Nighttime Rumination in Grief

Coping with Grief / Coping with Grief : Eleanor Haley

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Some nights feel like an abyss.  It starts small, with a thought, memory, or worry that cracks the ground beneath me, and before I know it my foundation has crumbled away and I am tumbling into darkness.

These thoughts appear in the evening, while I'm brushing my teeth or putting on pajamas. And in the quiet of night, when working hours are over and my family is asleep, there is little to stand in the way of the snowballing inertia of my mind's most distressing thoughts.

I think it’s safe to say that my nighttime brooding is a form of rumination. Rumination definitions vary but generally speaking it is when a person continuously goes over a thought, issue, memory, or problem without making progress, reaching conclusions, or finding peace of mind.

There have been many studies on what psychologists call ‘depressive rumination’ as well as ‘grief rumination’ which may be defined as,

“repetitive and recurrent thinking about causes and consequences of the loss and loss-related emotions.” (Eisma & Stroebe, 2017).

When compared to non-ruminators, both types of rumination are associated with poorer outcomes following the death of a loved one and experiences like depression, PTSD, poor problem solving, negative thoughts, and self-blame.

Rumination is something everyone does, but for some, it is an itch that they can't help but scratch raw. But why? Is it in hopes of stumbling on some tidbit that might make their worries seem more bearable? Is it a form of problem-solving?

The answer to these questions depends on which theorist you ask. Some theorists view rumination as ineffective attempts to confront or problem-solve one’s worries, experiences, and anxieties. Other theorists view rumination as an effort to avoid accepting reality.

For example, if a person continuously ruminates over what could have been different in the past (you know those old familiar "if-onlys"), they may never get around to accepting the reality of the present. Eisma & Stroebe (2017) explain how this avoidance could potentially have a negative impact on coping with grief,

“This may have negative consequences because such avoidance could interfere with acceptance of the loss and/or could impede integration of one’s personal memories about the loss with existing memories, thereby fueling grief complications”

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Coping with Nighttime Rumination

I'm writing this article from the perspective of someone who is searching for a solution, just like many of you. As someone with a background in counseling and grief, my first question was whether a person should try and put their thoughts at bay, or attempt to confront the underlying issues in a more effective way.

Interestingly, I think the answer may be both, especially if your ultimate goal is getting a good night's sleep. Below are a few suggestions that I've put together after doing a little reading. You may also wish to read our article Grief and Getting a Good Night's Sleep for a more in-depth discussion on good sleep hygiene.

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Examine your stress-level and how you are coping with grief and stress during the day:

Stress is bound to increase the number of problems and worries that keep you awake at night. If you can reduce your stress during the day, theoretically you should feel calmer and more in control at night. To the extent that you can, get rid of unnecessary stressors and then take a look at how you are coping with the stress that remains. Do you set aside time to engage in self-care activities that will boost positive thoughts and emotions? Do you take the time to constructively cope with your own grief? Does it seem like you problem-solving effectively?

Keep in mind, it's important to address both stressors related to day-to-day logistics as well as emotions related to your grief. If you are grappling with rumination, guilt, anxiety, fear, intrusive thoughts, etc that are causing you significant personal distress or impacting your day-to-day functioning, you may want to consider seeing a counselor.

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Unwind before bed:

Most sleep experts recommend establishing some type of calming bedtime routine that lasts at least 30 minutes. I know it's hard, but you should turn off all screens. Not only are devices portholes to further stressors (think annoying social media posts, depressing late-night television, and stressful work emails), but the light from these devices can trick your brain into thinking it's daytime and prevent the secretion of your body's natural sleep chemical, melatonin. Instead, opt for calming (and boring) activities like taking a shower or bath, meditation, reading, listening to music, etc.

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Say "Not tonight!" to distressing thoughts: 

When you notice yourself starting to ruminate, it may be helpful to stop the cycle in its tracks by distracting yourself. Focus on something boring or mundane like making a meaningless list (ex. boys names that begin with each letter of the alphabet). Sometimes I find it helpful to daydream (at night) and make up fictional stories. Or try distracting yourself from thinking about the past and/or the future is by focusing on the present. For example, try naming 5 things you hear around you and 5 things you feel, then 4 of each, 3...2...1...you get the idea. And if all else fails, go ahead and count those sheep.

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Learn relaxation techniques:

We're always quick to recommend easy tools like breathing exercises (focusing on your breathing), progressive muscle relaxation (progressively tensing and relaxing each muscle group from your head down to your toes), meditation, guided imagery, and mantras (repeating a simple word or phrase to focus and calm your mind). I know these may seem new agey to some of you, but they are actually really simple and accessible coping tools.  This is a big topic that begs its own article, but in the meantime check out the following:

UCLA Health has 8 free guided meditations ranging in length from 3 minutes to 19 minutes

Headspace: Headspace is a meditation app that you can also access from your computer. It has paid options, but you can sign up for their free version which walks you through a 10-day introduction. I like the introductory meditations because the incorporate short, engaging videos that explain different meditation techniques.

YouTube: YouTube has a ton of mindfulness and meditation videos. For example, the searches "meditation for sleep" and "progressive muscle relaxation" bring up many different results.

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Practice accepting your thoughts:

Sometimes the harder you try to stop thinking about something, the more you wind up thinking about it. In these instances, instead of trying to avoid the thought, you may want to work on changing your relationship with the thought and how you respond to it. Now I'll admit this does take some work, often through things already mentioned like therapy and meditation, but it's a worthwhile effort.

Something you could try include:

• Remind yourself that these thoughts are a normal part of your grief and/or anxiety and that they can't hurt you.
• Remember that sometimes thoughts, especially those related to grief, depression, and anxiety, are untrue and irrational and search for evidence that refutes your worst-case scenarios.
• Try to think of one positive or optimistic thought for every negative
• Get up and go write about whatever is on your mind in a dimly lit room. Not only do sleep experts recommend you get up and do something like reading and writing when you can't sleep, but people often find that writing helps them to get a handle on their worries.

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December 12, 2017