What is Rumination-Focused Cognitive Behavioral Therapy (RF-CBT)?

What Is Rumination?

Rumination means getting stuck in repetitive negative thoughts about:

• Problems that feel unsolvable
• Past mistakes or upsetting events
• Negative beliefs about yourself

Everyone ruminates sometimes, but for some people, it becomes a serious problem. Instead of leading to solutions, it causes distress and makes people feel worse. Some common signs of rumination include:

• Replaying past mistakes over and over
• Focusing on worst-case scenarios
• Feeling “stuck” in negative thoughts
• Struggling to move on from a bad experience

One way people try to cope with rumination is distraction—like binge-watching TV to avoid their thoughts. While distractions can offer temporary relief, they don’t stop the cycle.

Why Do People Ruminate?

At first, rumination may seem useful. People often ruminate because they think it will help them understand a problem better or avoid making mistakes. It can feel similar to problem-solving. But unlike real problem-solving, rumination keeps looping without reaching a conclusion.

Researchers have found that rumination can start early in life, even before anxiety or depression develop. This means that helping someone break the rumination habit early may prevent mental health struggles later on.

Who Can Benefit from RF-CBT?

RF-CBT is especially helpful for people who struggle with:

• Anxiety disorders, especially generalized anxiety
• Depression
• Suicidal thoughts or self-harm
• Obsessive-Compulsive Disorder (OCD)
• Body Dysmorphic Disorder
• Chronic overthinking and worry

Since rumination often remains even after other treatments for anxiety or depression, targeting it directly with RF-CBT can prevent future mental health struggles or stop old symptoms from returning.

Who is RF-CBT not a good fit for?

RF-CBT may not be a good fit for people who:

• Are unwilling to work on their rumination – Some people find it too uncomfortable to examine their thoughts deeply.
• Are dealing with high life chaos – If someone is struggling with meeting basic needs, they may need other support first.
• Have dissociative disorders – Since RF-CBT involves deep reflection, individuals who dissociate may have difficulty engaging in the process.

How Does RF-CBT Work?

RF-CBT is a structured therapy that lasts about 12 to 14 sessions. It follows clear steps to help people break free from rumination by:

1. Understanding Rumination Habits

• In early sessions, therapists help clients recognize when, where, and why they ruminate.
• People keep a rumination log to track their overthinking patterns.

2. Functional Analysis: Breaking Down the Thought Cycle

• Instead of just talking about rumination, RF-CBT guides people through it in real time.
• Therapists ask clients to re-experience a ruminative moment in detail, moment by moment, to understand how it starts and what keeps it going.

3. Learning to Shift Thought Patterns

• People learn specific strategies to replace rumination with healthier thinking.
• Therapy focuses on active, concrete, and experiential exercises—meaning people practice new skills in-session, not just talk about them.

4. Practicing New Behaviors

As Dr. Crowell explains, “ the only way to change habits is through repetition and practice. So if you’re not doing stuff in between sessions, you’re not going to be getting the benefits of the therapy.”

• Since rumination is a habit, the only way to change it is through repetition and practice.
• Clients work on exercises between sessions to reinforce what they learn.

Why RF-CBT Is Different

Unlike traditional CBT, which focuses on changing thoughts directly, RF-CBT targets habitual thinking patterns. According to Dr. Sheila Crowell,   “although it [RF-CBT] is targeting thought, what it is really targeting is habitual thought. And habitual thought is tricky to target…so you really have to get into the experience in order to identify it.”

This approach is:

• More experiential – Instead of just analyzing thoughts, people experience and change them in real time.
• Focused on habits – RF-CBT treats rumination like a habit that needs to be replaced, not just a symptom.
• Highly structured – Each session has a clear goal, making progress easier to track.

Therapists also use a rule called E6, meaning every session includes:

• Exploring experience – Understanding how rumination happens in real life.
• Experimenting with experience – Practicing new ways to respond in the moment.
• Exercising and engaging – Trying out skills between sessions to build new habits.