Catastrophizing
Catastrophizing is jumping from a problem to the worst way it could turn out, and then treating that ending as likely. A late text becomes a car crash. A headache becomes a tumor. It's a habit of prediction, not a flaw in you, and the fear it brings is real even when the outcome never arrives.
- Also called: Magnification, catastrophic thinking, or "what if" thinking.
- Listen for: "What if...", "This is going to be a disaster", "I can't handle this".
- Close relative: Fortune telling, which predicts a bad outcome but not always the worst one.
- One question to ask: What is the most likely outcome, and how would I cope if the bad one came?
An hour without a text
It rarely arrives as one thought. It runs as a chain, and each link feels as if it follows from the last.
- What happened: My daughter said she'd text when she got there. It's been an hour.
- First jump: Something has gone wrong.
- Second jump: She's been in an accident.
- Third jump: She's in the hospital and nobody has called me.
- The catastrophe: I'll never forgive myself for letting her drive.
Only the first step is a fact.
Every step after it is a guess, and each guess needs the one before it to be right. That's why the end of the chain can feel so certain while being so unlikely: the mind adds up the fear and forgets to multiply the odds.
The psychologist Albert Ellis gave the pattern its name, and Aaron Beck later used it for a thinking style he saw in people with anxiety and depression.1 David Burns put it on his list of 10 distortions as magnification, blowing up the size of a problem or a mistake while shrinking your own strengths.2
Four more chains
Each one starts with something true. All four are made-up examples.
"This chest tightness hasn't gone away. It's my heart. I'm going to collapse in the supermarket."
"The car repair is $600. That wipes out savings, then one more bill and we can't make rent."
"He said 'we need to talk' and then went quiet. He's leaving. I'll be on my own again at 40."
"My son failed his driving test. He'll lose confidence, drop out of things, and never get going."
What's missing from all four is the middle: every other way it could go, and what you'd do about it.
The body joins in
Your heart often speeds up before you've finished the thought. Your stomach drops, and sleep goes. Then the alarm itself becomes evidence: "If I feel this bad, it must be serious."
That loop sits at the center of a well-known model of panic. The psychologist David Clark proposed that panic attacks come from misreading ordinary body sensations, such as a racing heart, as a sign of immediate disaster, such as a heart attack.3
Next comes the urge to make the fear stop: call again, search the symptoms, ask someone to promise it'll be fine. A check can buy a minute of relief, and the next "what if" is just as loud.
When the pain is physical
Pain is a well-studied case. The Pain Catastrophizing Scale, developed by Michael Sullivan and colleagues, breaks it into three parts: rumination (not being able to stop thinking about the pain), magnification (fearing it means something serious) and helplessness.4
Across many studies, people who score higher report more severe pain, more disability and more depression.1 In pain treatment, drops in catastrophizing have gone along with drops in pain intensity, though nobody has shown that one causes the other.1
None of this says the pain is imagined. It says the thoughts about the pain are worth paying attention to.
The same process turns up well beyond pain. Reviewing the research, Gellatly and Beck found catastrophic thinking playing a part in panic, phobias, health anxiety, obsessive compulsive disorder, PTSD and chronic pain, with the content changing from one to the next and the process staying the same.5 They describe it as a cycle: a feared outcome pulls attention toward danger, and that attention makes the fear feel more justified.5
Why arguing the odds rarely works
Telling yourself "it won't happen" seldom sticks. A catastrophe is a guess about the future, and you can't win an argument with a guess. You can check one, though.
In one study, when 29 people with generalized anxiety disorder wrote their worries down for 10 days and checked them later, 91.4 percent of the predictions did not come true.6 The rest of that study, and a daily slot to run your own check in, are on the worry time page.
A test can also beat a debate on speed. Belief in a negative thought moved sooner after a behavioral experiment than after a thought record, in one session with 91 adults, though both worked.7
Breaking the chain
- Write the chain down, one link at a time. Seeing "late text, accident, hospital, guilt" on paper shows how many guesses sit between the fact and the fear.
- Rate each link from 0 to 100 for how likely it is. The last step can't be more likely than the step before it, however it feels.
- Turn the worst case into a prediction with a date. Write exactly what you fear and when you'll know. On that date, look.
- Ask the coping question as well as the odds question. If the bad outcome did come, what would you do first, and who would you call? Burns paired magnification with shrinking your own strengths, so this is the half the fear leaves out.2
- Try a small test instead of another check. If the fear is "I'll fall apart if I don't hear back", wait 30 minutes before texting again and watch what the fear does.7
The thought record has a separate path for worries that asks what you fear, when you'll know, and later what happened. For the other nine patterns on Burns' list, see cognitive distortions.
When the checking takes over
Catastrophic thoughts that keep you checking your body, searching symptoms or avoiding places, or that come with panic attacks, are worth bringing to your doctor or a therapist trained in CBT. Anxiety disorders are among the problems with the strongest research support for CBT.8
Write down one "what if" that showed up this week, exactly as it came. What would have to happen, step by step, for it to come true, and when will you know?
Answer this with JoyQuestions people ask about catastrophizing
What is the root cause of catastrophizing?
There isn't one known cause. Researchers point to a self-feeding loop instead, in which fear narrows attention onto danger.5
Is catastrophizing a form of OCD?
No. Catastrophizing is a thinking pattern, not a condition. It does show up in obsessive compulsive disorder, with its own content there.5 If unwanted thoughts come with strong urges to check or repeat things, ask a professional about OCD specifically.
Is catastrophizing a symptom of anxiety?
It travels with anxiety and is central to some models of panic.3 Plenty of people catastrophize now and then without having an anxiety disorder. It becomes a reason to seek help when it takes up hours, keeps you from things or wakes you at night.
Is catastrophizing the same as worrying?
They overlap. Worry is running through what might go wrong, and it can stay on fairly ordinary outcomes: a late bill, an awkward call. Catastrophizing is the version that skips to the worst ending and treats it as the likely one. A single worry can turn into a catastrophe halfway through, which is why the chain above is worth writing out.
Related
- Thinking patterns: every page in this section, from the 10 distortions to worry time.
- Jumping to conclusions: fortune telling is catastrophizing's smaller cousin.
- Emotional reasoning: when the feeling of dread becomes the proof.
- Thought record: fill one in on your phone, with the worry path.