What is Catastrophizing and Why Does it Influence my Pain?

Orthopaedic & Spine Center

 by Cal Robinson, PsyD, MSCP, ABMP

Have you ever known someone who finds the absolute worst in every situation and exaggerates its significance?  Or that fits the description “they make a mountain out of a molehill”?  We all have known someone like this or perhaps this can describe our own pattern of thinking.   Having this magnified and negative world-view about our own personal events is called catastrophizing.  Doing this routinely can be harmful to one’s psyche, overall health and can lead to increased and chronic pain.

Most of us will exaggerate and dramatize the events in our lives from time to time.  Without some drama, our lives would be pretty boring.  There would be no soap operas, Jerry Springer Show or National Enquirer magazine to add spice to our everyday existence.  But overly-dramatic reactions to normal occurrences are not desirable for long-term emotional health.  So, what exactly qualifies as a catastrophe?  When does catastrophic thinking become dangerous?

The Merriam Webster Dictionary defines a catastrophe as the following:

  1. the final event of the dramatic action, especially of a tragedy
  2.  a momentous, tragic event ranging from extreme misfortune to utter overthrow or ruin
  3.  a :  a violent and sudden change in a feature of the earth b :  a violent usually destructive, natural event (as a supernova)
  4. utter failure

Looking at these definitions, most of us would understand that very few of our life events would qualify as a catastrophe.  However, in my practice as a Medical Psychologist, I often treat individuals who feel that their lives are overwhelmed by bad luck and that they live under a cloud of misfortune. They anticipate that any new life event will be a disaster and that they will be powerless to change the outcome, whether it be getting married, having surgery or buying a house. They have lost the ability to feel gratitude for their lives and the values that are important to them.  This belief system can be reinforced by socioeconomic, psychological or health issues.  Their doom and gloom approach to life can turn into a self-fulfilling prophecy.

I also observe that many of these people have chronic pain from arthritis, failed surgeries or other disease processes which affect their joints or muscles.  I am not the only one.  A new study by a team of psychiatrists at Harvard and Massachusetts General Hospital looked at patients who had musculoskeletal problems accompanied with depression and/or PTSD.  These researchers found that pain at rest, pain during activity, and disability were significantly predictable in these patients, due to their catastrophic thinking.   In these patients recovering from musculoskeletal trauma, catastrophic thinking was strongly associated with pain intensity and disability.  There is strong evidence that people suffering from pain, who also catastrophize, risk developing chronic pain syndrome.

There is a simple formula that is used to determine if patients have fallen into this way of thinking, which is:  Obsession with one’s pain or a focused mindset on pain + magnification (turning pain into something greater than it is) + a sense of helplessness = catastrophizing

The good news is that these researchers also saw a great response in these patients when they were given Cognitive Behavioral Therapy (CBT) to treat their catastrophic thinking.  In as little as 2-4 CBT sessions, pain was significantly reduced.  The researchers feel that if CBT is used much sooner with catastrophic thinkers, they can be kept from developing chronic pain syndromes.  CBT is also quite effective for all patients with chronic pain, whether they catastrophize or not.

Using Cognitive Behavioral Therapy, we try to redirect focus or modify thinking of those in pain to realize that they do have power over their pain and to recognize the strong influence that their thoughts can have on their pain experience.

Armed with this knowledge, it is easy to wonder why anyone would choose to have a negative outlook, if doing so increases their pain.  The fact is that most people are unaware of the links between catastrophic thinking and pain and they get caught in the cycle of pain and depression.  When given education and resources to become aware of their catastrophic thinking, most patients can begin a mental journey toward positivity and reap many benefits, pain relief being one of them.

If you suffer from pain and feel you need to break out of your patterns of ineffectual thinking, help is available to you.  Taking this pro-active step could make a world of difference in your level of pain and quality of life.