What Is Catastrophizing?

Cognitive distortions, cognitive biases, or “unhelpful thinking styles” are the characteristic ways in which our thoughts can become biased (Beck, 1963). Catastrophizing is a cognitive bias that is common in many presentations, particularly anxiety-related problems. This article explains what catastrophizing is and offers suggestions for how therapists on can effectively address this thinking style.

What is catastrophizing?

Individuals who catastrophize jump to the worst possible conclusions, focus on the most catastrophic outcomes, and assume these scenarios are highly likely to occur. People who catastrophize often have a “what if… ?” thinking style, especially when they are faced with uncertain or ambiguous situations. Some examples of catastrophizing might include:

• Noticing a new freckle and immediately thinking “What if it’s skin cancer?”

• Assuming a loved one has died when they don’t return home on time.

• Thinking “What if the meeting with my boss doesn’t go well?”, followed by spiraling thoughts like “I’ll be fired” and “I’ll end up destitute.”

• Interpreting a racing heart as “I’m having a heart attack.”

How catastrophizing has been described in CBT

Descriptions of catastrophizing in the cognitive behavioral therapy (CBT) literature have changed over time.

• Ellis (1962) described catastrophizing as the tendency to magnify the likelihood and awfulness of a potential threat. He suggested that people can learn to examine their catastrophizing internalized sentences and change them for a more realistic philosophy. For example: “It would be an awful nuisance or a bad thing if this danger occurred; but it would not be terrible, and I could cope with this nuisance or bad thing.”

• Beck (1963) referred to catastrophizing within his definition for the cognitive distortion ‘magnification and minimization’: “It was frequently observed that patient’s initial reaction to an unpleasant event was to regard it as a catastrophe. It was generally found on further inquiry that the perceived disaster was often a relatively minor problem.”

• Burns (1981) described catastrophizing in similar terms: “Magnification (catastrophizing) or minimization: You exaggerate the importance of things … or you inappropriately shrink things until they appear tiny … This is also called the ‘binocular trick’.”

• Clark (1986) suggested panic attacks result from catastrophic interpretations of bodily sensations. Sensations in normal anxiety responses are misinterpreted in a catastrophic fashion. For example, a healthy individual perceiving palpitations as evidence of an impending heart attack, slight breathlessness as evidence of impending cessation of breathing and death, or shakiness as evidence of impending loss of control and insanity.

• Kendall and Ingram (1987) suggested that anxiety-related thoughts often take the form of a ‘what if … ?’ questioning style, which tends to produce and maintain uncertainty. Subsequent research has revealed that ‘what if … ?’ questions often relate to catastrophic outcomes and are especially prevalent among people who worry (Vasey & Borkovec, 1992).

Clinical presentations associated with catastrophizing

Different cognitive biases are associated with different clinical presentations. Catastrophizing is associated with a wide range of anxiety disorders (Noël et al., 2012), as well as other clinical problems. They include:

• Chronic pain.

• Health anxiety.

• Insomnia.

• Obsessive compulsive disorder (OCD).

• Panic disorder.

• Persecutory delusions.

• Post-traumatic stress disorder (PTSD).

• Social anxiety.

Common consequences of catastrophizing

People who tend to use a catastrophizing thinking style may find it difficult to:

• Make accurate estimates about the probability of events.

• Anticipate realistic or positive outcomes.

• Recognize their ability to cope with unfortunate events.

As with many cognitive biases, there are evolutionary reasons why people might think in a catastrophic manner. Gilbert (1998) suggests many information processing biases are “built in” because they were adaptive in our evolutionary past. In potentially dangerous situations, speed can be more adaptive than rationality. Moreover, assuming the worst, being prepared for it, and taking action to avoid it may help avert the most serious outcome.

Clinical implications: top tips for therapists

1. Help clients identify the catastrophizing when it occurs

Signs of catastrophizing include “what if … ?” thoughts and anxiety-provoking imaginary scenarios. Clients can practice labeling the process of thinking rather than directly engaging with the content of these thoughts (e.g., “I’m catastrophizing again”).

2. Use grounding when worry chains move clients into an imagined future

Catastrophizing and worry chains take the mind to a frightening imagined future. Distraction, grounding techniques, and mindful awareness can bring the mind back to the safety and reality of the here-and-now.

3. Address physiological arousal linked to catastrophic thoughts

Strategies such as diaphragmatic breathing or progressive muscle relaxation can calm fight or flight responses that have been triggered by catastrophic thinking.

4. Use thought records to re-evaluate catastrophic predictions

People who catastrophize overestimate the probability of danger and underestimate their ability to cope. Thought records can be used to re-evaluate catastrophic thoughts as they arise. Useful prompts include: “Is the worst likely to happen?”, “What is a better and more realistic outcome?”, and “If the worst did happen, how would you cope with it?”

5. Use data logs to help recalibrate likelihood estimates

If clients frequently make catastrophic predictions, outcome records can be used to log how often these catastrophic events actually occur. This information can help recalibrate their predictions and expectations.

6. Use the anxiety equation to evaluate catastrophic predications

Salkovskis’ (1986) anxiety equation proposes:

Anxiety = (Likelihood × Awfulness) / (Coping + Rescue)

For people who catastrophize, the components of this equation can be explored separately:

• Likelihood is addressed by considering the most likely outcome rather than the worst.

• Awfulness is addressed by considering the details of the catastrophe and its consequences.

• Coping is addressed by considering what the client could do if the worst happened.

• Rescue is addressed by considering the resources the client could draw upon.

Further reading

• Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324–333.

• Burns, D. D. (1981). Feeling good: The new mood therapy. Penguin.

• Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.

• Ellis, A. (1962). Reason and emotion in psychotherapy. Lyle Stuart.

• Gilbert, P. (1998). The evolved basis and adaptive functions of cognitive distortions. British Journal of Medical Psychology, 71, 447–463.

• Ingram, R. E., & Kendall, P. C. (1987). The cognitive side of anxiety. Cognitive therapy and research, 11(5), 523-536.

• Noel, M., Chambers, C. T., McGrath, P. J., Klein, R. M., & Stewart, S. H. (2012). The role of state anxiety in children's memories for pain. Journal of pediatric psychology, 37(5), 567-579.

• Salkovskis, P. M., & Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597–602.

• Vasey, M. W., & Borkovec, T. D. (1992). A catastrophizing assessment of worrisome thoughts. Cognitive Therapy and Research, 16(5), 505-520.