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Rumination in Teens: The Role of Mindfulness

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Mindfulness-Based Cognitive Therapy (MBCT) Helps Teens Manage Unwanted Thoughts

When we read or hear the word rumination, most of us have a basic idea of what it means. It means to dwell on an idea, a thought, or a memory. Sometimes it’s for a purpose and sometimes it’s not. We may replay a troubling conversation in our head to find out where it went wrong. We may review a pleasant memory in our head simply to enjoy the event again, and savor the joy it brought – and can still bring – through thinking about it.

If that’s our definition of rumination, we’re almost right.

But in those examples, we’re mixing two concepts: ruminating and reminiscing. Let’s leave the word reminiscing – i.e. simply thinking about the past – behind and focus on the word rumination. First, let’s check a standard dictionary definition:

Rumination, noun:

The act or process of pondering or musing on or about something.

That’s what most of us think rumination is: a process akin to reminiscing.

But in the field of psychology, and in clinical mental health, specifically, rumination means something entirely different. Here’s a definition from the online dictionary maintained by the American Psychological Association (APA):

Rumination, noun:

Obsessional thinking involving excessive, repetitive thoughts or themes that interfere with other forms of mental activity.

That definition is different. It tells us rumination is not reminiscing, pondering, or taking a pleasant walk down memory lane. It’s more akin to what we mention first: reviewing an unpleasant conversation to see where it went wrong. Or it’s like thinking about unpleasant events from the past that we don’t enjoy thinking about, but we run them over and over in our heads anyway.

Rumination and Mental Health Disorders

The key phrase in that definition is interfere with other forms of mental activity. Another key feature of rumination – in the clinical context – is that the thoughts are unwanted. Therefore, when we connect the dots, we learn that rumination is what happens when we focus on specific thoughts we don’t necessarily want to focus on, and those thoughts interfere with our typical thought processes, affect our emotions, and in some cases, affect our behavior.

Now it’s easy to see how and why rumination is related to mental health: it’s a maladaptive – i.e. negative – mental behavior that can cause significant psychological and emotional distress. Research connects rumination to the following mental health disorders:

In addition, some studies connect rumination to chronic pain. Researchers showed that thinking about pain can increase the pain itself and lead to negative clinical outcomes. In other words, thoughts can exacerbate physical symptoms – in this case, pain – although researchers don’t know exactly why.

However, that research insight helps us understand a new trend in treating specific mental health disorders in adolescents: the use of a technique called mindfulness-based cognitive therapy (MBCT). It helps us because it highlights the mind-body connection in healing. Or, in the case of healing and recovery from mental health, behavioral, or addiction disorders, it highlights what we’ll call the mind-mind connection or the mind-thought-emotion connection.

We’ll explain what we mean, beginning by defining mindfulness and explaining exactly what mindfulness-based cognitive therapy (MBCT) is.

Mindfulness, MBCT, and Teen Mental Health

What is Mindfulness?

The contemporary practice of mindfulness in the U.S. is based on a form of Zen Buddhism popularized by Buddhist monk Thich Nhat Hanh, who introduced the concept at a lecture at Princeton University in 1960. Here’s how Hanh defines mindfulness:

Mindfulness is our ability to be aware of what’s going on both inside us and around us. It is the continuous awareness of our bodies, emotions, and thoughts.”

That’s the essence of mindfulness: awareness. There’s another important element of mindfulness that makes its practices directly relevant to mental health: nonjudgment. When Thich Nhat Hanh asks us to be aware of what’s going on in and around us, and to be continuously aware of our emotions and thoughts, he asks us to do one more thing: maintain this awareness of our emotions and thoughts without judging them.

Mindfulness teaches us to see our emotions and thoughts and allow them to be there, in our minds, without trying to control them and without attaching positive or negative value to them. When we’re able to do that, we realize something: humans habitually and unconsciously attach positive or negative judgments to emotions or thoughts.

And we do it without realizing it.

But when we realize we do it, something powerful happens.

We gain the ability to detach those automatic judgments from our emotions and thoughts, which does two things. First, it mitigates their power over us, and second, it allows us to define those thoughts in the manner of our choosing.

Mindfulness in Clinical Practice

The first person to apply this concept to modern medicine was Dr. Jon Kabat-Zinn. In the late 70s, working at the University of Massachusetts Medical School, Dr. Kabat-Zinn examined how deep breathing and other mindfulness exercises reduce pain and stress. He taught people to acknowledge their pain work through it using mindfulness – and it worked. He later codified this process into a technique called mindfulness-based stress reduction (MBSR), which teaches people to use mindfulness to manage stress.

In the 80s, another clinician, Dr. Zindel Segal, picked up where Kabat-Zinn left off when he recognized the potential of mindfulness for the treatment of depression. Along with a group of colleagues trained in a therapeutic technique called cognitive behavioral therapy (CBT), he realized people with depression often relapse when stressful or challenging events trigger negative thoughts or thought patterns. Since CBT prioritizes analyzing thoughts and how they affect behavior, they realized combining CBT and mindfulness might help prevent relapse – and they were right.

They used mindfulness practices to teach people recovering from depression to work with the feelings of sadness that led to relapse. Rather than work against the feelings, he taught them to work with and through them, which resulted in a new approach to mental health treatment: mindfulness-based cognitive therapy (MBCT). MBCT teaches people with mental health disorders to acknowledge the presence of their thoughts and feelings, then use mindfulness to interrupt any negative judgments around those thoughts and replace them with productive emotional coping and processing techniques.

For a deep dive into MBCT, please navigate to our page Mindfulness-Based Cognitive Therapy.

Decades of research show MBCT is effective for adults with mental health disorders such as depression and anxiety. Additional research shows MBCT is effective for adolescents with high emotional reactivity, as well.

Now, new research shows that MBCT is effective in helping teens with depression, anxiety, and addiction disorders manage disruptive thoughts that can lead to relapse. Or, to say that another way, this new research shows MBCT – and mindfulness specifically – can help teens manage the types of thoughts and thought patterns that are the topic of this article, i.e. rumination.

MBCT Reduces Intrusive Thoughts and Rumination

Two studies published recently – one from Iran and one from the Netherlands – show that mindfulness practices can reduce the presence of unwanted, intrusive thoughts often associated with anxiety, depression, and addiction.

We’ll look at the one from Iran first. In that study, researchers examined the effect of the following mindfulness practices on teenage boys with rumination associated with social anxiety and addiction:

  • A body scan self-awareness exercise designed to ground participants in the present moment
  • Seeing and hearing exercises designed, likewise, to focus participants on the present moment
  • Seated meditation for relaxation and monitoring thought processes
  • Prone meditation for relaxation

After teaching a group of 45 teenage boys these mindfulness techniques and pairing them with MBCT, researchers observed significant reductions in:

  • Rumination
  • Avoidance related to social anxiety
  • Fear related to social anxiety
  • Physiological symptoms related to social anxiety
  • Overall symptoms of social anxiety

These reductions were significant when compared to a control group, which did not receive treatment with MBCT, but a traditional approach to emotional regulation. In this case, the data showed MBCT was more effective.

Mindfulness App Increases Mindfulness Skills and Improve Quality of Life

Now let’s look at the other study, conducted in the Netherlands. This study is interesting because it analyzed data collected from teenagers using a smartphone app called the VGZ Mindfulness Coach. Researchers recruited 400 teens and split them into two groups. They taught one group to use the mindfulness app over a period of three weeks (the experimental group) and gave no specific mindfulness instruction to the other group (the control group). They administered questionnaires before the study, one month into the study, and 12 weeks after the study.

Here’s what they found at their 12-week follow up:

  • Significant increases in mindfulness-specific skills:
    • Observing
    • Describing
    • Acting with awareness
    • Nonjudging
    • Nonreactivity
  • Significant decreases in:
    • General psychiatric symptoms:
      • Depression
      • Anxiety
    • Moderate increases in:
      • Psychological quality of life
      • Emotional quality of life
      • Social quality of life

When we read the results of these two studies together, what we realize is that something important is happening here. When mental health professionals combine the latest developments in technology – i.e apps and smartphones – with cutting-edge therapeutic techniques – i.e MBCBT – the results are promising.

The fact that MBCBT can help teens manage mental health symptoms like rumination through a smartphone app is huge. That means therapists can leverage teenager’s love for their phones and their love for self-directed learning via smartphone apps into adopting a positive therapeutic tool they can literally carry around in their pocket.

That’s good news for teens, because treatment works. If it takes an app to get teens interested in the benefits of mindfulness, and that mindfulness app helps those teens manage the symptoms of a mental health disorder with an evidence-based therapeutic technique – MBCT – then we all win.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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