What’s the worst that could happen?

What’s the worst that could happen?What is catastrophizing?

Have you ever woken up with greater-than-normal back pain and thought, “Oh no! It’s going to be a bad pain day!” Your attention is completely on your physical pain and you can’t possibly get past the experience. Then, your mind goes on a journey of its own. Are the following thoughts familiar?

“I can’t stand this pain.” “My life is completely ruined!”

If you’ve had this experience, you are not alone. According to a report released by the Institute of Medicine in June, 2011, at least 116 million American adults suffer from a common chronic pain condition. Those who can keep an active, healthy lifestyle often use a combination of medication, support groups, and coping strategies. Research has shown that a person’s beliefs and coping skills can positively or negatively affect his or her experience of pain. An important consideration is whether they learn not to catastrophize. Catastrophizing means to focus on pain and magnify it, and doubt your ability to cope with it. It is an exaggerated negative outlook toward pain causes, and pain experiences.

Usually, for those living with chronic pain, the goal of completely getting rid of the pain is not possible. Many people have to unlearn a lesson learned early in life – that pain is the result of ongoing tissue damage. When pain is chronic, the presence of pain does not necessarily mean ongoing damage. Understanding that you are not generally worsening your condition when doing normal activities, even when in pain, can go a long way to helping you stay more active.

People with pain may have a downward spiral of negative thoughts, especially when pain seems to be at its worst. These exaggerated negative thoughts lead to catastrophic conclusions, such as,”my life is completely ruined”. This is called catastrophizing. These kinds of thoughts can lead to feeling defeat and discouragement. People with pain who catastrophize report higher pain, poorer physical functioning, and more depression and distress.

What to do? Step one

The first step to solving a problem is recognizing that it’s there. John is a carpenter who incurred a back injury at work. He says, “I didn’t realize what I was saying to myself, and how much difference it made in my outlook. I had no idea that the conversations in my head were so negative.”

Step two: find out what you are saying to yourself

Become an observer of your behavior. Make a thought diary when you experience increased pain or a negative mood. Notice and write down what you are doing, and when these thoughts occurred. At the end of one week, look for similarities in time, situation and activities with increased pain.

Step three: analyze your thought diary

When Julie slipped on ice and injured her back, she could not stand very long to cook, an activity she loved to do. Her thought diary included:

       “I will never be able to cook again.” “I’m a terrible wife and mother.” “My husband will probably leave me.”

Julie noticed catastrophizing thoughts happened more on evenings when she could not prepare part of the meal earlier in the day. She knew that her family ties were strong, that her husband had never complained about interruptions in meals, and realized that her thoughts were not realistic.

Step four: try changing your thoughts

Once you know what you are thinking, change your thoughts to more realistic, helpful ones. Substitute these thoughts:

“I’m having a hard time coping with pain right now.” “I am not able to do some things I did before, but I can still do other things.” “I am still the same person, but with added challenges.”

Your feelings are likely to change when you change what you tell yourself. If you find yourself catastrophizing regularly talk with your doctor about finding assistance. Remember that pain generally cycles, so what seems hardest to handle on a difficult day, may not be so difficult tomorrow or next week. When you interrupt a catastrophizing cycle, you change your emotional experience for the better.

What research has shown

Studies involving married couples with one partner who suffers from chronic pain, have found that catastrophizing the pain led to a negative experience for both partners. During times of short-term pain, the spouse who did not have chronic pain, usually reinforced catastrophizing by providing emotional support, as they felt that the chronic pain sufferer was making reasonable requests. However, their efforts to help were often not successful. This then led them to withdraw or react negatively, and help less during longer periods of pain. While catastrophizing pain initially appeared to help the partner with chronic pain, it was actually more harmful and debilitating for the individual and the couple.


Learning to recognize and change your negative thoughts can improve the quality of your life.


Cano, A. (2004). Pain catastrophizing and social support in married individuals with chronic pain: the moderating role of pain duration. Pain, 110, 656-664.

Chaves, J.F. & Brown, J.M. (1987). Spontaneous cognitive strategies for the control of clinical pain and stress. Journal of Behavioral Medicine, 10, 263-276.

Institute of Medicine (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. http://www.iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx

Pavlin, D.J. (2005). Catastrophizing: a risk factor for postsurgical pain. Special Topic Series: Cognitive-Behavioral Treatment for Chronic Pain. Clinical Journal of Pain, 21(1), 83-90.

Sullivan, M.J.L. (1995). The pain catastrophizing scale: development and validation. Psychological Assessment, 7, 524-532.