3 Ways to Reduce Rumination, Worry, and Attachment to Self Stories

Have you ever found yourself caught up in thoughts about the past? What life was like before your chronic illness/pain? Ruminating over and over about that old life… What about thoughts about the future? Worrying about what will happen to you and how your health will affect you, maybe even getting worse? Perhaps you are also really fused with the idea that you are just a sick person now and that is all your life will be. These are all common thought processes when you have a chronic illness or chronic pain. I’ve certainly dealt with these before. The problem with this dominance of the conceptualized past or future, or the conceptualized self, is that it often takes us away from living right now. It makes life worse. It increases suffering.

Rumination and worry are like the fog. Can you come back to the present?

I remember having the thought that I don’t want to suffer any longer. This was in the fall of 2016. My very recent ex blamed me for all the things that were wrong in the relationship because of WHO I was. What I quickly came to realize was that I was ruminating and worrying and fused with having an autoimmune disease. We didn’t break up because of who I was (trust me there were a lot of other issues that didn’t stem from me at all). However, the dominance of my thought processes wasn’t helping me at all. It was taking me away from the life I wanted to live and away from the person I wanted to be.

The Conceptualized Past & Future
I don’t think that being able to reflect on our pasts or contemplate our futures is inherently problematic. Our brains have evolved to be able to do this. Initially to keep us safe and alive. We just don’t run into as many instances of life-and-death situations anymore. When we excessively focus on the past, or ruminate, we tend to feel overwhelmed and depressed. When we excessively focus on the future, or worry, we tend to feel overwhelmed and anxious. Both anxiety and sadness can increase pain and set of flares for those of us with autoimmune disease, which in turn tends to lead to more sadness and/or anxiety. It’s a vicious cycle.

The Conceptualized Self
We all have stories we tell ourselves about ourselves. Like who we are, where we came from, and why we act the ways we do, essentially why we are the way we are right now. Often being sick or in pain is a large part of this story. The problem with these stories is that while they do contains some objective facts, they are also chalk full of our own subjective interpretations. When we are really fused with these stories about ourselves, we forget that life is constantly changing, most of it is not predictable, and we can also create change for ourselves. And yep, I know this is really hard to grasp when you have a chronic illness.

Why we need to contact the present moment
We we are stuck in the past or future, and when we dwell on our stories about ourselves, we are definitely not experiencing the here-and-now. The benefits of being present are plentiful, including the ability to gain more self-knowledge and self-awareness, enjoying our experiences more, feeling less pain (emotional and physical), and being more flexible in our interpretations of ourselves and of life. I meditate daily because it helps me become more present (and it took me so long to get into a daily routine). I also notice myself being able to come back to the present much faster throughout the day, even when I notice physical pain.

How do we counteract rumination, worry, and attachment to our self stories?

  • Mindfulness – it can be meditation, but really mindfulness means contacting the present moment, being here-and-now. So it can also be yoga, or mindful walking or eating. It can be fully engaging in an activity. It can be noticing your thoughts/feelings/sensations and then coming back to the present by noticing your feet on the floor. It can be many, many things, but it is always: being curious, open and nonjudgmental about your present moment experiencing. Check this out.
  • Noticing Self – the idea that there is a part of us that can step back and notice. Like the sky and the weather. The sky always has room for the weather. Even when the weather is thunderstorms and hurricanes, the sky is not bothered by it because eventually the weather changes. We can use this same part of ourselves, to just step back and watch our experiences without being swept away. It’s a safe place that just notices. This is particularly helpful for attachment to our conceptualized self.
    Check this out.
  • Creating Distance Between Ourselves and Our Thoughts – we can’t stop our minds from thinking, but we can notice when our thoughts are unhelpful and learn to let them pass like leaves on a stream. The more distance we can create, the more psychological flexibility we can have in order to return to the present. Check this out.

I know that was a lot of information! I’m a big believer in seeking help from a mental health professional in your area if you are really struggling with your mental health. Many people with chronic illness, chronic pain, TBI, etc. find it hard to cope on their own. One of the best things I ever did was go to therapy. I learned a lot of skills to help me cope and felt I had nonjudgmental support as I continued down this path we call life. And on that note, keep making the most of it!

Effective Ways to Challenge Chronicity Thoughts

How much time do you spend thinking about your pain or illness? Does it consume most of your day? Just a little bit? I remember the time when I was spending a lot of time thinking about being in pain, and wondering “why me” or what my life would be like going forward etc. These are often referred to as chronicity thoughts. Happily, this was the past for me and is not my experience anymore. I know that many of you may be having this as your current experience though, so I wanted to take sometime to talk about it.

As human beings, we spend a lot of time thinking.

First of all, I want to say that this is a totally normal experience for anyone with chronic pain or a chronic illness. Our minds are literally trying to help us (or they think they are trying to help us, which is what they evolved to do). The problem is, this kind of constant thinking about pain makes our lives worse, not better. There are three types of common chronicity thoughts: (1) ruminating about being in pain/sick – I keep thinking about it, it’s all I can think about because it hurts; (2) magnifying our pain/illness – it will get worse, something terrible is going to happen; and (3) thoughts of helplessness – nothing I do makes it better, nothing I can do will ever make it better.

Are your thoughts making your life better, worse, or the same?

If you went to a doctor (Western or functional) or a therapist, they’d likely assess this with a tool called The Pain Catastrophizing Scale (PCS). My commentary is that I don’t like the name because “catastrophizing” sometimes has the connotation that it’s all in your head, but that’s not what it means in this case – it’s really referring to chronicity thoughts. The questions on the scale include:

  • I worry all the time about whether the pain will end
  • I feel I can’t go on
  • It’s terrible and I never think it’s going to get any better.
  • I wonder whether something serious will happen.
  • and so (there are 13 questions total, and you self-report on a scale of 0-4 for each question, with 0 meaning not at all and 4 meaning all the time.)

So what can we do about all these chronicity thoughts? First, I will always suggest that working with a therapist is the way to go. Remember this blog is educational and not mental health/medical advice. We all have unique situations and unique thoughts, so having someone you can work with one-on-one (or in a small group) is always the way to go. I will let you know about a few different approaches. First, let’s talk about classic Cognitive Behavioural Therapy approach, where we challenge thoughts.

  • Notice and name the thought: I’m having the thought that “It’s terrible and I never think it’s going to get any better.”
  • Review evidence for and against the thought: For might include things like, it occurs frequently, has high intensity, a doctor’s prognosis, etc. Against might be things like, there are times of day when I don’t notice it or it’s less intense or my doctor said with this medication or these lifestyle changes it will improve
  • Replace the thought with a more accurate one: This doesn’t mean being optimistic or denying anything that’s true. Instead it’s incorporating the evidence against the thought (not just for the thought which is what we tend to do). So a different thought might be: “It’s really unpleasant right now, but it might not always be this bad/constant.” (You choose a thought that works for you, this is just what might work for me.)

As a therapist, I am well-trained in CBT but I prefer to use Acceptance and Commitment Therapy (ACT) on myself and with clients, especially those with chronic pain/illness. There is no step-by-step way to challenge thoughts in ACT because we don’t challenge them, but here’s now I might work with them.

  • Contact the present moment: ground myself my noticing and acknowledging my thoughts and feelings, while noticing what I can touch, taste, smell, hear, and see. (Here’s a guided version of this).
  • Use my noticing self: the part of me that notices everything and even notices my noticing. And the similar part of me that can put myself in my shoes on the days when my pain is less. (Here’s a guided version of how to learn to do this).
  • Creating distance between myself and my thoughts: This might be noticing and naming the thought. It might be reminding myself that my brain is just trying to help me and saying “thank you mind.” This might be just watching my thoughts come and stay and go in their own time (guided version of this one is here).
  • Accepting my experiences: particularly physical and emotional pain that I might be going through. This could be actual sensations or emotions such as sadness or anxiety. For this I often just observe what the sensation/emotion looks like, where it is in my body, and so on. Then I send my breathe into the part of my body I feel it most intensely. Then I make some room for it, noticing that my body is bigger than it. Finally, I just allow it to be there without consuming me. (Guided version here).
  • I connect with my values: what qualities of being are important to me? I know that compassion (for myself and others) is a big one that is often helpful in moments of pain, sadness, anxiety, etc. (Here’s an exercise on connecting with your values.)
  • Taking an action to live by my values: So if we’re going with my above example/value than it might be doing some self-compassion work. (Here’s a guided practice). It could also be setting goals to make some of those lifestyle changes that might help. It doesn’t matter what the action is as long as it is rooted in your values. (podcast episode on how to do this available here).

So that’s it. A bunch of different ways to work with your chronicity thoughts so that hopefully you can improve your life and keep making the most of it!

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