Eileen Davidson’s first experience with catastrophizing happened right around the time of her rheumatoid arthritis (RA) diagnosis seven years ago: “I didn’t really know what was going on, I was super depressed, plus I had an aunt who had gotten RA 40 years before me. She was in a wheelchair and had lots of comorbidities — she passed away the same week I was diagnosed,” recalls the 36-year-old patient advocate and author from Vancouver (see her blog at chroniceileen.com). “I was terrified my hands were going to stop working any moment and that I was going to be in a wheelchair. It was really easy to go straight to how RA would affect every aspect of my life.”
For people living with a painful chronic disease like RA, fibromyalgia, lupus, or psoriatic arthritis, the fear, dread, and anxiety around their symptoms is often warranted. “Anybody living with arthritis can feel at times like the pain is never going to go away, or my life sucks,” says Eileen. “And sometimes the worst-case scenario really can be the reality so it’s easy to feel negative.”
Adds Illinois- and Wisconsin-based psychotherapist Shannon Garcia, LCSW: “You are most likely to catastrophize during a flare because your mental fuse is shorter. You’re exhausted, uncomfortable, and potentially in pain. Your brain is going to view things more negatively than if you were having the best day ever.”
Why We Catastrophize?
Ironically, catastrophizing is the mind’s way of protecting you. When something negative happens, the brain tries to create a sense of control by preparing you for the worst, explains Garcia.
“I often use a smoke detector analogy when describing catastrophizing anxiety,” says Garcia. “Smoke detectors go off at full power when they detect any sort of smoke, whether an actual fire or cookies starting to burn in the oven. The catastrophizing alarm in your brain functions the same way, going off at full power even when it’s not an appropriate response.”
The Downside of Catastrophizing
Another downside of catastrophizing: It can lead to avoidance, preventing you from enjoying a life you value, says therapist Anna Zuidema, MA, LMHC, NCC, Clinical Director of Good Life Therapy in West Des Moines, IA. For example, she had a client, a college student, who refused to use an assistive device even though the long walks on campus were really hard for her. The reason? She imagined people would think poorly of her and she’d never make any friends. “But by the time she got to class, it was hard for her to be present, and her refusal to use the device was making it hard for her to do other things she loved, like travel,” says Zuidema.
Lene Anderson, 59, says she tries not to use the word “catastrophizing” at all. “I think it diminishes an oft-justified reaction to a serious and very painful illness, as well as having an undertone of negative judgment. It’s an ableist term that stigmatizes people who live with pain and chronic illness. It makes you feel as if you are not entitled to have a panicked reaction to, say, a bad RA flare or severe chronic pain. Yet that kind of panic (which I think is a better word than ‘catastrophizing’) is part and parcel of RA,” says the Toronto resident and author of the blog theseatedview.com.
Still, both Lene and Eileen believe that it’s helpful to curb the negative thinking. “There are parts to having RA that absolutely suck, but if I focus on that all day, I’m not going feel any better,” says Eileen. “Whenever I get into those moments when I have those catastrophizing thoughts, my fatigue increases. I sleep less, and I have an increase in all my symptoms.”
Tips to Take Control of Catastrophizing
Try these tips for interrupting catastrophic thinking before it gets the best of you.
Think about why you’re having negative thoughts
Eileen analyzes the “catastrophe.” “Say, I’m having more pain lately or higher fatigue or higher anxiety. I ask myself, ‘Why could this be? Am I nearing my infusion? Have I been doing too much lately? Am I nearing my period?’ ” Getting to the bottom of the thoughts can help you defuse it.
Play it out
Philadelphia-based clinical psychologist Ann Rosen Spector says that many people never fully play out the worst-case scenario. For example, if a person is worried a flare will keep them from dancing at their cousin’s wedding, “they just get to the point of ‘Oh, my God, this is what will happen and then…DOOM!’ ” But if you can’t dance at your cousin’s wedding, ask yourself what will really happen if that’s the case. You can still watch other people dance; you can still hug people. It’s not the 0 percent or 100 percent polarized way of looking at the world that often accompanies catastrophizing.”
Remember that thoughts are not facts
“Your brain is going to secrete thoughts — it’s doing its job,” says Zuidema. “And you may be filtering the thoughts based on your mood or other stressors. Just because you’re having those thoughts doesn’t make them reality.” Adds Rosen Spector, catastrophizing is the narrative you create; it’s not the actual event.
Use realistic thought challenging
“When people think of thought challenging, they often think it means to just think positively,” says Garcia. “This is typically not effective, especially for people living with chronic illnesses. Instead, try changing the thought to something that is realistic to the situation. For example: Instead of ‘I will always be miserable,’ try ‘I’m in the middle of a flare right now. I wish I wasn’t, and I know it will end in time.’”
Try the “chances are” method
“I use the phrase ‘chances are’ and then fill in the blank,” says 27-year-old San Diego resident Carly Lemmon, who is living with lupus and fibromyalgia. “It makes me really look at the situation for what it is. An example would be Oh, my gosh, I’m 30 minutes late for work. Everyone probably noticed and is judging me and doesn’t think I’m good at my job, and everyone is annoyed at me… and then say to myself Stop. You are spiraling…chances are, everyone is focused on their own stuff. Chances are, even if they noticed, they won’t care that much.”
Talk to the catastrophizing part of your brain
Say to your brain, “Thank you, but no thank you,” says Garcia. “This acknowledges that your brain was trying to be helpful, but that type of thinking is not needed right now.”
Give yourself space
“I try to be gentle with myself and remember that there are times when having RA is very difficult, that long, painful, and life-changing flares have happened several times in my past, so it’s understandable that I’m anxious and afraid,” says Andersen. “Sometimes, I need to talk to friends who have been with me during much of my life to remember that RA ebbs and flows and that I have come through difficult times before.”
Preempt catastrophizing with wiggle room
Sometimes stress can send Eileen down a rabbit hole, so she breaks overwhelming chores into achievable tasks — and builds in extra time. “If today I want to tackle five tasks, but by 11 am I might be having a bad day, I’ll move some tasks to the next day,” she says. “The key is to space out to-dos and put in moments of rest.”
Practice “acceptance-commitment” therapy
While you might not be able to turn off the catastrophizing switch for good (that means accepting that thoughts like “This pain is never going go away!” will pop up from time to time), you can take control of what you do with those thoughts, explains Zuidema. So, for example, you can visualize placing catastrophizing thoughts on a canoe and sending them down a river.
“I try to become very present when I notice myself spiraling,” says Carly. “This could be going outside and feeling the ground with my bare feet, taking a deep inhale through my nose and exhaling through my mouth. This helps stop the spiral, stop the futuristic thinking, and make me present again.”
Garcia, who lives with interstitial cystitis and admits to falling prey to catastrophic thinking herself, says, “Catastrophic thinking is all about the future, so bringing yourself back to the present is the goal. I will pet my dog and focus on how it feels, take some deep breaths, or do simple stretches and focus on the sensation it brings.”
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Interview with Illinois- and Wisconsin-based psychotherapist Shannon Garcia, LCSW.
Interview with therapist Anna Zuidema, MA. LMHC, NCC, Clinical director of Good Life Therapy in West Des Moines, IA
Petrini L, et al. Understanding Pain Catastrophizing: Putting Pieces Together. Frontiers. December 2020. doi: https://doi.org/10.3389/fpsyg.2020.603420.