S2E30 Worry and Rumination

Why do we worry about the future and ruminate about the past? In this episode, Dr. Rubin and Dr. Pete discuss and distinguish between these two “covert” behaviors (behaviors happening inside you that are invisible to everyone else), their evolutionary purposes, and why the brain thinks these behaviors help solve problems (spoiler alert: they don’t!) Unsurprisingly, you’ll see once again how all roads lead to mindfulness and how mindful practices can help you let go of worry and rumination behaviors.




Nikki: Pete, today we're going to be talking about two covert behaviors that everybody does worry and rumination, are you excited?


Pete: Well, I mean, you start right away with like the behavioral definition, overt behaviors. Yes, well, 


Nikki: Well, these are covert.


Pete: What I just say?


Nikki: You said overt.


Pete: Oh my bad. Yeah. So yes. These covert behaviors of worry and rumination, because all of us do it,


Nikki: We all do it. No, yeah, we all…well, 


Pete: Is there a human who doesn't?


Nikki: No, because we all have language and we all try to use that language to figure things out that can't be figured out. So that's really the problem here. And I know we've talked about worry and rumination in other episodes. Like we talked about it, I believe in our controlling behavior episode, last season, we talked about anxiety and uncertainty. We've talked about it, but I just really thought, I think we got to dive in and really clarify what these are because one, a lot of people I work with don't know the difference between the two of them. And two, if you don't know what they are, it's harder to catch. Because we can't see them, they're invisible behaviors.


Pete: Yeah. And well, you know that I like my definitions, 


Nikki: I know, yeah, I do.


Pete: Okay. So quickly,


Nikki: [inaudible 1:440]


Pete: Just quickly, worry, give way to anxiety or unease allows one's mind to dwell on difficulty or troubles. 


Nikki: Oh, you know,


Pete: You don’t like that


Nikki: I hate it


Pete: I know. I know you did already. And then rumination, a deep or considered thought about something.


Nikki: So inaccurate


Pete: Break it down Dr. Rubin.


Nikki: Who's that, Webster who said that?


Pete: Yeah


Nikki: Okay.


Pete: Oxford and Webster, yeah.


Nikki: Well they need to consult with some psychologists…


Pete: They sure do


Nikki: Try to do some definition. Okay, so let's start with just a brief review of overt versus covert behaviors. 


Pete: That’s smart, yeah.


Nikki: Right, let's yeah. Thank you. So overt behaviors, if our listeners would recall from previous episodes are behaviors that basically other people can see you doing, so they're observable. So if you're walking, that's an overt behavior. If you're…


Pete: Chewing Oreos,


Nikki: Chewing Oreos, you’re eating them,


Pete: I blended chewing gum with eating Oreo


Nikki: I was a imagining you just like, sucking on an Oreo,


Pete: I do savor an Oreo


Nikki: You do, Pete's savoring an Oreo, overt at behavior, that's right. 


Pete: There it is, you’re welcome.


Nikki: So basically anything that you can see that's visible is an overt behavior. But what most of us are not accustomed to identifying are what we call in behaviorism, are covert behaviors, and covert behaviors are behaviors that you're doing inside of your body that no one can see you doing. And we do covert behaviors all the time. So thinking is a covert behavior, pushing a thought away as a covert behavior, practicing being mindful is a covert behavior, fantasizing or imagining are covert behaviors. Any other ones you would throw in there before I get to rumination?


Pete: Well, there's just, no… I mean, I…because I was also thinking like your heartbeat or sometimes even breathing, like there's a lot of things that happen, is what…the point is there's a lot of things that happen that people don't know because it's a really busy human experience.


Nikki: Totally, right. And I think, and some of those things, like, even like your heartbeat, we would call, like that is…I mean, it's something happening, it is behavior, but it's an involuntary behavior, like we're not choosing it. So the ones that we're talking about in behaviorism and covert behaviors are the ones that we are doing, we control, we have control over them,


Pete: I don’t like that word. I don’t like that word.


Nikki: Oh yeah, you don't like that word. You like manage, you like the word manage. Okay, so how about choose? Choose, the ones that…behaviors that you choose to do. 


Pete: Well, but I also don't think we can choose to think or not think.


Nikki: Well that's fair. Oh well, yes. Well we can choose to interact with what our mind is doing. So there's a both, it's always a both. Well, because actually, we can even say that about the heartbeat. We don't choose what our heart does, but we can interact with it in a way that can slow the heart rate down or increase it. So…


Pete: You're welcome. 


Nikki: Yeah. Thank you. No, that is…


Pete: Served that to you,


Nikki: Sure did [inaudible 4:40] football. All right, so let's get in specifically to worry and behavior, and that's the definitions I…this is an episode where we're talking about not liking things very much. 


Pete: It's okay.


Nikki: Yeah, it's okay, was just saying it.


Pete: Well, you haven't said how much you don't like the brain yet, [inaudible 4:56] but you always correct me, I know.


Nikki: I love it, I just…what I don't like is that people put it on a pedestal. That's what I don't like. It's like, brain, it's just tissue in there. So anyway, okay. So worry behavior is the type of behavior we do when we're trying to figure out what is going to happen in the future, that's what it is. I tell patients, it really should be named fake problem-solving, because it is. So another way to identify it, and most people, if they're [inaudible 5:29] go like, ‘huh, how do I know if it's a worry?’ If you start the sentence with, ‘what if'.


Pete: Well, I think that should be a cognitive distortion. I always add that to David Burns list.


Nikki: Well, I mean, 


Pete: ‘What if’


Nikki: Except well, what if… I mean, yeah, I guess you could say it that way. I mean, I would say it's also, it's a ‘what iffing’ like is trying to figure something out,


Pete: That's right, David, if you're listening,


Nikki: He's not, no he's around, but no, he's not listening. If you are, I'm honored. Thank you for listening to this.


Pete: And there should be 11 cognitive distortions. Because I do think ‘what iffing' should be on there. I honestly see that as one of the most common ones. And so for our listeners, we'll break that down where the worry is about the future. Like ‘what if I don't make the team?’ Or ‘what if I screw up this talk I'm about to give to people', or ‘what if I have a panic attack on my next flight?’


Nikki: Totally. So, it's like, what I would say is, the distortion would be what the person with the answer to that question is, is like, ‘I'm going to have a panic attack'. The assumption, like the ‘what if’ is that you're trying to figure out if it will happen.


Pete: Yeah. Well, the ‘what if' is the precursor to the move…


Nikki: To the distortion.


Pete: To the distortion, like it's the movie film. So when you say, ‘what if', ‘what if I mess up the speech', I'm already seeing myself like, well it happens to me a lot of times, I see myself having a panic attack, like Dan Harrison leaving the stage in the middle of it all. I literally always see that video, which I use for exposure because it…and Dan, thank you. I mean 10% happier, like this is all really good tools. And I'd be curious because my guess is Dan still feels nervous once in a while as he's presenting and on air.


Nikki: Well, he's a human being, we all are. All right, I forgot that part, we all do. No, totally. So it's like, ‘what iffing’, worrying is what happens when our brains are trying to figure out what's going to happen. And the problem with that is that, and this is really important for listeners to hear, it might sound obvious. That is information we never have access to, it's imaginary information, when I say like, the future is a darkness, we don't know what it is. So you can, ‘what if' till the cows come home, it's never, you can't reach your hand into the future and pull information and figure it out.


Pete: You're too young and hip to say something like that. She go, “What if until the cows come home”, I feel like my grandma used to say that, but all right,


Nikki: You're going to laugh because I'm also going to bring up cows when I’m talking about rumination.


Pete: Oh, here we go,


Nikki: Oh yeah. But one more thing about worry is that to say that the more we… because sometimes people will say to me, “well, I'm trying to think of all the possible outcomes”. Do people say that to you?


Pete: All the time.


Nikki: Yeah. What do you say? What do you say to them?


Pete: Well, so there's infinite amount of outcomes, which means that even all the ones that you've thought of, there's another one that you haven't thought of.


Nikki: There it is. That's right. So it doesn't do anything. You're not,[inaudible 8:29] it's fake problem solving, you're not figuring anything out. The only truth is that about the future is we don't know what it is. So, but that's uncomfortable, as we talked about in our uncertainty episode.


Pete: Someone said it to me today, we were talking about something and he was like, “I don't know what the future holds for this person”. I was like, “well, none of us do”.


Nikki: I don’t know what the next millisecond holds for me.


Pete: I have no idea. I might get into my next appointment that I have after we're done recording, but maybe not, 


Nikki: Maybe not, who knows? Yeah, it's… so knowing that and being able to label and recognize worry is helpful because you start to become attuned to this fact that your brain is trying to do a behavior that is, it literally doesn't work. Anything you would add, Pete, to that?


Pete: No, let's go to the rumination.


Nikki: And the cows. My…


Pete: I just, I want to hear more about cows.


Nikki: You want to hear about cows. So okay, so when I'm teaching people what rumination is, so I say ruminate, that term actually comes from cows, cows…


Pete: No, it doesn’t,


Nikki: Yeah, it does,


Pete: I didn’t know that.


Nikki: Yeah, cows  ruminate, which means to chew cud, it what it means. And so…


Pete: What?!


Nikki: Yeah. And so I say...


Pete: You're so smart, 


Nikki: Well, I wish I found that out on my own, someone taught me that once. So rumination is chewing cud. What it is, is while worries about the future, rumination’s about the past, it's going over something in your mind. If you're watching our YouTube video, you're going to see me doing this little hand gesture,


Pete: Circles, 


Nikki: Yeah, circles and circles, where you go over something in your mind, over and over again. Now this is also fake problem solving, but in a different way, because oftentimes when people ruminate on things, it's like they're trying to figure out a different way it could have happened. Like they're trying to like mine for information. And the problem with rumination is, number one, past is gone. So just like the future is a darkness, the past week, we know what it is, we have information about what occurred, but we can't reach into the past and grab it, it's already gone. And the research is really, really, really clear that the more we ruminate, it intensifies emotion dysregulation. In fact, the more someone ruminates it's highly correlated with depressive symptoms, Nolen-Hoeksema, who is no longer with us, but she was at Yale. That was her research. 


Pete: That's important for people to digest. So think, because as we always joke around here on When East Meets West, that all roads lead to mindfulness, and that's exactly why we do that. So because worry about the future or ruminating about the past takes us out of the present moment, and ultimately what we're trying to do is just be as grounded as we can in this moment, which is the present moment is not always great.


Nikki: No. And, and you know what, I'm really glad that you're bringing this up. And of course I knew we would get to mind mindfulness, because that's really the antidote here for both worry behavior and rumination behavior. But what I often find though, is when I'm presenting that and I start to introduce people like, okay, we want to come back to the present, they'll say to me, “well, what I'm never supposed to plan ahead”, or “I'm never allowed to like, think about my past”. What do you say to patients when they bring up that?


Pete: Well, it happens all the time because especially with high performers, they're like, “well, but I want to get a gold medal”, or “I want to win a world championship”. It's like, yes, you do, in this moment, you set that goal in this moment.


Nikki: Well, and then how about if they say to you something along the lines of, “yeah, but like, I do need to think about future”, oor” I need to think about like the mistake that I met, made”, excuse me, in the game.


Pete: Yeah. Well, you do that in this moment and then you let it go. I mean, you're allowed to learn from mistakes and you certainly want goals towards the future, but, I'm not answering the question the way that you want me to.


Nikki: Oh, [inaudible 12:21] No, I like what you're saying. No, it's funny, no I'm actually just processing what you're saying. No, I like what you're saying. I'm just curious, I think about like, because the part of like…


Pete: Yeah what do you say?


Nikki: Well, I think what I'm wondering is when you're like that's happening in this moment, that's right. But they're talking about letting their minds wander away from it,


Pete: Oh, gently bring it back.


Nikki: Gently bring it back. Okay, yeah. So I guess like what I find, or what I'm thinking about is that, because people, it's like they, I think sometimes want the answer for me to be like, ‘how do I stay in the present moment all the time?’ And I'll say like, “look, we do have human brains.” Like I'm not saying don't plan or don't think about the future, don't reflect. In fact, that can be helpful. It's just recognizing it doesn't exist at the same time, like it's not happening. So even in therapy, I say like, “look, we play Monday morning quarterback all the time”, there's a sports metaphor for you, sports psychologist.


Pete: You could play Monday morning quarterback until the cows come home and you still won't know what to do with the present moment.


Nikki: I'm just filled with [inaudible 13:27] today, I don't know why. I don't know what's gotten into me. Yeah, so, but that's what we're doing in therapy a lot of times. We're talking about things that happened and I'll say like, there's benefit to that, but that's not the same thing as ruminating on it. Like reflecting is not rumination, like reflecting is also recognizing it has happened. Planning for the future, like planning how I’m going to get to work, it doesn't mean I know what's going to happen. I might have a plan, and then there's like an accident and there's traffic or whatever,


Pete: Yeah, and I just wanted to throw in before we end, like just thinking about Buddhism in here, like that really, that suffering is the natural order of being. And in Buddhism they kind of think of worry or like rumination is about being restless, and it's like the fourth of five hindrances because the focus, like the goal within any kind of Buddhist meditative practices to focus, and so if I'm restless, I can't be focused. And so it's a hindrance that's really accepted as a common suffering aspect. And so really like that's where you come back to, like understanding. And one of the words that they use is like [inaudible 14:36] which is, that is worry.


Nikki: Oh, interesting


Pete: Yeah, and so thinking about like ways in which, and again, I think the way that they would teach them, because if you look up this stuff and any listeners, every article you read is going to be like, how do I get rid of worry? Or how do I get rid of the rumination? We're actually going to say like, don't…


Nikki: Don’t, right, you can’t.


Pete: You just, you focus and you just focus on the present moment.


Nikki: Yeah, that's, of course I always love when you bring in the Buddhist stuff here. Yeah, that's really lovely because basically what you're saying is we have to start by accepting, like, this is what our brains do. This is like, we're not... like the work that we do, as psychologist and also the work that is practicing Buddhism, isn't saying get a new brain. But you're right, like that's often how it's sold. Like we're going to get rid of it. It's like, no, we're trying to interact with it in a different way and have the option to come back. So thank you for sharing that. Well…


Pete: But can you get rid of my brain?


Nikki: I don't want to, love your brain.


Pete: Okay, thank you.


Nikki: I don’t want to.


Pete: I love your brain too. 


Nikki: Oh, thank you. I actually do love all brains. They just give them way too much credit.


Pete: That’s it.


Nikki: Yeah. So, for listeners, see if you can begin to observe and label when you're engaging in worry behavior about the future or when you're engaging in rumination behavior about the past and see if you can pause and acknowledge it's fake problem solving. It's not getting you anywhere and decide, instead to mindfully, come back to the moment that you're in.


Nikki: This has been When East Meets West, I'm Dr. Nikki Rubin,


Pete: And I'm Dr. Pete Economou, be present, be brave.


Pete: This has been When East meets West, all material is based on opinion and educational and training of doctors Pete Economou, and Nikki Rubin.


Nikki: Content is for informational and educational purposes.