Mindfulness for Worry and Rumination

Interrupting the "What If" Cycle and Rumination

Worry (future) and rumination (past) are cognitive processes that hijack attention.

Mindfulness intervenes not by discussing the content of the thought (as cognitive restructuring would do), but by changing the attentional focus.

When the patient detects that he or she has entered a "What if I get fired?" loop, he or she is instructed to use a sensory anchor to return to the present.

By withdrawing attention from the worry process and placing it on a present neutral stimulus, the anxiety cycle is cut off due to lack of attentional fuel.

The External Object Exercise (The Clip)

A specific technique to train this is the exercise of focused attention on an object, such as a paper clip or a pen.

The patient is asked to voluntarily induce a preoccupation and then radically shift his or her focus to observe the object in microscopic detail: its color, how it reflects light, its texture, its shape.

When the mind attempts to return to the preoccupation (which it will), the patient should notice that movement and gently but firmly return attention to the physical properties of the object.

This experientially demonstrates that the patient has control over his or her focus of attention and can "disengage" from the distressing thought.

Breathing as a Portable Anchor

Since one does not always have an object to observe, the breath serves as an ever-available anchor.

The exercise consists of noticing the physical sensations of air coming in and going out (nostrils, movement of the abdomen).

It is essential to clarify to the patient that the goal is not to "not think," but to notice the distraction and return.

Each time the mind goes to a past rumination and the patient brings it back to the breath, he or she is strengthening the "muscle" of mindfulness.

It is taught that background thoughts may be ther