Part I: “Catastrophizing”

Your pain is bad enough, but yes, some types of thinking can make it feel worse and cause greater disability. 2 types of thinking can make your pain worse, 1) catastrophizing and 2) fear avoidance. Today we’ll look at “catastrophizing.” This is a tendency to:

• focus more so than necessary on sensations of pain
• focus on how bad the pain is
• not try to reduce or manage pain

“Catastrophizing” comes from “catastrophe,” the idea being that with this type of thinking, you’re looking at your situation as a catastrophe. Do thoughts like these run through your mind?

• “Is my pain getting worse now?”
• “How bad is my pain now? … And now? … And now?”
• “This is so bad, I can’t stand it.”
• “This is the worst pain I’ve ever had.”
• “This will never go away.”
• “I can’t do anything to help myself.”
• “That relaxation exercise didn’t help yesterday, so I’m not trying it today.”

Before we go further, let’s acknowledge that you may actually be having your worst pain ever. And that at times you do feel discouraged. Looking at this type of thinking is not meant to minimize your difficult experience or to say you “shouldn’t” have this type of thinking.

How do you minimize this type of thinking?

1. Avoid focusing on your pain

Focus on other things instead, as much as this is possible. Use distraction. Get involved with activities. Don’t let your pain be a repetitive topic of discussion.

One caution: “Pain Logs,” which are charts or forms on which you are asked to chart your pain levels daily or even several times a day, can actually cause you to pay more attention to your pain, which can then feel worse. Do these only when really needed, and then for the minimal mount of time they’re useful, e.g. evaluating a new medication.

Use “Activity Logs” instead! These chart how much you can do, rather than how bad your symptoms are.

2. Emphasize the positive

Saying, “This is so bad, I can’t stand it,” actually reinforces in your mind that you can’t stand it. Change these statements to a positive perspective. For example, “My pain is bad, but it’ll get better.” Or, “I’m tough. I can tolerate this a little while longer.”

3. Emphasize your ability to cope

Practice your skills to lower your pain levels. Practice your skills to cope with your pain.
Catastrophizing is a type of thinking that most of us fall into at one time or another. Recognizing these types of thoughts is important, so you can, instead, focus on something else, change to more positive thoughts, and practice, practice, practice your coping skills.