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Method 8: Persistent Interruption of Rumination.

Ruminative worry has a life of its own, consistently interfering with every other thought in your client's mind. Thought-stopping/ thought-replacing is the most effective cognitive-therapy technique for interrupting chronic rumination, but I find the key to making it work is persistence . Clients very quickly pick up on the technique itself, but they're always shocked by how rumination can subvert all their good efforts, and by how persistently they have to keep at it to succeed. I've had clients come back and say the technique didn't work, because they'd tried it 20 to 30 times in a day and they still were ruminating. I tell them that they must do it every time they catch themselves ruminating, even if it is 1,000 times a day or more! That's what I mean by persistence.

Darla is a good example. She was a self-described worrywart before she got cancer, but after her diagnosis, her anxiety zoomed out of control. Although treatment was successful and she'd been in remission for some time, she still had constant, negative, racing thoughts about whether her cancer would recur. A really hard worker in therapy, she did every method I suggested, and was ready to use thought-stopping to interrupt her ruminations about cancer. "Remember," I told her, "winning this game is about persistence. Do the thought-stopping exercise every single time you find yourself worrying, no matter how many times you have to do it."

At the next session, she reported her success--she really had radically cut back the amount of worrying she was doing. But it worked only because I'd warned her about how persistent she'd have to be. "When you told me I'd have to thought-stop every time, even if it was 1,000 times a day," she said, "I thought you were kidding. If you hadn't warned me, I'd have given up in despair after about 100 times, thinking it would never work for me. Since you said 1,000, I figured I'd better stay the course. After a couple of days, it got markedly better." Rumination is persistent, and the only way to beat it at its own game, so to speak, is to be even more persistent.

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