Anxiety Lesson 4: De-Catastrophizing

Difficulty Level: Easy to moderate

Frequency: Any time you are anxious about an uncertain outcome

Duration: 2-5 minutes

How to do it

1. In the moment that you’re feeling anxious about a potential bad outcome, list out all the possible “what if …?” statements. For example, let’s say someone is really concerned about how they performed in a recent sporting event. The “what if’s” will flood their thinking: “What if this is an indication that I will continue to perform poorly? What if I keep getting worse? What if I get kicked off the team?” And so on, and so on. Now do yours. List out all the “what if’s” tied to your anxiety.
   
   
2. Change each statement from a “what if” into a clear prediction about what you fear will happen. Be precise. For example, “What if I keep getting worse?” would be changed to “I fear I will continue to get worse.” Rate how awful you believe this “catastrophe” will be (0-100).
   
   
3. Next, consider how likely this event is to happen. Ask yourself: Has this happened before? What is the likelihood of it happening now? Then, ask yourself: What is the worst case scenario? Best case scenario? Most realistic scenario?
   
   
4. Supposing the worst did happen, what would you do to cope? What resources, networks, skills, or abilities would you have to help you resolve the issue. Have you “lived through” something similar before, and if so, what did you do? Write down your answers.
   
   
5. Now, see what sort of positive, reassuring things you’d tell yourself about the ‘catastrophe’, almost how you would tell a friend experiencing the same thing. Finally, rate how awful you believe the catastrophe would be now (0-100). Compare this value to the earlier value. Continue until you see a drop in the rating.
   
   

Why you should try it?

• Reframes generic anxiety-inducing thoughts into specific statements (1)
• Reappraises meaning of physical sensations (1)
• Helps conceptualize anxiety into tangible thoughts that can be understood (2)
• Helps reduce physical chronic pain (3)

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The research

This technique is one of the pillars of cognitive behavioral therapy (CBT), a dominant form of psychotherapy. There have been hundreds of clinical trials assessing the effectiveness of CBT on a range of different issues including anxiety and depression. A comprehensive report summarized and analyzed all these findings, and found that the primary techniques of CBT are highly effective (4). These techniques are a part of the treatment guidelines addressed by leading national associations including the American Psychiatric Association, and are considered part of the required curriculum for residency training programs in psychiatry and psychotherapy (5).

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How it works

Catastrophization is one of the primary forms of cognitive distortions: It involves making something into a really big deal when it’s not. It happens automatically when you become anxious. The heightened anxiety then fuels more distortions in catastrophizing, leading you into a vicious cycle of worst-case-scenario and anxiety. Researchers have found three underlying mechanisms. i) Rumination causes you to overthink and dwell on a thought, which ii) magnifies the potential problem, inevitably creating a sense of iii) helplessness in believing the problem can’t be overcome (6).

Engaging in conscious and targeted “what if” thinking is an antidote to catastrophization. A recent study found that applying this technique over an 11-week session led to reduced catastrophization and was associated with increased cerebral grey matter in certain key brain regions within the prefrontal cortex. The technique facilitates growth of neural tissue in areas of the brain that are responsible for top-down control and reappraisal (7).

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The evidence

1. Craske, M. G., & Barlow, D. H. (2007).
   Mastery of Your Anxiety and Panic. 4th ed.
   New York, NY: Oxford University Press.
   
   
2. Burns, D. B. (1980).
   Feeling good: The new mood therapy.
   Harper: New York.
   
   
3. Smeets, R. J., Vlaeyen, J. W., Kester, A., & Knottnerus, J. A. (2006).
   Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.
   The Journal of Pain, 7, 261-271.
   
   
4. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006).
   The empirical status of cognitive-behavioral therapy: a review of meta-analyses.
   Clin Psychol Review, 26, 17-31.
   
   
5. Sudak, D. M., Beck, J. S., & Wright, J. (2003).
   Cognitive behavioral therapy: a blueprint for attaining and assessing psychiatry resident competency.
   Academy of Psychiatry, 27, 154-159.
   
   
6. Boyes, B. (2015).
   The anxiety toolkit.
   TeacherPerigee: Toronto, Ontario.
   
   
7. Seminowicz, D. A., Shpaner, M., Keaser, M. L. et al. (2013).
   Cognitive behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain.
   Journal of Pain, 14, 1573-1584.

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