Let It Go

Rumination, in which one’s thoughts are stuck in a loop on one subject, can at times be useful in helping us concentrate and solve problems. But living too much in one’s mind is by no means healthy. Scientists have known for decades that ‘inward-focussed’ rumination is linked to depression and other psychiatric disorders. There is now evidence that the mental health of people who ruminate excessively on events impacting the whole population can also be affected.

Professor Eric Chen Yu-hai, Chi-Li Pao Foundation Professor in Psychiatry, and Research Officer Dr Stephanie Wong Ming-yin identified this phenomenon in a study involving over 10,000 people who participated in a large-scale online survey conducted in the wake of the 2019 social events in Hong Kong and the COVID-19 pandemic.

Over half reported frequent rumination on these events to the extent their thoughts disrupted their tasks at hand. Such ‘event-based’ rumination was also associated with higher levels of depressive and post-traumatic stress disorder symptoms.

“Previous research had identified depressive rumination as a sort of selective focus on repetitive negative thoughts surrounding one’s distress that prevents you from updating the contents in your awareness,” Professor Chen said. “We have broadened this idea to accommodate our observation that a relatively strong influence of external events can also trigger such fixated, repetitive thoughts.”

Smartphones don’t help

These loops of thoughts can be worsened by smartphone use. Professor Chen and his team found links between smartphone overuse and poorer mental health among youths. Their latest research further showed that higher levels of smartphone overuse are also associated with event-based rumination but not depressive rumination, suggesting the intake of information via smartphones may keep one fixated even more on negative events beyond one’s control.

“When we feel distressed, it is now common for us to try to seek comfort or an outlet through information or activities via our smartphones. But often, negative and sometimes exaggerated news will come up, which may form another ‘external’ technological loop of rumination that further aggravates mental health problems,” he said.

Rumination’s role in suicide – specifically, rumination about suicide – was also investigated in youths between 2019 and 2022. That epidemiological study also sought to examine the roles of other factors such as hopelessness, family functioning, cognitive functioning, and COVID-19 on suicidal ideations, plans and attempts.

“We found each of those factors was related either to suicidal ideation or plan, and COVID-19 stressors were related to suicide attempt; but importantly, suicide-related rumination was the only factor associated with all three outcomes,” Dr Wong said. “This gave more support towards the transdiagnostic nature of rumination and the need to look at rumination beyond the depressive type.”

The team has also looked at how rumination may be disrupted before it becomes harmful. Normally, our thoughts flow spontaneously from one to another, but ruminators become stuck in one place. This often happens imperceptibly, so it is important to use methods that penetrate daily life, Professor Chen said.

Their data showed that event-based rumination often involves anger and a sense of injustice, which can further perpetuate the feelings of frustration and cycles of rumination. It is important to support people in being aware of their rumination processes, realising that the problems could not be solved merely by fixating on these thoughts, and exploring whether there could be alternative perspectives, he said.

Need for intervention

Professor Chen further noted that rumination can also induce changes in the brain and those with higher levels of rumination may require more intensive interventions. Evidence has shown the positive impact of exercise-based intervention on the brain, which may be a promising future direction.

Bringing these two ideas together, Dr Wong is studying the effectiveness of smartphone-based ‘ecological momentary intervention’ – providing prompts in everyday life to engage a person in simple in-the-moment interventions designed by the team that engage both body and mind, such as guided finger-tapping.

“It may sound a little contradictory to use smartphones but we’re very aware that complete abstinence from smartphone use is not possible – and probably also not ideal – in today’s world. So we are looking at how to utilise it optimally as a mode of intervention to help reduce rumination and improve mental health of the population more generally,” she said.

Professor Chen added: “We do need to develop new habits of using the smartphone healthily in terms of having more control over the device rather than being at the mercy of whatever information comes up. This would be important in understanding mental health and future intervention strategies in many societies.”