Anxiety & Mood
Overthinking: what it is and what helps
Overthinking explained: worry and rumination, when repetitive thinking helps and when it harms, how it relates to anxiety, depression, OCD and ADHD, and what helps.
Overthinking is thinking that circles around the same subject without getting anywhere. It takes two forms: worrying about what will happen and “chewing over” what has already happened. It is not a diagnosis. But when it becomes a daily pattern, it is linked with anxiety, depression and insomnia. There are techniques, tested in studies, that can help you get out of the cycle.
Worry and rumination: the two forms
In research, overthinking is called “repetitive negative thinking”, and it takes two forms:
Worry: thoughts about the future, which often start with “what if…?”.
Rumination: going back again and again to what happened, or to “why do I feel like this?”.
In 513 patients with anxiety disorders or depression, worry and rumination were at similar levels across all diagnoses: depression, generalised anxiety, social anxiety, panic disorder. Those with more than one diagnosis also had more repetitive thinking. In plain words: overthinking is a common thread in many mental health difficulties.
When does thinking help, and when not?
Going over a thought is not always harmful. A review from the University of Exeter showed that it can help us recover from a difficult event and prepare for what is coming. Whether it helps or harms seems to depend on three things: whether the content is negative, the situation, and whether the thinking is abstract or concrete.
Abstract: “Why do I always get things wrong?”
Concrete: “What exactly went wrong in yesterday’s meeting, and what will I change next time?”
The second ends in a step you can take.
When thinking stays stuck on the injustices of the past, it does not help psychologically. What helps is looking ahead: what can I do from here on?
When does overthinking become a problem?
Depression. In a University of Michigan study, people who “ruminated” on their negative feelings were more likely to develop a depressive disorder, even a new episode. Rumination also predicted anxiety symptoms.
Generalised anxiety disorder. When someone worries repeatedly about many different things, the British NICE guideline asks doctors to consider this diagnosis.
Sleep and mood. Excessive worry is linked with anxiety, low mood and sleep problems.
Overthinking feeds on thoughts such as “if they are slow to reply, they don’t want me” or “is it my fault?”. What you feel is not proof of what is real. A useful question: “What evidence do I actually have for this, and what says the opposite?”
Overthinking, OCD or ADHD?
Obsessive-compulsive disorder (OCD). Obsessions are repeated thoughts, urges or images that intrude into the mind, are unwanted and bring anxiety. They are often followed by compulsions: repeated actions, such as checking or washing, that bring only temporary relief.
ADHD. In a King’s College London study, adults with ADHD had much more “mind wandering”: their thoughts kept drifting elsewhere. This made everyday life harder, independently of the core ADHD symptoms.
The distinction is not always easy and is made in the assessment. More in the article on intrusive thoughts.
What helps
From “why” to “what do I do”. One form of cognitive behavioural therapy targets rumination specifically. In a small randomised study with 42 people whose depression persisted despite medication, adding it improved symptoms and remission rates. The improvement came through a reduction in rumination. The study had no comparison group receiving another psychotherapy.
A fixed “worry time”. In a study with 53 people who worried a lot, those who set aside half an hour a day for two weeks to worry, at a fixed time and place, had less worry, anxiety and insomnia than the comparison group. When a worry comes outside that time, you note it down and leave it for later. The results are preliminary.
Cognitive behavioural therapy and mindfulness. A systematic review of 19 studies found that they may reduce both rumination and worry, whether delivered in person or online.
When there is generalised anxiety disorder. The NICE guideline suggests, depending on the person’s preference, cognitive behavioural therapy, applied relaxation or medication. As medication it suggests a selective serotonin reuptake inhibitor (SSRI) and considers sertraline first, because it is the most cost-effective option. It does not recommend benzodiazepines, except for short-term use in a crisis.
If the overthinking is about a relationship, one practice I suggest is simple: ask once, “is everything OK?”, and then give the other person space.
When to ask for help
Your thoughts keep you awake or wear you out on most days.
You find it hard to make decisions or to function at work, in your studies or in your relationships.
It comes with low mood, panic attacks or physical symptoms of anxiety.
The thoughts are unwanted, frighten you or push you into repeated actions.
Safety: If your thoughts turn to death or to harming yourself, ask for help immediately: 166 (ambulance, EKAV), 112, or the Suicide Prevention Line 1018, 24 hours a day.
How I can help
Book a psychiatric assessment, at the practice in Trikala or online. See also the page on anxiety and panic attacks. The first conversation can also take place from your home: see how working with an online psychiatrist works, or book an appointment.
This article is educational and does not replace individual clinical assessment. Do not change or stop any treatment you are already taking without talking to your doctor.
Sources
Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull. 2008. https://doi.org/10.1037/0033-2909.134.2.163
McEvoy PM, Watson H, Watkins ER, Nathan P. The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct. J Affect Disord. 2013. https://doi.org/10.1016/j.jad.2013.06.014
Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000. PMID: 11016119. https://pubmed.ncbi.nlm.nih.gov/11016119/
Mowlem FD, et al. Validation of the Mind Excessively Wandering Scale and the Relationship of Mind Wandering to Impairment in Adult ADHD. J Atten Disord. 2019. https://doi.org/10.1177/1087054716651927
Watkins ER, et al. Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial. Br J Psychiatry. 2011. https://doi.org/10.1192/bjp.bp.110.090282
McGowan SK, Behar E. A preliminary investigation of stimulus control training for worry: effects on anxiety and insomnia. Behav Modif. 2013. https://doi.org/10.1177/0145445512455661
Querstret D, Cropley M. Assessing treatments used to reduce rumination and/or worry: a systematic review. Clin Psychol Rev. 2013. https://doi.org/10.1016/j.cpr.2013.08.004
NICE. Generalised anxiety disorder and panic disorder in adults: management (CG113). Key priorities for implementation. Accessed 12 November 2026. https://www.nice.org.uk/guidance/cg113/chapter/Key-priorities-
National Institute of Mental Health. Obsessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over. Revised 2023. https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over
