Previous articles have addressed the concept of irrational thinking and given examples of the different types of irrational thought patterns. One specific thought pattern has been researched to determine its link to chronic pain (in general) and migraine (specifically). It is commonly present in people with comorbid depression and anxiety. However, it can be present without any mood disorders. Even in those with depression or anxiety, catastrophizing can be measured as a distinct thinking pattern2.
I tried to find a simple layman's term, but the closest I came was the phrase, "making mountains out of molehills". That's too simplistic and minimizes the suffering of those who use this thinking style. Catastrophizing is not something anyone makes a conscious choice to do, nor is it easy to change once well-established. There are a number of theories as to why and how people start catastrophizing. Some believe it is acquired in early childhood by modeling the thinking patterns of adult caregivers. Others think it is a protective coping mechanism in response to trauma or disaster. Either way, it is a healthy response to unhealthy circumstances. Like all other adaptive habits, catastrophizing continues long after the danger has passed. Because of the brain's ability to remember trauma at the cellular level, changes take place that get generalized to any stressful situation. Over time, the instinct to catastrophize becomes problematic because it actually worsens the body's perception of pain and emotional distress. The more a person catastrophizes, the worse they feel.
So what is catastrophizing?
It is a combination of thoughts and emotions that are triggered in response to anticipated or actual physical or emotional pain. It involves rumination, magnification, and feelings of helplessness. Rumination is excessive negative thoughts. These thoughts are not intentional. Rather they are unwanted and difficult to stop even when you're aware of them. Magnification is an exaggeration of the perceived consequences of pain. Excessive worry and fear are typical. Feeling helpless generally includes a belief that there is nothing that can be done to help the pain1,2.
Examples of catastrophic thinking:3
- I worry all the time about whether the pain will end.
- I feel I can't go on.
- It's terrible and I think it's never going to get any better.
- It's awful and I feel that it overwhelms me.
- I feel I can't stand it anymore.
- I become afraid that the pain may get worse.
- I think of other painful experiences.
- I anxiously want the pain to go away.
- I can't seem to keep it out of my mind.
- I keep thinking about how much it hurts.
- I keep thinking about how badly I want the pain to stop.
- There is nothing I can do to reduce the intensity of the pain.
- I wonder whether something serious may happen.
Sound familiar? We've all been there.
However, long-term frequent castrophizing is associated with more frequent attacks, poor treatment response, increased use of health care resources, impaired daily functioning, and a reduced quality of life2.
In a 2009 study of patients with high-frequency episodic migraine, catastrophizing was associated with:2
- Higher perception of pain
- Reduced pain tolerance
- Increased pain behaviors
- Increased risks of psychological disorders
- Greater disability
- Greater impact on quality of life
- Increased risk of progression to Chronic Migraine
- Poorer doctor-patient relationships
In a 2014 study, Dawn Buse, PhD discovered that the rate of catastrophizing among obese female migraineurs participating in a weight loss program was about 25%. Future studies are needed to determine if the rate of occurrence is the same across a broader range of migraineurs. She also discovered that when compared to those in the study who did not catastrophize, patients who catastrophize had:1
- Higher BMI
- More frequent attacks
- Longer attack duration
- Higher Headache Impact Test scores
- More allodynia
- More depression
- More anxiety
- Lower self-efficacy
- 4x greater risk of Chronic migraine'
What to do if you think you catastrophize.
In order break through the pattern of catastrophizing, you will need the help of a good behavioral therapist who understands chronic pain. A good therapist will validate your experiences while helping you create new strategies for coping with the difficulties of life with migraine. You do not have to be at the mercy of your own thoughts and feelings. There are tried-and-true methods for breaking the cycle. By learning to change this thinking pattern, you can improve your chances of treatment success.
Resources to find a good behavioral therapist:
American Headache Society Healthcare Provider Search
American Psychological Association Psychologist
Association for Behavioral and Cognitive Therapies
Applied Psychophysiology and Biofeedback
American Psychiatric Association
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