When you’re in pain, it’s easy to fear the worst and imagine all the terrible things that may lie ahead. With catastrophic thinking, everything bad that has happened or might happen becomes magnified. You worry about everything—that your relationships will crumble, you’ll lose your job, you’ll remain disabled, and more. You feel more and more helpless, as if there’s no point in trying to get better.
Many scientific studies have looked at the relationship between catastrophic thinking and chronic pain, and the results are eye-opening. These studies show that those who engage in high levels of catastrophic thinking are more likely to misuse their prescription opioid medications,1 and that catastrophic thinking is one of the key factors determining the intensity of nerve pain.2 Catastrophic thinking also increases the attentional interference seen with pain,3 which is the disruption of the brain’s ability to concentrate and perform tasks, making it more difficult to function on a daily basis.
Catastrophic thinking takes you out of your real life and traps you in an imaginary world of misery. It worsens the mental storm, sets you on a path toward potentially destructive behavior, and makes it much harder to heal. It also increases the intensity of your pain, making you feel worse.
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Fortunately, you can easily put the brakes on catastrophic thinking just by reframing your thoughts. The process is fairly simple:
• Pay attention to your thoughts—Tune in to your thoughts, and when you find yourself thinking about the future, listen to what you’re telling yourself and try to analyze the scenario you’re imagining. Are you thinking about terrible things that are actually happening, or things that might happen? Odds are, you’re imagining the worst-possible outcome. This is not realistic and certainly not productive. Fortunately, you don’t have to think this way. You can control your thoughts.
• Remind yourself that what you’re imagining is not really happening—Yes, it’s possible that the terrible thing you’re worrying about might happen, but it probably won’t. And in any case, it’s not happening right now. What matters most is what’s happening now. If it’s not happening at this moment, why allow your brain and body to be flooded with stress hormones? Why trigger the fight-or-flight response, given how much damage it causes over the long run? Tell yourself, “It’s not happening now. I’ll worry about it if and when it becomes a problem”
• Know that you are resilient—You’ve already come through a variety of problems and crises in your life, and you’ll do so again. I’ve seen so many patients, who had thought they could never smile again, take control of their lives and find joy and satisfaction. Remind yourself, “Others with my problem have reclaimed their lives, and so can I.”
• Realize that you are contributing to your own suffering—Mark Twain once said, “I am an old man and have known a great many troubles, most of which never happened.” How many of your troubles have never actually happened, and probably never will? What you tell yourself can make your problems worse—or better. So say to yourself, “With every thought I think, I will help myself heal.”
• Reaffirm your power to stop this destructive mindset—You’re in charge of your thoughts, and that gives you tremendous power. It may take a little practice and a certain amount of time, but you can turn destructive thoughts into neutral or even positive ones. Tell yourself, over and over again, “I can control my thinking.”
I once treated a woman who had suffered a neck injury several years earlier and had undergone neck fusion surgery. Her surgeon told her she should always wear a soft neck brace and limit how much she turned her head so she wouldn’t reinjure herself. Always concerned and imagining the worst, this woman wore her neck brace constantly and avoided driving, exercising, and doing anything else that required turning her head. Unfortunately, her problems persisted. When she came to my practice I did a careful assessment and told her it was perfectly safe to stop wearing the brace. I also said that she could do much more involving her neck than she had done in years. At first she didn’t want to let go of the neck collar and become more physically active. But I got her to try going without it for brief periods, say fifteen minutes a day. Her success was the result of very gradual changes, slowly building up to four hours a day, then six hours. These little behavior modifications led to bigger changes and, ultimately, a huge shift in how she viewed herself and her pain and what was possible.
Today, she no longer wears anything around her neck, engages in a regular exercise program, and is much happier about her increased independence. And her neck, by the way, is fine.
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