Blog Series on Rumination

Have you ever found yourself alone with your thoughts, feeling frustrated or disappointed? These moments often arise when you’re driving home, lying in bed before sleep, or even walking through the grocery store. You might replay what you wish you’d said to a coworker who joked about you in front of your boss, feel annoyed that your partner hasn’t emptied the dishwasher as promised, or think about a friend who’s always late and never apologizes.

It’s perfectly normal to reflect on everyday problems. This kind of reflection helps you understand your feelings, recognize patterns in situations that trouble you, and consider the impact these issues have on your life. Thoughtful reflection can lead to greater self-awareness and problem-solving.

However, sometimes negative thoughts become persistent and hard to shake. When this happens, you may feel sad, annoyed, or guilty for longer periods, and it can affect your behavior—like staying in bed, snapping at others, or canceling plans. It may feel as though negative thinking has taken over your life.

What Is Rumination?
Rumination is when your thoughts keep circling around the same issue. The term comes from “ruminant,” describing animals like cows that regurgitate and rechew their food as part of digestion. Similarly, rumination involves repeatedly “chewing over” a problem without reaching a solution. While it’s often linked to depression and other mental health challenges, rumination is common and can help us explore the reasons behind unresolved problems.

Is Rumination Normal?
It’s normal to ruminate after major life changes, such as the loss of a loved one, the end of a relationship, or losing a job. Rumination can help us process these changes and adjust. Repeated thoughts about a problem or goal can also be constructive, helping us identify the gap between what we want and what we have, and motivating us to take action.

When Does Rumination Become a Problem?
Rumination becomes problematic when it turns into a mental habit—when you start ruminating in similar situations repeatedly. For example, if you’ve ruminated while driving before, you’re likely to do it again in that context. Over time, this pattern can become ingrained and automatic.

Rumination vs. Worry
Rumination and worry are both repetitive thought patterns about unresolved issues, and both can contribute to depression and anxiety. The key difference is their focus: rumination centers on past problems and failures, while worry is about future threats and uncertainties. In practice, these thought patterns often blend together, shifting between past and future concerns.

How Can You Reduce Rumination?
Here are some strategies to help break the cycle of rumination:

• Analyze the ABCs (Antecedent-Behavior-Consequence): Examine what happened just before you started ruminating (the antecedent), the rumination itself (behavior), and the feelings or actions that followed (consequence). This functional analysis can reveal patterns and help you understand the purpose of your rumination.
• Track Your Thoughts: Write down when you ruminate, what triggered it, and how it affected your mood and behavior. This can help you spot recurring patterns and triggers.
• Reward Yourself: Schedule activities that boost your mood and provide a sense of accomplishment or pleasure. Experiment with different activities and note which ones are most effective at improving your mood.

Dr. Robbie Woods (C. Psych.) is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR). He provides psychological services to adults who are seeking assessments and treatments for a variety of conditions including anxiety (e.g., generalized, social, health, panic), obsessive-compulsive (e.g., body dysmorphia, skin-picking), and depressive disorders (e.g., major depressive, persistent depressive).

References:
Kircanski, K., Thompson, R. J., Sorenson, J., Sherdell, L., & Gotlib, I. H. (2018). The everyday dynamics of rumination and worry: Precipitant events and affective consequences. Cognition and Emotion, 32(7), 1424-1436.

Watkins, E. R. (2018). Rumination-focused cognitive-behavioral therapy for depression. Guilford Publications.

You might understand why you feel anxious, low, or stuck re-experiencing difficulties from the past, and have a number of concrete strategies to soften those experiences. However, you might still find your body responding as though it’s bracing for distress, feeling heavy or on edge. Much of how we experience the world is shaped by our nervous system — how we respond to stress, connect with others, and feel safe or unsafe in our own bodies. Even when we’re not fully aware of it, the body holds the stories of what we’ve lived through – the stress that lingers in our breath, the tension in our shoulders, the flutter in our chest when we feel uncertain.

When our nervous system feels more balanced, it can become easier to think clearly, regulate our emotions, and stay connected. When our nervous systems are overwhelmed or dysregulated, even ordinary moments may start to feel like too much, and we can experience burnout, anxiety or general distress.

As we notice the ways our body speaks, we come to understand that emotional pain isn’t just “in our heads” — it also lives in the places where we’ve learned to brace, hold, and protect ourselves. Our automatic responses — fight, flight, freeze, or connection — are intelligent survival strategies. The nervous system is always working to protect us. From this lens, experiences like anxiety, shutdown, or emotional reactivity can be seen as signals from the body — messages about safety, connection, and overwhelm.

Therapy with the right kind of mental health professional can provide a space to gently reconnect with the body — to slow down, notice, and begin to make sense of what it’s been carrying. As we tune into this connection, we open up the possibility of feeling more at home within ourselves. We can learn to collaborate with our nervous system: listening to its signals, recognizing its patterns, and gently guiding it toward safety and connection when possible.

Practices like gentle awareness, grounding, movement, or breath can help the nervous system begin to find its way toward balance. This isn’t about forcing relaxation or pushing through discomfort, but about slowly teaching the body that safety is possible in the present moment — and reconnecting with your innate capacity for self-regulation.

The over 70 clinicians at CFIR provide high quality therapy to help you gain more awareness to, and capacity to better regulate your nervous system in support of your mental health. Help is available to help you become a stronger, more resilient self, and to strengthen your relationships.

Juliana Riffat is a Registered Psychotherapist at the Centre for Interpersonal Relationships (CFIR) in Toronto. She works with children aged 8 years and older, teens, adults, and parents, supporting individuals and families navigating a range of emotional, relational, and developmental challenges. Juliana believes that healing begins with understanding and connection — that by attuning to the body’s quiet signals and the stories that shape our inner world, we can begin to restore a sense of safety and trust in ourselves.

Her approach is holistic and integrative, drawing from many approaches such as psychodynamic, attachment-based, somatic, and trauma-informed frameworks. Juliana brings warmth, curiosity, and care to her work, creating a collaborative space where healing can unfold at each client’s own pace.

References:

Dana, D. (2023). Polyvagal practices: Anchoring the self in safety. W. W. Norton & Company.

We’ve all experienced this: trying to focus on a work task, school essay, or work meeting – but you simply cannotfocus on what you’re doing. 

“Why can’t I just focus on this? What am I doing wrong?” you might wonder.

Often emotions, and particularly anxiety or stress, are the main culprits (Pacheco-Unguetti, Acosta, Callejas, & Lupiáñez, 2010). We evolved to be able to shift attention in response to external and internal factors – for example, by internally narrowing your focus on a conversation, or an external occurrence, like a loud noise, capturing your attention – to navigate the world. This usually works to our advantage by focusing on important and relevant things. However, this can also hinder our objective if our attention is hijacked by something seemingly irrelevant or unknown. For instance, you may have a tight deadline for a high stakes work report that is inducing anxiety, and despite needing to finish it, the stress around it can prevent you from engaging as much as you want. And it may be happening unconsciously.

So, what can be done about this?

Awareness: The first step is to notice a potential a problem and identify it. If you can rule out factors like fatigue, then stress may be the issue. Reflect on potential sources of stress, whether it’s the task, other things happening in your life at the same time, or some context for the task (e.g., being previously criticized for the work task).

Self-soothe: Rather than brute-forcing yourself to complete the task, try stepping away for a few minutes to self-soothe. This can include deep breathing, meditation, a short enjoyable activity, etc. Try to avoid simple distractions, like social media, because while they provide momentary relief, they don’t actively reduce distress.

Neuropsychological evaluation: If you continue to find yourself struggling to focus your attention, you may consider a neuropsychological assessment to disentangle potential neurodevelopmental conditions–such as ADHD–and emotional factors that could impact your attention and productivity (Mueller, Hong, Shepard, & Moore, 2017). CFIR provides both neuropsychological and psychological assessments, either in-person or virtually, as well as follow-up psychotherapeutic support.

References

Pacheco-Unguetti, A. P., Acosta, A., Callejas, A., & Lupiáñez, J. (2010). Attention and Anxiety: Different Attentional Functioning Under State and Trait Anxiety. Psychological Science, 21(2), 298-304. 

Mueller, A., Hong, D.A., Shepard, S., & Moore, T. (2017). Linking ADHD to the Neural Circuitry of Attention. Trends in Cognitive Sciences, 21(6), 474-488.

Dr. Peter Egeto, R.P., C.Psych is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships. He provides psychological treatment, as well as psychological and neuropsychological assessments for adult clients with a range of issues, including mood, anxiety, trauma, interpersonal relationships, personality, attention deficit/hyperactivity disorder, autism spectrum disorder, acquired brain injury, and neurological conditions. In treatment, he practices primarily with an integrative therapeutic approach and draws on multiple strategies, including cognitive-behavioural, emotion-focused, interpersonal, and psychodynamic therapies.

Has anyone ever told you to “just take a walk outside to clear your head” or “go out and get some fresh air; it will make you feel better!”?  Recommendations to “get outside” when we are feeling overwhelmed or stressed are quite common, and oftentimes when we accept this advice, it works! Have you ever wondered why this might be the case? 

The diverse sights and sounds afforded by natural environments such as natural or urban forests draw our attention away the everyday commotion of our lives, allowing us to relax our bodies and effortlessly turn our curiosity and attention to the beauty of the world surrounding us. 

Research has been conducted that supports the psychological and emotional benefits of nature experience. Going for a walk in a natural or urban forest or simply sitting and breathing in the fresh air is a simple and effective way to reduce physical expressions of stress and anxiety, reduce rumination and improve mood as well as increase capacities for attention and cognitive functioning. 

Finding ways, even if only for a few minutes, to integrate nature experience into your daily life may provide additional support to your healing journey and overall well-being.  

Jimenez MP, DeVille NV, Elliott EG, Schiff JE, Wilt GE, Hart JE, James P. Associations between Nature Exposure and Health: A Review of the Evidence. Int J Environ Res Public Health. 2021 Apr 30;18(9):4790. doi: 10.3390/ijerph18094790. PMID: 33946197; PMCID: PMC8125471.

Dr. Jennifer Bradley, PhD, C.Psych is a psychologist at CFIR. She works with individuals experiencing a wide range of psychological and relational difficulties including life transitions, anxiety and stress, trauma, depression, mood and grief, interpersonal difficulties, and issues related to self-esteem. Dr. Bradley is an integrative therapist with a particular interest in existential and relational approaches to psychotherapy. In her academic and research work, Dr. Bradley studies how spending time outdoors and our relationship with the natural worlds supports psychological health and well-being.

In the part 1 of this blog, we discussed intolerance of uncertainty, and how it presents and works within anxiety. Now let’s discuss how to manage and change this intolerance of uncertainty. 

Chances are that if you identify with being intolerant of uncertainty, that over time you have developed habits in your life that either help you avoid uncertain situations, or strive to achieve as much certainty as possible. But these methods are not effective, since uncertainty is an unavoidable part of life. Awareness and acknowledgement of the problem is not enough to change our relationship with uncertainty; Action is required to truly change those deep-rooted beliefs and thoughts about uncertainty mentioned in part 1. This action is reflected through the Cognitive-Behavioural Therapy technique of Behavioural Experiments, and/or exposures (Hebert & Dugas, 2019).

For example, take the common parenting/coaching technique used on young children who were afraid of getting hit by the ball in baseball, where the parent intentionally throws the ball at the child. Once the child has faced their fear of getting hit with the ball, they have objective evidence that helps them learn: 1) whether the feared outcome was as bad as they anticipated, and 2) whether they could cope with the feared outcome. This is how action helps us gather evidence to re-evaluate our beliefs and assumptions, and form new, more adaptive ones.

If I were tolerant of uncertainty, how would I act?

This question forms the basis of behavioural experiments and exposures directly targeting intolerance of uncertainty. But behavioural experiments are developed in a more intentional and systematic way than unpredictably being hit by a baseball and finding out that it wasn’t that bad afterwards. Behavioural experiments take exposure exercises one step further by not only requiring you to face situations that involve uncertainty (i.e., eating at a new restaurant), but facing uncertain situations in order to test specific beliefs about uncertainty (i.e., “Uncertainty will lead to disappointment and regret.”) (Hebert & Dugas, 2019).

Working with a CBT therapist will help you practice behavioural experiments that are effective and therapeutic, via empirically supported treatment. They will help you identify unhelpful or negative beliefs about uncertainty that drive your intolerance and symptoms of anxiety, develop a list of uncertain situations you either avoid altogether or seek out certainty around, and successfully conduct behavioural experiments or exposures that directly target and challenge your specific beliefs about uncertainty. 

Reference:

 Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436.

Erin Tatarnic, R.P. is a registered psychotherapist at the Centre for Interpersonal Relationships (CFIR). She provides psychotherapy to individual adults experiencing a range of mental health difficulties including anxiety and anxiety-related disorders, obsessive-compulsive concerns, depression, relationship difficulties, and coping with neurodiversity differences. Erin works from a client-centred approach using a cognitive-behavioural framework (CBT), while also integrating therapeutic techniques from emotion-focused therapy (EFT) and mindfulness-based cognitive therapy.

Yes, you read that right. Not gluten-, not dairy-, but an Intolerance of Uncertainty, which is a key driver within anxiety (Koerner & Dugas, 2006). When one has a medical allergy, they experience very strong physical reactions when exposed to even a small trace of the substance they’re allergic to. Intolerance of uncertainty is like a psychological allergy, where even a miniscule amount of uncertainty in a situation, creates negative and uncomfortable effects, such as excessive worrying and physical symptoms of anxiety. No matter how unlikely an outcome is, such as being in a plane crash, unless one can achieve 100% certainty of the outcome, it will be worried about. This intolerance of uncertainty can go as far as those with anxiety even preferring a negative outcome to their problem, over an uncertain one (Hello, self-sabotage!). 

So what are some telltale signs that you have an intolerance of uncertainty?

No, not hives, anaphylactic shock, or swelling. Some of the most common ways those with anxiety may act in the face of uncertainty include:

• Avoiding doing uncertain things altogether
  • Avoiding investing in therapy because it’s uncertain what the outcome will be or how the experience will feel
• Making up obstacles or excuses to not do things
  •  “I know exercise would be good for me, but what if I end up injuring myself?”
• Procrastinating
  • Avoiding asking a friend for a favour because you’re uncertain of how they’ll respond
• Having difficulty delegating tasks or trusting others
  • Doing all the chores yourself because you can’t be certain that your partner will do it “right”
• Seeking excessive information before making decisions or acting
  • Researching several different options of blenders from several different stores before buying one 
• Seeking reassurance from others
  • Asking multiple people in your life for advice or reassurance about the same problem, or asking them to decide for you

Intolerance of uncertainty is due to unhelpful beliefs held about uncertainty: That it is dangerous, that we cannot cope with it, and that it must be avoided at all costs (Koerner & Dugas, 2006). However, operating under those beliefs only strengthens the adverse reaction to uncertainty, shrinks your comfort zone, and exhausts you from constantly trying to achieve certainty in a world where it’s impossible to not come across uncertainty in some way or another. Read on for part 2 of how to face uncertainty if you identify as uncertainty-intolerant.

Reference:

 Koerner, N., & Dugas, M. J. (2006). A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty. Worry and its psychological disorders: Theory, assessment and treatment, 201-216.Erin Tatarnic, R.P. is a registered psychotherapist at the Centre for Interpersonal Relationships (CFIR). She provides psychotherapy to individual adults experiencing a range of mental health difficulties including anxiety and anxiety-related disorders, obsessive-compulsive concerns, depression, relationship difficulties, and coping with neurodiversity differences. Erin works from a client-centred approach using a cognitive-behavioural framework (CBT), while also integrating therapeutic techniques from emotion-focused therapy (EFT) and mindfulness-based cognitive therapy.

It may come as no surprise to any parent to hear that anxiety is the number one mental health difficulty children and adolescents face today. There are a myriad of different factors that contribute to the stress that children and adolescents experience, such as school, social, and familial expectations. Youth can be excellent at hiding their anxious symptoms not only from their parents but even from themselves! Some symptoms are easier to see while others take a keener eye to spot and may take more effort to uncover. 

Look for Physical Signs…

• Tenseness
• Jitteriness
• Restlessness
• Fidgeting
• Sweating
• Complaining of aches and pains (e.g., stomach, chest, or head aches)
• Trouble breathing

It’s important to remember that any of these physical signs of anxiety can occur during everyday events. Any one of these occurring on their own, or with others, can be felt by every person at one point or another for both positive and negative experiences. When these physical signs occur frequently and are consistently displayed before or during a specific situation, there is likely something anxiety provoking about that situation. 

… And Subtle Signs

Less easy to notice are actions, behaviours, and thoughts that can fly under the radar. Notice what it is your child is doing and when they are doing it. Are they often late to leave for school? Do they procrastinate on difficult subjects but not on easier ones? Do they check things repeatedly, like locked doors, before doing something else? It’s just as important to notice what your child is not doing. Are they not studying, doing homework, going out with friends, or attending extra-curricular activities? Refusal to do something can be a subtle way to avoid situations that provoke anxiety. If you suspect your child is experiencing anxiety, talk to them about it to better understand what they are thinking. Listening to what they say and understanding their perspective can help uncover what they are worried about. Anxiety can grow when left unchecked and your child needs your support to cope with it. 

Massimo Di Domenico, M.A., is a therapist working under the supervision of Dr. Nalini Iype, C.Psych. and is also working towards the completion of his PhD in Clinical Developmental Psychology. He provides both treatment and assessment services to individuals of all ages – children, adolescents, and adults. Working with an integrative framework, he treats those suffering from depression and anxiety, difficulties in social relationships, and concerns related to parenting and family dynamics. For those seeking answers on how they, or their child, learn or work best, he also provides assessment services for learning disorders and ADHD.

Major life transitions can occur at any stage in life. Whether it is starting university or college and living on your own for the first time, starting a new job, becoming a parent, or experiencing a death or loss of a loved one, life transitions can evoke many complex feelings. When we experience a big life-altering change, we are often faced with many unknowns and a sense of unpredictability regarding our future. Confronting the unknown and uncertain can evoke feelings of stress, worry, fear, self-doubt, grief, and depressive experiences. While these feelings are normal when faced with a major life change, they can still feel intense and overwhelming. To support yourself or loved ones during a time of major life transition, it is important to remember to: 

1. Acknowledge and validate your feelings—Sometimes our emotions can feel so overwhelming and intense because we don’t yet know why or what we are experiencing. Acknowledging that a life transition is likely to evoke strong emotions and finding new and healthy ways to identify and validate your feelings can help you navigate change. 

2. Accept the inevitability of change— We are constantly changing, growing, and evolving in our lives and relationships. Change can be difficult and overwhelming, but it can also provide an opportunity for self-growth and development. Through experiencing change, we can discover new possibilities and parts of ourselves, which can be exciting and motivating!

3. Reach Out and Connect—Sometimes experiencing a major change in your life can feel lonely and isolating. Connecting with loved ones, members of your community, or others who may be experiencing a similar life change can help you to navigate this difficult time. Engaging in psychotherapy can be another way to address any difficulties that you are facing because of a major life change. In the process of psychotherapy, you can learn new ways to navigate difficult emotions, and develop a deeper understanding and meaning about what this major life change means to you. 

If you are experiencing a major life transition, and wanting to better understand and navigate your experience, CFIR has counsellors, psychotherapists and psychologists who are available to support you!

Jennifer Bradley, M. A. is a Registered Psychotherapist (Qualifying) at CFIR. She works with individuals experiencing a wide range of psychological and relational difficulties including life transitions, anxiety and stress, trauma, depression, mood and grief, interpersonal difficulties, and issues related to self-esteem. Jennifer is an integrative therapist with a particular interest in existential, relational, and psychodynamic approaches to psychotherapy. 

By Cherisse Doobay MSc.

One of the first things I ask people about when they start working with me is their nutrition – why would a therapist do that? There is a strong connection between the food we eat and our mood. The relationship between diet and mood is complex, and the specific effects of different food on mood can vary from person to person. However, research has shown that certain dietary patterns and nutrients can have a significant impact on our mental health, most notably depression and anxiety symptoms. 

One important factor is the balance of nutrients in our diet. A diet that is high in fruits, vegetables, whole grains, and lean proteins, and low in processed and sugary foods, is generally considered to be healthy and can have a positive effect on mood. These types of foods provide the body with the necessary nutrients it needs to function properly, including essential vitamins, minerals, and antioxidants. On the other hand, a diet high in processed and sugary foods can lead to fluctuations in blood sugar levels and contribute to feelings of irritability, fatigue, and low mood. 

Another factor that can affect mood is the presence of certain nutrients in the diet. For example, omega-3 fatty acids, which are found in fatty fish and certain plant-based sources, have been shown to have a positive effect on mood and cognitive function. Similarly, vitamin B12, which is found in animal products, has been linked to improved mood and cognitive function.

In addition to the types and balance of nutrients in our diet, the overall quality of our diet can also have an impact on our mood. Research has shown that following a healthy, balanced diet can lead to improved mood and cognitive function, while a diet high in unhealthy foods can have the opposite effect.

It is important to remember that the relationship between nutrition and mood is complex, and the specific effects of different foods on mood can vary from person to person. However, following a healthy, balanced diet and getting adequate nutrients can have a positive impact on mood and overall well-being. So, the next time you’re feeling down, grab a broccoli crown! 

Cherisse is an integrative therapist and cognitive nutrition practitioner with a specialty in addictions for 17 years. She works with individuals, couples, and families to address a multitude of issues such as relationships, stress, depression, anxiety, trauma, depression, anxiety, and addictions. 

1. Harvard Medical School (February 15, 2021) “Food and Mood: Is there a connection?” https://www.health.harvard.edu/mind-and-mood/food-and-mood-is-there-a-connection

2. Firth, J, Gangswisch, J., Borsini, A., Wooton, R, Mayer.E. (November 9, 2020) “Food and mood: how do diet and nutrition affect mental wellbeing?” https://www.bmj.com/content/369/bmj.m2382

By: Dr. Peter Egeto, C.Psych (Supervised Practice)

Everyone has this thought run through their head when they’re having trouble focusing on a work task, school assignment, or other commitment. It is a very frustrating obstacle, so why can’t we just focus?

Attention is the first, and crucial step to apply our thinking power to a task. Without it, we’re unable to learn, problem solve, or think clearly. There are lots of reasons why our attention can be challenged. 

Anxiety often takes attention away from the task at hand. Evolutionarily, anxiety developed partly to help us survive by looking for threats in the environment. Although your project deadline may not be a life or death “threat,” the emotion still kicks in and draws your attention away from the work you’re trying to do.

Alternately, some people’s brains develop differently, and have trouble controlling their attention. This is referred to as attention deficit/hyperactivity disorder (ADHD). People with ADHD have great difficulty focusing because they are easily distracted by other thoughts or things in their surroundings. It can feel like your head is a vortex of racing thoughts, which can make a simple task frustrating or daunting.

How can I focus better? 

Luckily, there are ways to optimize your attention. Completing a neuropsychological assessment is a good way to tease apart whether your attention is hindered by anxiety, or potentially ADHD. It can also offer solutions tailored to your unique issues. Anxiety management strategies can free up your attention, while ADHD can be managed with medication, therapy, or both.