Catastrophizing involves believing that you’re in a worse situation than you really are or exaggerating your difficulties. It can be a symptom of anxiety or depression.
For example, someone might worry that they’ll fail an exam. From there, they might assume that failing an exam means they’re a bad student and bound to never pass, get a degree, or find a job. They might conclude that this means they’ll never be financially stable.
Many successful people have failed exams, and failing an exam isn’t proof that you won’t be able to find a job. A person who is catastrophizing might not be able to acknowledge that.
It’s easy to dismiss catastrophizing as over-exaggeration, but it’s often not intentional or that simple. People who do it often don’t realize they’re doing it. They may feel they have no control over their worries, and it can even impact their health. Fortunately, effective treatments exist.
It’s unclear what exactly causes catastrophizing. It could be a coping mechanism learned from family or other important people in a person’s life. It could be a result of an experience, or could be related to brain chemistry.
People who have other conditions such as depression and anxiety, and people who are often fatigued may also be more likely to catastrophize.
The combination of chronic pain and catastrophizing happens often and is widely studied.
Because someone with chronic pain is used to constantly being in pain, they might conclude that they’ll never get better and will always feel discomfort. This fear may lead them to behave certain ways, such as avoiding physical activity, which rather than protecting them, can ultimately make their symptoms worse.
Multiple studies have found that patients who catastrophize report an increase in the severity of their pain, worse post-op outcomes, and needing to use healthcare services more often.
Another 2023 study indicates that some patients feel the term “catastrophizing” invokes stigma from healthcare providers who may not empathize with patients because of gendered notions of “hysteria.”
However, this does not mean that chronic pain should not be taken seriously. Catastrophizing isn’t the same as exaggerating about pain.
Anxiety and depressive disorders
The authors concluded that this was because assuming that the worst will always happen leads to feelings of hopelessness. Constantly feeling hopeless can lead to depression.
The findings highlight the importance of taking both catastrophizing and fatigue into account when forming a treatment plan for chronic pain patients.
A combination of cognitive-behavioral therapy and walking may prove effective, even though patients frequently report feeling more pain and fatigue, at least in the beginning, when starting a walking protocol.
Since catastrophizing is closely associated with mental health conditions, it’s no surprise that therapy can effectively treat it. Cognitive-behavioral therapy, or CBT, is one of the most common forms of talk therapy.
CBT tries to address your thinking and behavioral patterns. In the case of catastrophizing, a therapist might help you recognize irrational thoughts and replace them with rational ones.
For example, you might be used to thinking, “I handed this report in late. I’m a total failure, and I’m going to lose my job. I’ll be financially destitute.”
Through CBT, you’ll recognize that this is an irrational thought. A therapist might help you replace that thought with, “I handed this report in late. If I apologize for it my boss will understand. They won’t fire me for this single mistake. I’ll be okay.”
Other forms of therapy
In place of or in combination with CBT, a therapist may use different techniques to address catastrophizing, such as:
- Dialectical behavioral therapy (DBT): Originally developed to help people with borderline personality disorder, DBT shares similarities with CBT but has a stronger emphasis on emotion regulation and distress tolerance. DBT aims to show patients healthy ways to recognize and cope through emotions before they lead to catastrophizing.
- Mindfulness-based stress reduction (MBSR): If you often find yourself catastrophizing, mindfulness may be helpful. A therapist will work to help you channel your thoughts through different forms of meditation, such as a body scan or deep breathing exercises. You can follow the MBSR steps outlined here to get started.
- Acceptance and commitment therapy (ACT): Accepting all of your emotions, especially distressing feelings from catastrophizing, is the core of the ACT approach. Rather than getting bogged down with the thinking that something is “wrong” with you, ACT gives patients the tools to detach from their emotions and see things more objectively.
- An example: “I’m worthless and will never not be in pain.” Instead, ACT helps you think, “I recognize that I’m having thoughts of worthlessness, which is normal. With the pain, this too will pass.”
- Exposure response prevention therapy (ERP): This therapeutic approach slowly helps patients overcome cycles of catastrophizing through habituation and extinction. ERP exposes patients to the source of their fear and anxiety to minimize negative associations gradually.
- Psychodynamic therapy: Focused on revealing unconscious thought patterns and behaviors, psychodynamic therapy goes a bit deeper to address catastrophizing, anxiety, and related mental health conditions. This form of therapy can last years as the therapist and patient delve into childhood experiences, past traumas, and recurring dreams tied to catastrophic thinking.
If your catastrophizing is linked to another condition, such as depression, a doctor might prescribe medication for that underlying condition. That said, there’s no medicine that specifically treats catastrophizing.
Catastrophizing is a symptom of many mental health conditions, and it can affect your quality of life. While it might feel overwhelming, there are many ways to treat catastrophizing. If you think you have a tendency to catastrophize, talk to a psychologist or therapist.