What Is Catastrophizing, and How Do You Stop?

Biggs September 08, 2023
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Catastrophizing is when someone focuses on the worst that can happen. Most of the time, it involves magnifying small problems and thinking you’re in a worse situation than you actually are, or that the consequences of a situation will be the worst possible outcome. The exact cause of catastrophic thinking is unknown, but some researchers theorize that it may stem from trauma or other underlying health conditions.1

It may be easy to dismiss catastrophizing as over-exaggeration, but most of the time, it’s not intentional, and people who do it often don’t realize they’re doing it. They may just feel an excessive amount of worry that they have no control over. Catastrophizing can be a symptom of anxiety, depression, insomnia, and chronic pain. But thankfully, it is treatable through therapy, mindfulness, medications, and self-care.2

Catastrophizing

Causes of Catastrophic Thinking

Researchers aren’t exactly sure what causes catastrophizing. For some people, it’s a coping mechanism they learned from their family, a result of a traumatic experience, or it could be related to their unique brain chemistry.1

Researchers involving people who catastrophize and also have chronic pain suggested that they may have some alterations in their hypothalamus and pituitary responses, as well as increased activity in the parts of the brain that register emotions associated with pain.3

Catastrophic thinking also involves problems with other systems in the brain. This includes:4

  • The hypothalamus and pituitary gland: These regions regulate your “fight or flight” response. This could lead to fear or anxiety over everyday events.
  • Amygdala and hippocampus: These parts of the brain are involved in memory recall and emotion. This may contribute to negative thinking over past events.
  • Prefrontal cortex: The part of the brain responsible for complex thinking and personality. It may be the source of cognitive errors involved with this type of thinking.

Signs of Catastrophizing

Common signs of catastrophizing include:15

One small thought could lead to a spiral of overthinking and anxious thoughts. Common examples of catastrophic thinking include:6

  • “The pain feels awful and overwhelming.”
  • “I’m so stupid/ugly/awful.”
  • “I’m going to fail my test and get kicked out of school.”
  • “I can’t stop thinking about how awkward I sounded the other night.”
  • “I deserve all the awful things that happen to me.”

Conditions Associated With Catastrophizing

There are many conditions associated with catastrophizing. Some conditions affect mental health but others are linked to chronic pain.

Anxiety

Anxiety is an umbrella term for many common mental health conditions. Anxiety involves a feeling of dread, worry, or fear over everyday circumstances.7

People with painful conditions, with high levels of anxiety over their pain are prone to pain catastrophizing.85 There isn’t a lot of research linking catastrophizing to anxiety in the absence of pain. However, one 2015 study of teenagers found that higher levels of catastrophizing were linked to anxiety disorders.7

Depression

Depression is the most common mental health condition worldwide.9 It co-occurs with other conditions involving catastrophizing, including chronic pain conditions and anxiety.10,11

Catastrophizing is a recurrent symptom reported across dozens of depression studies. Women were more likely to self-report these symptoms than men. However, those in non-Western countries were less likely to report catastrophizing as a symptom.9

Insomnia

Catastrophizing is also linked with difficulty sleeping. In this case, the catastrophizing thoughts are about insomnia. High levels of catastrophizing could make it more difficult for people to fall asleep, and stay asleep. In some cases, they are also linked to anxiety.12

Pain

Conditions involving chronic or physical pain are associated with pain catastrophizing. It can cause people to feel helpless, dwell on the idea of their pain, and magnify the physical experience.5,3 However, the idea behind catastrophizing pain has drawn criticism from patient groups.13,14

There are also racial biases within pain research which lead to misconceptions over pain tolerance and biology. As a result of these biases, doctors may be more likely to consider Black patients are catastrophizing their pain.14,13

How to Stop Catastrophizing

Through a combination of therapy, mental health skills and other support, it may be possible to stop or reduce this pattern of negative thinking:

Talk Therapy

There are many types of therapy that may be helpful. However, most have only been tested in the context of pain catastrophizing. These include:15

  • Cognitive behavioral therapy (CBT): This helps reframe your negative thought patterns and behaviors. It may lead to small improvements in catastrophizing.
  • Acceptance and commitment therapy (ACT): This form of therapy helps a person feel more comfortable with discomfort and anxiety. This may help break the cycle of intrusive thoughts, however more research is needed.
  • Dialectical behavioral therapy (DBT): This form of therapy is modeled off of cognitive behavioral therapy. However, it puts more emphasis on self-acceptance and learning to regulate emotions. More research is needed to determine whether it is effective for catastrophizing.

When therapy on its own doesn’t work, a psychiatrist may prescribe medication. The anti-anxiety medication belongs to a class of drugs called selective-serotonin reuptake inhibitors. They affect chemical signaling in the brain, helping with issues of underlying anxiety or depression.16

Mindfulness

Practicing mindfulness may be effective for treating pain catastrophizing. Mindfulness helps people stay in the moment, and experience their thoughts in an open and nonjudgmental manner. This technique helps people accept catastrophizing thoughts without overthinking.17

Self-care Strategies

There are many self-care strategies to help you cope with catastrophizing thoughts. Some of these self-care tips are also taught by mental health professionals. These include:

  • Journaling: Writing down these thought-patterns while you experience allows you to revisit them later. It can help you recognize patterns in these thoughts.18
  • Accepting uncertainty: Working on spending time to sit with these thoughts, and accept their inherent uncertainty is helpful for some people.19
  • Challenging your thoughts: Some people use “what-if” scenarios to go through catastrophic thoughts and their consequences. It helps by challenging the fears and worries.19
  • Social support: Speaking with trusted friends or family members may provide extra mental health support.2

A Quick Review

Catastrophizing involves excessive worrying that the worst possible outcome will happen. It can be a symptom of anxiety, depression, insomnia, and chronic pain. Thankfully, there are many different treatments that can help people cope with this negative thinking pattern.

Sources:

  1. Flaskerud JH. Catastrophizing at 3 a.m. Issues in Mental Health Nursing. 2022:1-3. doi:10.1080/01612840.2022.2140538
  2. Brecht DM, Gatchel RJ. An overview of a biopsychosocial model of epigenetics and pain catastrophizing. Journal of Applied Biobehavioral Research. 2019;24(3). doi:10.1111/jabr.12171
  3. Petrini L, Arendt-Nielsen L. Understanding pain catastrophizing: Putting pieces together. Frontiers in Psychology. 2020;11. doi:10.3389/fpsyg.2020.603420
  4. Han C, Pae C-U. Pain and depression: A neurobiological perspective of their relationship. Psychiatry Investigation. 2015;12(1):1. doi:10.4306/pi.2015.12.1.1
  5. Cox AR. “It’s all in your head”: Managing catastrophizing before it becomes a catastrophe. Canadian Urological Association Journal. 2021;15(10). doi:10.5489/cuaj.7592
  6. Gellatly R, Beck AT. Catastrophic thinking: A transdiagnostic process across psychiatric disorders. Cognitive Therapy and Research. 2016;40(4):441-452. doi:10.1007/s10608-016-9763-3 
  7. Chan SM, Chan SK, Kwok WW. Ruminative and catastrophizing cognitive styles mediate the association between daily hassles and high anxiety in Hong Kong adolescents. Child Psychiatry & Human Development. 2014;46(1):57-66. doi:10.1007/s10578-014-0451-9
  8. Fisher E, Heathcote LC, Eccleston C, Simons LE, Palermo TM. Assessment of pain anxiety, pain catastrophizing, and fear of pain in children and adolescents with chronic pain: A systematic review and meta-analysis. Journal of Pediatric Psychology. 2017;43(3):314-325. doi:10.1093/jpepsy/jsx103
  9. Nieto I, Robles E, Vazquez C. Self-reported cognitive biases in depression: A meta-analysis. Clinical Psychology Review. 2020;82:101934. doi:10.1016/j.cpr.2020.101934
  10. Deschênes SS, Burns RJ, Schmitz N. Associations between depression, chronic physical health conditions, and disability in a community sample: A focus on the persistence of depression. Journal of Affective Disorders. 2015;179:6-13. doi:10.1016/j.jad.2015.03.020
  11. Steffen A, Nübel J, Jacobi F, Bätzing J, Holstiege J. Mental and somatic comorbidity of depression: A comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data. BMC Psychiatry. 2020;20(1). doi:10.1186/s12888-020-02546-8
  12. Jansson-Fröjmark M, Harvey AG, Flink IK. Psychometric Properties of the insomnia catastrophizing scale (ICS) in a large community sample. Cognitive Behaviour Therapy. 2019;49(2):120-136. doi:10.1080/16506073.2019.1588362
  13. Hobson JM, Moody MD, Sorge RE, Goodin BR. The neurobiology of social stress resulting from racism: Implications for pain disparities among racialized minorities. Neurobiology of Pain. 2022;12:100101. doi:10.1016/j.ynpai.2022.100101
  14. Booker SQ, Bartley EJ, Powell-Roach K, et al. The imperative for racial equality in pain science: A way forward. The Journal of Pain. 2021;22(12):1578-1585. doi:10.1016/j.jpain.2021.06.008
  15. Williams AC de C, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (Excluding headache) in adults. Cochrane Pain, Palliative and Supportive Care Group, ed. Cochrane Database of Systematic Reviews. 2020;2021(11). doi:10.1002/14651858.cd007407.pub4
  16. Chu A, Wadhwa R. Selective serotonin reuptake inhibitors. In: StatPearls. StatPearls Publishing; 2022.
  17. Tomlinson ER, Yousaf O, Vittersø AD, Jones L. Dispositional mindfulness and psychological health: A systematic review. Mindfulness. 2017;9(1):23-43. doi:10.1007/s12671-017-0762-6
  18. Sohal M, Singh P, Dhillon BS, Gill HS. Efficacy of journaling in the management of mental illness: A systematic review and meta-analysis. Family Medicine and Community Health. 2022;10(1). doi:10.1136/fmch-2021-001154
  19. Levine AZ, Warman DM. Appraisals of and recommendations for managing intrusive thoughts: An empirical investigation. Psychiatry Research. 2016;245:207-216. doi:10.1016/j.psychres.2016.08.040
Important Notice: This article was originally published at www.health.com by Simon Spichak where all credits are due. Medically reviewed by Michael MacIntyre, MD

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