I notice it around me a lot that people joke about being overthinkers. A friend mentions over a beer that they will spend the rest of the night going over the same conversation, the same moment, the same worry, until they finally fall asleep from exhaustion rather than peace. Someone else laughs about how they cannot make a simple decision without running through every possible outcome. It is said lightly, almost as a personality quirk, something to be a little proud of even.
If you have read my previous article on moral distress and injury, you will know that in some articles on my website I write about issues that can look simple but which can actually be analysed quite thoroughly through empirical research or from a more philosophical standpoint. Overthinking is one of those, so let's get into it.
My first real encounter with it as a clinical concept happened some years ago, during a winter I spent in Finland. The lack of light in Nordic countries plays real tricks on your sleep, and I remember being awake at three in the morning with nothing to do and nobody to call, and finding myself watching a lecture delivered to the Australian Psychological Society by an older, sympathetic-looking man. It read: "How to recover from depression." My first reaction was mild scepticism. It seemed a little bit vulgar to me that someone would give a lecture sounding as if it was TikTok advice on the top things that will help you cure your depression. I don't like quick fixes because they usually don't work, create false expectations, and are click-bait means to light your dopamine receptors on fire.
But I clicked on it because it was 3am and the bait worked. And I found the content genuinely interesting. One section in particular stayed with me. The lecturer had a name for a specific kind of (over)thinking that I had not heard before - he called it 'useless rumination'.
That lecturer, as I later confirmed, was Michael Yapko, a clinical psychologist who has actually built a good reputation as a clinician over the past couple of decades. His claims about useless rumination went something like this: thinking is only useful if it generates action. Thinking that circles back on itself indefinitely, that revisits the same material without moving anywhere, is not problem-solving and is making people feel worse when they're already depressed (Yapko, 2018).
This night in Finland was five years ago. Recently, I've had more time to think about some clinical concepts and specifically 'overthinking' came back around. So this week, I reserved a morning for reading a dense research review, and here is what I've learned.
In this article, I use the terms overthinking and rumination interchangeably, but the clinical concept I'm referring to is specifically rumination as defined in depression research: passive, repetitive, mood-focused thinking. If your version of overthinking looks more like worry about the future, or thoughts you cannot control and did not invite, the picture is partly different and worth a separate conversation.
It's not by accident that the word rumination comes from Latin for the way cattle chew and re-chew the same food. This is because rumination is a mode of responding to distress that involves repetitively and passively focusing on symptoms of distress and on the possible causes and consequences of those symptoms, without taking action to change anything (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). You're chewing and chewing the same thoughts again and again.
But let's be careful here. Rumination is not the same as reflection. Healthy self-reflection has a direction to it: you examine something in order to understand it, and the understanding changes something - either your thinking, your behaviour, or your relationship to the experience. Rumination does not do that. It revisits without resolving and while the thinking feels purposeful, it does not go anywhere (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008).
And yet, most people who do it believe they are working on their problems (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008).
When overthinking becomes harmful
If you feel like you're closer to a cow that chews and rechews rather than someone who reflects, you may be an overthinker. Welcome to the club of many. The bad news is that the research has quite a lot to say about what this is actually doing to you, and not much of it is flattering. The good news is that understanding it is, at minimum, a useful place to start. Now let's get serious.
The psychological literature on rumination, developed most extensively by Susan Nolen-Hoeksema over several decades, describes a number of ways in which this kind of thinking makes things worse rather than better. When a person is already feeling low, rumination amplifies the effects of that mood on their thinking. It makes them more likely to interpret their current circumstances through the lens of the negative thoughts and memories that the low mood has already activated. Their view of the past darkens, their assessment of the present becomes more critical, and their expectations for the future narrow (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008).
Rumination also interferes with problem-solving, not by preventing thought, but by making that thought more fatalistic and pessimistic, so that problems come to seem unmanageable. Over time, it gets in the way of taking action, which increases the stressful circumstances a person is already dealing with. And people who ruminate chronically tend, over time, to lose social support, which then adds to the depression rather than relieving it (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). These consequences feed each other. What begins as a period of low mood can, through the mechanism of rumination, become something considerably more serious.
Are you a ruminator?
Now, instead of vibe-checking whether you feel like a cow or more of a reflective person, there is actually a scale that has been empirically validated for exactly this. It measures the tendency to engage in ruminative thoughts and behaviours, it is self-reported, and you can use it to evaluate yourself right now. It was developed by Nolen-Hoeksema and Morrow and is called the Ruminative Responses Scale (Nolen-Hoeksema and Morrow, 1991, cited in Nolen-Hoeksema, Wisco and Lyubomirsky, 2008).
A few questions from the Ruminative Responses Scale (ibid)
When you feel down, sad or depressed, how often do you:
- Think "What am I doing to deserve this?"
- Think "Why do I always react this way?"
- Think about all your shortcomings, failings, faults, mistakes
- Think "Why can't I handle things better?"
- Go away by yourself and think about why you feel this way
Response options: 1 = almost never, 2 = sometimes, 3 = often, 4 = almost always
"But when I think about things a lot, I come up with better solutions to my problems"
You may feel like you are working on something when you ruminate. It feels like effort, like turning a problem over carefully until it finally yields. For example, you may be going over an argument you had with your partner, but instead of finding a different angle to look at it and going to your partner to discuss it and move on, a lot of time has already passed and you're just thinking about how bad you feel about the conflict or what made you react a certain way. Or you're dissatisfied with a colleague who annoys you to your core but instead of facing them and discussing what bothers you, you spend your evenings thinking about why they act that way. It feels productive, as if you were to arrive at a magical reveal of "Oh! This explains everything!", but instead of the relief coming, you're only torturing yourself.
The more you think, the less likely you are to act
Even for people who spend time ruminating and actually manage to come up with a perfectly reasonable solution, rumination actually does not help them. According to research, ruminators are significantly less likely to actually do anything about their situation even if they think of a way to solve it (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008).
In one study, students who had been ruminating came up with sensible answers to real problems in their lives, things like "study harder" or "spend less money," and then simply did not follow through. Compared to people who had not been ruminating, they were also less confident in the solutions they had generated themselves, asked for more time before committing to anything, and were less assured when they had to present those solutions out loud (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008).
The thinking did not build toward action. Instead, it quietly dismantled the confidence that action requires.
Inaction due to overthinking can sometimes be dangerous
Research in health contexts has also found that women with chronic ruminative tendencies experience heightened distress when they discover a potential health symptom, and consequently delay seeking a medical diagnosis. In one study, women who had developed breast cancer and who tended to ruminate had delayed presenting their initial symptoms to a physician by more than two months longer than women who did not ruminate (Lyubomirsky, Kasri, Chang and Chung, 2006, cited in Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). The thinking in those cases was standing between them and the care they needed.
This example may be difficult to read, particularly if you have been putting off getting something checked. If that is the case, it is worth noticing that response and considering reaching for some support. There is no shame in asking for it directly rather than sitting with the thought alone.
Rumination may lead to depression or make a depressive episode worse
Just like the research on problem-solving, studies linking rumination and depression paint a consistent picture. Across different populations, in different countries, with adults and with adolescents, the same pattern keeps showing up: people who ruminate when they are distressed are more likely to experience prolonged depression and more likely to develop a depressive disorder (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). What is particularly striking is that rumination seems to be especially good at predicting the onset of depression in people who are not yet depressed, rather than how long an episode lasts once it has begun (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). In other words, it is one of the mechanisms that tips you over the edge.
And it is not only depression. Research has found the same pattern with anxiety disorders, eating disorders, and post-traumatic stress symptoms (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). Rumination is, in that sense, a fairly general risk factor for psychological distress, not a depression-specific one.
Do you feel like you are bothering your friends and family with your issues?
Something that sometimes accompanies prolonged overthinking is a gradual erosion of social connection. It may be that you find yourself wanting to talk about the same things repeatedly, going back over the same ground, because you have not yet found a way to settle it internally. That is completely understandable, and there is nothing wrong with needing to talk things through more than once. Difficult things take time.
What the research does document, though, is that people who ruminate heavily sometimes find that their social support diminishes over time. Friends and family may become less available, not out of indifference, but because sustained distress can be hard for others to hold (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). If you are noticing this, please do not take it as evidence that you are too much, or that your pain is not valid. It is not your fault. People have different capacities, and the fact that someone cannot stay present with you for as long as you need does not mean you do not deserve that presence. It means you may need to look for it somewhere else, or in a different form.
If you are not feeling well, please do not be alone in this
I really enjoyed writing about this issue, because something as simple as a friend mentioning overthinking over a beer can actually be a sign of distress and something worth inspecting closely. I also really like informing my work with research, because it paints patterns that we might otherwise not see or have good reason to feel confident about.
But the main point I want to leave you with is this: if you are recognising yourself in any of this, you may be experiencing real discomfort and pain. I am thinking of you, and I want to encourage you not to be alone in this. You deserve care and support. Please speak to a close family member, friend, or partner, or consider reaching out to a professional. Therapists are here to guide you through difficult moments like this and help you find some relief from that pain.
You can check out my website to see if I may be a fit for you. If you're not sure how to find a therapist, you can refer to my article How to pick a therapist.