Treatment of Overthinking: A Multidisciplinary Approach to Rumination and Obsession Spectrum
Open accessAbstract
Classic psychiatry patients are rare; real-world patients tend to have overlapping features of multiple disorders. Striving for diagnostic certainty, and treatments aimed at tentative diagnoses, often fail these patients. In such cases, tolerating diagnostic ambiguity and "treating the symptoms" can sometimes be transformative. An important symptom, often undertreated in a diagnosis-based approach, is rumination. We present a case study of a woman who, after 20 years of treatment failure, achieved significant symptom relief when her primary complaint-"labored thinking"-was targeted specifically. However, because no seriously ill person has only 1 symptom, 6 clinicians from different subdisciplines will discuss the patient's other issues, ones that an overfocus on rumination might leave out.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Ruminations about one's obsessions can make obsessions even more intrusive and ego-dystonic in OCD.
“while ruminations about one ' s obsessions can make obsessions even more intrusive and ego-dystonic in OCD. 101”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [101]
In Dr Anne Chosak’s section (page unavailable), the paper describes OCD obsessions as intrusive and unwanted and says that actively engaging with ruminations reinforces symptoms. This supports the general idea that rumination can worsen OCD symptoms, but it does not say that rumination makes obsessions more ego-dystonic or specifically more intrusive. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2022) · doi:10.1176/appi.books.9780890425787 · Cited by 23,476 · see citing works
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008) · Perspectives on Psychological Science · doi:10.1111/j.1745-6924.2008.00088.x · Cited by 5,172 · see citing works
Tervalon, M., & Murray-García, J. (1998) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2010.0233 · Cited by 3,646 · see citing works
The role of rumination in depressive disorders and mixed anxiety/depressive symptoms.
Nolen-Hoeksema, S. (2000) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.109.3.504 · Cited by 2,998 · see citing works
Repetitive Negative Thinking as a Transdiagnostic Process
Ehring, T., & Watkins, E. R. (2008) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2008.1.3.192 · Cited by 1,172 · see citing works
Effects of self-focused rumination on negative thinking and interpersonal problem solving.
Lyubomirsky, S., & Nolen–Hoeksema, S. (1995) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.69.1.176 · Cited by 1,162 · see citing works
Rumination as a transdiagnostic factor in depression and anxiety
McLaughlin, K. A., & Nolen-Hoeksema, S. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.12.006 · Cited by 842 · see citing works
A habit-goal framework of depressive rumination.
Watkins, E. R., & Nolen–Hoeksema, S. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0035540 · Cited by 342 · see citing works
(2004) · Cited by 225 · see citing works
Ruminative self-focus, negative life events, and negative affect
Moberly, N. J., & Watkins, E. R. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.06.004 · Cited by 197 · see citing works
Ionescu, D. F., Bentley, K. H., Eikermann, M., Taylor, N., Akeju, O., Swee, M. B., Pavone, K. J., Petrie, S. R., Dording, C., Mischoulon, D., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.09.037 · Cited by 179 · see citing works
Rumination in posttraumatic stress disorder: A systematic review
Moulds, M. L., Bisby, M. A., Wild, J., & Bryant, R. A. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101910 · Cited by 162 · see citing works
Ghaleiha, A., Entezari, N., Modabbernia, A., Najand, B., Askari, N., Tabrizi, M., Ashrafi, M., Hajiaghaee, R., & Akhondzadeh, S. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.09.015 · Cited by 152 · see citing works
Self-directed thought and response to treatment for depression: A preliminary investigation
Ciesla, J. A., & Roberts, J. E. (2002) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.16.4.435.52528 · Cited by 122 · see citing works
Hirsch, C. R., Krahé, C., Whyte, J., Loizou, S., Bridge, L., Norton, S., & Mathews, A. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000310 · Cited by 108 · see citing works
Effects of rumination and initial severity on remission to cognitive therapy for depression
Jones, N. P., Siegle, G. J., & Thase, M. E. (2008) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9191-0 · Cited by 106 · see citing works
Dean, R. L., Hurducas, C., Hawton, K., Spyridi, S., Cowen, P. J., Hollingsworth, S., Marquardt, T., Barnes, A., Smith, R., McShane, R., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011612.pub3 · Cited by 95 · see citing works
Kertz, S. J., Koran, J., Stevens, K. T., & Björgvinsson, Þ. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.03.006 · Cited by 91 · see citing works
Maladaptive Rumination as a Transdiagnostic Mediator of Vulnerability and Outcome in Psychopathology
Luca, M. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8030314 · Cited by 73 · see citing works
Lois, G., & Wessa, M. (2016) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsw085 · Cited by 66 · see citing works
Meulemeester, C. D., Lowyck, B., Vermote, R., Verhaest, Y., & Luyten, P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.061 · Cited by 58 · see citing works
Tang, H., Xiong, T., Shi, J., Chen, Y., Liu, X., Zhang, S., Wang, H., Lü, Q., & Yao, Z. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03119-z · Cited by 44 · see citing works
Rumination and Prospective Changes in Depressive Symptoms
Grassia, M., & Gibb, B. E. (2008) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2008.27.9.931 · Cited by 40 · see citing works
Wahl, K., van den Hout, M., Heinzel, C. V., Kollárik, M., Meyer, A. H., Benoy, C., Berberich, G., Domschke, K., Gloster, A. T., Gradwohl, G., et al. (2021) · Journal of Abnormal Psychology · doi:10.1037/abn0000677 · Cited by 33 · see citing works
Genetic and environmental influences on rumination and its covariation with depression
Johnson, D. P., Whisman, M. A., Corley, R. P., Hewitt, J. K., & Friedman, N. P. (2014) · Cognition & Emotion · doi:10.1080/02699931.2014.881325 · Cited by 32 · see citing works
Depressive rumination and the C957T polymorphism of the DRD2 gene
Whitmer, A. J., & Gotlib, I. H. (2012) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/s13415-012-0112-z · Cited by 30 · see citing works
Memedovic, S., Slade, T., Ross, J., Darke, S., Mills, K. L., Marel, C., Burns, L., Lynskey, M., & Teesson, M. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.05.028 · Cited by 24 · see citing works
Kubiak, T., Zahn, D., Siewert, K., Jonas, C., & Weber, H. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813000325 · Cited by 23 · see citing works
Andreotti, E., Congard, A., Vigouroux, S. L., Dauvier, B., Illy, J., Poinsot, R., & Antoine, P. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.2.127 · Cited by 23 · see citing works
Effect of Ketamine on Rumination in Treatment-Resistant Depressive Patients
Vidal, S. I., Jermann, F., Aubry, J., Richard-Lepouriel, H., & Kosel, M. (2020) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001305 · Cited by 21 · see citing works
Assessment of worry and OCD: how are they related?
van Rijsoort, S., Emmelkamp, P. M. G., & Vervaeke, G. A. C. (2001) · Personality and Individual Differences · doi:10.1016/s0191-8869(00)00133-1 · Cited by 20 · see citing works
Rumination and Dissociation: The Mediating Role of Poor Sleep Quality and Presleep Cognitions
Vannikov-Lugassi, M., & Soffer-Dudek, N. (2017) · Psychology of Consciousness · doi:10.1037/cns0000128 · Cited by 17 · see citing works
Exposure and response prevention of morbid ruminations and compulsive avoidance
Farkas, G. M., & Beck, S. J. (1981) · Behaviour Research and Therapy · doi:10.1016/0005-7967(81)90009-7 · Cited by 12 · see citing works
Zhang, X., Liu, C., Zhou, S., et al. (2021) · Pharmacogenomics · doi:10.2217/pgs-2020-0134 · Cited by 8 · see citing works
Effects of antipsychotics on rumination in patients with first-episode psychosis.
Lee, Y., Kang, N.-I., Lee, K.-H., Piao, Y.-H., Cui, Y., Kim, S.-W., Lee, B., Kim, J. J., Yu, J.-C., Lee, K. Y., et al. (2020) · Progress in Neuro-psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.109983 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 7
- Moberly NJ, Watkins ER. Ruminative self-focus, negative life events, and negative affect. Behav Res Ther. 2008;46(9):1034-1039.
- P u M e d C r o s s R e f 7. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci. 2008;3(5):400-424. · DOI · Paper page
- Hirsch CR, Krahé C, Whyte J, et al. Interpretation training to target repetitive negative thinking in generalized anxiety disorder and depression. J Consult Clin Psychol. 2018;86(12):1017-1030.
- P u b M e d C r o s s R e f 13. Moulds ML, Bisby MA, Wild J, et al. Rumination in posttraumatic stress disorder: a systematic review. Clin Psychol Rev. 2020;82:101910. · DOI
- Tang H, Xiong T, Shi J, et al. Global and reflective rumination are related to suicide attempts among patients experiencing major depressive episodes. BMC Psychiatry. 2021;21(1):117.
- Farkas GM, Beck S. Exposure and response prevention of morbid ruminations and compulsive avoidance. Behav Res Ther. 1981;19(3):257-261.
- De Meulemeester C, Lowyck B, Vermote R, et al. Mentalizing and interpersonal problems in borderline personality disorder: the mediating role of identity diffusion. Psychiatry Res. 2017;258:141-144.
Cited by
Sorted by citations
Scala, M., Fabbri, C., Fusar-Poli, P., Di Lorenzo, G., Ferrara, M., Amerio, A., Fusar-Poli, L., Pichiecchio, A., Asteggiano, C., Menchetti, M., et al. (2024) · CNS Spectrums · doi:10.1017/s1092852924002268 · Cited by 9 · see citing works
“101 Psilocybin is typically administered for a few weeks, a considerably shorter duration compared to treatment with SSRIs/SNRIs, which can last several months or years to show and maintain antidepressant effects.”
- Authors
- Flaherty, A., Katz, D., Chosak, A., Henry, M. E., Trinh, N.-H., Waldinger, R. J., & Cohen, J. N.
- Affiliations
- Harvard University (US)
- Corresponding author
- Flaherty, Alice
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2022-07-06
- Volume
- 83
- Issue
- 4
- ISSN
- 0160-6689 (ISSN-L)
- 1555-2101
- OpenAlex
- W4283766007
- Cited by
- 5
- References
- 35
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- overthinking, rumination, treatment-resistant psychiatric disorders, diagnostic ambiguity, symptomatic treatment, psychiatric comorbidity, case studies
- MeSH terms
- Female, Humans, Obsessive Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
