel resentful. In order to preserve these relationships we have to assess whether we are overburdening those who provide us with emotional support.

EXERCISE TO EVALUATE RELATIONSHIP STRAIN

Answer the following questions for each person in your social support system and take the recommended actions when it is relevant to do so.

  1. How much time has passed since the event in question?
Obviously some life events are extremely traumatic and they might dominate our thoughts and feelings for months and years. However, most of our ruminations do not fall in this category and we should be aware that people expect us to recover within a certain time frame. For example, a general rule of thumb for breakups is that it takes one to two months for every year of a relationship to recover. If we were in a relationship for three years, we should begin to recover from the initial surge of intense ruminations about how and why the breakup happened within three to six months and we should think twice about continuing to discuss the how and why aspect of things with our friends if the topic still dominates our discussions a year later.
  1. How many times have you discussed these issues with this person?
We all have our go-to people when it comes to getting social support. However, they are also the ones most likely to encounter “fatigue” when we discuss the same ruminative thoughts, events, and feelings too often. It might be wise to spread things around and utilize other sources of social support as well so as to avoid overburdening the people we go to most.
  1. Does this person feel comfortable bringing up his or her own issues and problems?
If your conversations with a friend are too one-sided and tend to be all about your problems and rarely about his or hers, you might be at risk of jeopardizing the friendship. To assure a balance, make time to ask your friends about their lives and to have entire conversations in which you focus solely on them. If they ask about you when you are trying to do this, respond briefly and refocus the conversation on them.
  1. What percentage of your communications with this person is dominated by the subject of your ruminations?
It is often only in hindsight that we realize the extent to which our discussions with friends were dominated by the subject of our ruminations. Allowing our emotional distress to dominate our relationships and determine what our friendships are about is bad for our friendships, but defining ourselves as victims is damaging to our own mental health as well. Make sure you keep a balance of light conversation, enjoyable moments, and fun whenever possible.
TREATMENT SUMMARY: GO EASY ON YOUR FRIENDS
Dosage: Apply periodically to evaluate the health of your supportive relationships. Take action to repair any relationship damage when necessary.

Effective for: Evaluating and repairing strained relationships.

When to Consult a Mental Health Professional

If you’ve applied the treatments in this chapter and your urge to ruminate is still strong, if you find yourself ruminating just as frequently as you had previously, or if your ruminations are so intense and distracting they interfere with your basic ability to function in your professional or personal life, seek the advice of a mental health professional. If your intrusive thoughts are not focused on emotionally painful experiences but on things like catching germs, forgetting to lock the front door, or whether you turned off the gas before you left the house, a mental health professional will be able to assess whether you’re exhibiting symptoms of obsessive-compulsive disorder.


Rumination is also strongly tied to depression. If you think you might be depressed and have symptoms such as a persistent low mood, feelings of helplessness about changing your situation, feelings of hopelessness about things getting any better, or disturbances in your eating and sleeping patterns, consult a mental health professional to assess whether you require professional treatment. If at any point you feel so emotionally distressed, sad, or angry that you have the urge to harm yourself or another person, seek immediate professional help or go to the nearest emergency room.








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