Rumination in Response to Repugnant Obsessions

Rumination is a mental process characterized by the repetitive analysis of concerns without taking concrete or helpful action. It has been shown to be transdiagnostic, contributing to the maintenance and exacerbation of symptoms across various mental disorders, including obsessive–compulsive disorder (OCD). Historically conceptualized as part of the obsessional domain due to its repetitive and intrusive qualities, rumination is now better understood as a covert compulsion—one that reinforces the overimportance of otherwise normal, unwanted intrusions, particularly in the case of repugnant obsessions. Consequently, it is crucial for clinicians to frame rumination as a mental habit or behavior in which individuals with OCD attempt to understand the causes, meaning, and consequences of their thoughts. This unproductive and time-consuming process not only amplifies intrusive doubts but also worsens mood, placing individuals at high risk for comorbid depression. This article outlines how rumination fits within the cognitive-behavioral model of OCD and, more importantly, offers practical refinements to standard cognitive-behavioral therapy interventions, drawing from evidence-based strategies for OCD and related disorders as well as from behavioral activation. The aim is to better equip clinicians with tools to effectively target rumination in OCD, particularly in presentations involving repugnant obsessions.