Catastrophizing: Monitoring Your Thoughts and Feelings

Have you ever woken up in the morning feeling higher-than-normal pain and thought, “Oh no! It’s going to be a bad pain day!” Your attention is completely on your physical pain because you can’t possibly get past the experience. Then, your mind goes on a journey of its own. Are the following thoughts familiar? “I can’t stand this pain.” “My life is completely ruined!”

If you have had this experience, you are not alone. Fifty million Americans currently live with chronic pain. Those who are able to maintain an active, healthy lifestyle often use a combination of medication, support groups, and coping strategies. Research has shown that a patient’s beliefs and coping skills can positively or negatively affect his or her experience of pain. An important consideration in the successful treatment of pain conditions is the patient learning to not catastrophize. Catastrophizing means to focus on pain as well as magnify and doubt your ability to cope with it. More broadly, it is an exaggerated negative outlook toward pain causes and pain experiences.

For those who live with chronic pain, the goal of completely getting rid of the pain is not possible. Instead, the task is to manage the pain to a level that allows for continued activities of daily living. Many people with chronic pain have to unlearn a lesson learned early in life – that pain is the result of ongoing tissue damage. When pain is chronic, the presence of pain does not necessarily signify ongoing damage. Understanding that you are not generally worsening your condition when you pursue normal activities, even when you are in pain, can go a long way to helping you be more active.

People with pain sometimes experience a downward spiral of negative thoughts, especially when pain seems to be at its worst. These exaggerated negative thoughts lead to catastrophic conclusions ~ like your life is completely ruined ~ and the process is called catastrophizing. These thoughts can lead to feelings of defeat and discouragement. People with pain who catastrophize report higher pain, poorer physical functioning, and more depression and distress. What can you can do about catastrophizing?

Recognize catastrophizing as a problem that you can solve

The first step to solving a problem is recognizing that it’s there. John is a carpenter who incurred a back injury at work. He says, “I really didn’t realize what I was saying to myself and how much difference it made in my outlook. I had no idea that the conversations in my head were so negative.”

Find out what you are saying to yourself

Become an observer of your behavior. Make a thought diary when you experience increased pain or a negative mood. Note what you are doing and the time these thoughts occurred. At the end of the week, look for similarities in time, situation and activities during times of increased pain.

Analyze your thought diary

When Julie, a stay-at-home mother of three, slipped on ice and injured her back, she could not stand very long to cook, an activity she loved to do. Her thought diary included:

“I will never be able to cook again.” “I’m a terrible wife and mother.” “My husband will probably leave me.” Julie noticed her catastrophizing thoughts were most likely to occur on evenings when she had not been able to prepare small parts of the meals earlier in the day. She knew that her family ties were strong and that her husband had never complained about interruptions in meals. She realized that her thoughts were not realistic or true.

Try changing your thoughts

Once you know what you are thinking, change your thoughts to more realistic, helpful ones. Substitute these thoughts: “I’m having a hard time coping with pain right now.” “I am not able to do some things I did before, but I can still do other things.” ” I am still the same person, but with added challenges.”

Your feelings are likely to change when you alter what you are telling yourself. Reward yourself when you are successful. If you find yourself catastrophizing on a regular basis, talk with your doctor about finding assistance. Remember that pain generally cycles, so what seems hardest to handle on a difficult day may not be so difficult tomorrow or next week. When you interrupt a catastrophizing cycle, you will be changing your emotional experience for the better.

What research has shown

In studies involving married couples with one partner who suffers from chronic pain, researchers found that catastrophizing pain led to a negative experience for both partners. During times of short-term pain, the spouse who did not have chronic pain usually reinforced catastrophizing by providing emotional support. The spouse felt the chronic pain sufferer was making reasonable requests. However, efforts to help were often unsuccessful. This then led to spouses withdrawing or reacting negatively. Subsequently, spouses were less able to help during longer periods of pain. While catastrophizing pain initially appeared to help the partner with chronic pain, it was actually more harmful and debilitating for the individual and couple.

Research studies that compare patients with pain who tend to catastrophize with those who do not have revealed that catastrophizing produces worse results. Patients who cope by using greater catastrophizing reported the following: depression, impaired mental health, weakened social functioning, reduced vitality, and overall increased pain. This is contrasted with patients who sought a social support network and reported fewer depressive symptoms. The practice of catastrophizing has also been shown to be a risk factor for more post-surgical pain.

Poor coping strategies, such as catastrophizing pain, lead to higher levels of disability and a reduced quality of life. If you live with chronic pain and feel defeated, you should seek support networks to prevent the further development of a negative attitude. For those who have unproductive coping skills, there exist alternative ways of learning to accept and manage pain. For some people, cognitive-behavioral therapy, meditation and relaxation training is the treatment of choice for catastrophizing and changing one’s cognitive coping style. These treatment approaches are designed to alter a patient’s reactions and behavior in response to pain. Discussing your pain and any available options with your doctor is the first step to not letting pain stop you from living your life.