Short case example
After an argument, a patient spends hours replaying what they “should have said,” becomes more ashamed, and withdraws.
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Formulation mechanism
Repetitive, passive, negatively toned thinking about distress, causes, meanings, or consequences.
What matters now
Fit, function, and alternatives
Use sequence, function, patient language, and disconfirming evidence to decide whether this hypothesis adds explanatory value.
Across the formulation
Short case example
After an argument, a patient spends hours replaying what they “should have said,” becomes more ashamed, and withdraws.
Formulation language
Rumination appears to keep the patient caught in repeated negative meaning-making, worsening mood and reducing behavioural movement.
Treatment implications
Shift from abstract replay to concrete next steps, attention shifting, or values-based action.