Defusing Catastrophic Thinking

Linked to anxiety and depression, it’s what happens when we make a proverbial mountain out of a mole hill. In this Psychiatric Times article, Mindpath Health’s Sandeep Vaishnavi, MD, PhD, explains why runaway thoughts occur and what to do about them.

Everyone has experienced moments when one bad outcome convinces us we are doomed to a life of failure. These catastrophic thoughts are akin to making a proverbial mountain out of a mole hill. It is why after a breakup, we think no one will ever love us. It is that seizing fear when waiting on a doctor’s report. It is that gnawing feeling when someone vaguely texts “we need to talk.”

This exaggerated expectation that only the worst possible outcome will occur can exert a powerful and debilitating influence over our lives. Left unchecked, these catastrophic thoughts can set dangerous patterns that prohibit us from taking reasonable chances, following inspiration, or recognizing life’s silver linings.

As psychiatrists, we often encounter catastrophic thinking in our patients. We understand how difficult it can be to change these patterns, even with professional help. And while it is often easier to see this in others, the demands of our profession make us susceptible to falling into these very same traps.

Getting out of a catastrophic funk requires following the same treatment and advice we might give our patients. This means asking for help when we need it—something many physicians find difficult to do. Our jobs require us to be stalwart and seemingly infallible, but without balance and mindfulness, we continue to walk a dangerous razor’s edge of catastrophic thinking.

What is catastrophic thinking?

Catastrophic thinking, also known as magnifying, is a kind of cognitive distortion—a thought pattern that is irrational or exaggerated. Psychologist Albert Ellis, PhD, first coined the phrase in 1957 as he was developing his rational-emotive behavior therapy, a precursor to modern-day cognitive behavioral therapy. His ABC model involved an activating event, beliefs that were irrational, and the consequences of those beliefs. His theory was that our emotions and perceptions are not formed by an event—rather, how we think about the event directs how we feel.

Catastrophic thinking shares some similarities with anxiety. The difference is that anxiety may serve a purpose, such as justified fear, while catastrophizing involves irrational magnification. It is also linked to depression, where feelings of unhappiness and helplessness can trigger an avalanche of catastrophic thoughts. Catastrophizing is common among those who have experienced traumatic events, or anything that threatens their safety and security or shatters their sense of control. It is common among those suffering from post-traumatic stress disorder (PTSD), depression, and anxiety. Among combat military troops, those with high levels of catastrophic thinking were 29% more likely to develop PTSD. Additionally, those who experienced high levels of catastrophic thinking coupled with higher combat intensity were 274% more likely to develop PTSD.

Catastrophizing and physician burnout

Among physicians, burnout is a leading cause of catastrophic thinking. Defined as emotional and physical exhaustion brought on by prolonged stress, burnout has been noted in 50% of physicians-in-training and practicing physicians. It is generally attributed to work environments rooted in excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, and a lack of input or control, leadership culture, or organizational support. Female and younger physicians are more likely to report higher rates of burnout.

Psychiatrists are particularly susceptible to burnout, more so than surgeons and other physicians. In some ways, the stakes are higher, as our patients are more prone to violence and suicide. Because we use ourselves as tools to treat patients, we are vulnerable to a powerful range of emotions. These include feeling powerless against illness, fear of becoming ill, and the obsessive need to rescue patients.

Decatastrophizing catastrophe

Ellis did more than identify catastrophic thinking. He highlighted a way out of it by expanding the original ABC model to include ABCDE. The “D” refers to the disputation of beliefs, which calls for irrational thoughts to be converted into rational ones. And the “E” represents the effects these new and healthier thoughts might have on a person’s well-being.

Sometimes, saying “stop” out loud can help disrupt the pattern of repetitive negative thoughts. In the heat of the moment, it can be difficult to recognize catastrophic thinking as it is happening. The help of a clinician can clearly define these patterns and use a cognitive-behavioral approach to decatastrophizing. In some situations, clinicians may prescribe antidepressants or other medications to address the root causes of catastrophic thinking.

Over time, this hard work of observing patterns and reframing our reaction pays off in the form of hard-earned resilience. Resilience is measured by our ability to quickly recover from stress. It is a way of building mental fortitude despite—and because of—life’s hardships. Other methods to build resilience include:

Transcendental meditation (TM): TM is a meditation technique that involves silently repeated mantras to help reduce stress and promote a relaxed state of awareness.

Mindfulness: This practice turns down the volume of mental chatter by engaging full attention on our daily and mundane tasks. By focusing on the here and now, mindfulness can help practitioners gain broader awareness of cognitive patterns and better control over irrational thoughts.

Sudarshan Kriya yoga (SKY): Through structured body postures, breathing exercises, and cognitive-behavioral processes, practitioners learn relaxation and stress-management techniques.

Self-care: Exercise, healthy eating, and getting enough sleep all help shore up our defenses against catastrophic thinking. Being kind and tending to one’s needs can have a calming effect on our tendency to dwell on the negative.

Clickable technology: Web- and phone-based apps provide quick, anonymous options to those hesitant about seeking mental health treatment. This technology helps users track moods, learn mindfulness techniques and exercises, and keep catastrophic moods in check.

Read the full Psychiatric Times article with sources.