Catastrophizing

Everyone gets worried about things they care about –health, family and friends, work, the state of the world. They may think that bad things are going to happen to people or things they care about. When people think the worst and focus their energy on the worst possible outcome, it’s like they are predicting a catastrophe. Because of this, we call thinking the worst catastrophizing. It is thinking that a disaster will happen, even when reality is very different. Some people with GI symptoms think this way from time-to-time.

Catastrophizing is one of the most common thoughts that people describe and conquer in "talk" therapy. People who catastrophize:

• Assume that the worst will happen.
• Overestimate the effects of that worst outcome.
• Believe they lack the skills to cope with that outcome.

When your GI symptoms flare up, you might feel that the worst will happen. You might feel embarrassed, worry that something is wrong with you, or think that you might die. Untested, these assumptions can be very powerful psychologically, often making GI symptoms worse and proving (incorrectly) that the assumption about the worst must be correct.

Imagine you are a patient who experiences regular stomach cramping. You may believe that terrible things will happen the second you feel your stomach cramp up – Am I going to lose control of my bowels? Will I have an accident in front of everyone? Maybe I should get out of here now? The fears of losing control and having to get away from the situation may become overwhelming. Maybe you would just stay home to manage your cramping.

In this example, the patient is not focused on the immediate symptom – the stomach cramping – and instead worries about the worst case scenario that could happen. Some patients are able to acknowledge stomach cramping and accept that it is happening. Others will catastrophize and perceive the stomach cramping as something much worse than it really is. These patients would choose to avoid activities away from their comfort zone instead of addressing the problems directly and realistically. In the end, living a life controlled by GI symptoms – instead of controlling thoughts and feelings about those symptoms – can truly become catastrophic.

People can conquer catastrophizing during "talk" therapy. In the previous example, the patient with stomach cramping is assuming the worst will happen, assuming people will think negatively of the patient, and believing that avoidance is the only solution. Therapy is useful for challenging these assumptions, allowing the patient to think that "A cramp is just a cramp," "An accident is unlikely, and has not happened," or "If I remain calm, I can find a bathroom when I need one." Ask yourself a series of "what-if" questions, give realistic answers, and see where they lead you.

My Quality of Life (MyQOL) Toolbox has several tips that are used during therapy to help you reduce catastrophizing. You can test your thinking, focus on the moment instead of the future, and find ways to relax.