Stopping Worst-Case Thinking

Living with arthritis pain can feel like the glass is half empty. But negative thinking and expecting worst-case scenarios can worsen pain. A person might think, “My fingers are getting swollen. Soon they’ll make it too hard to prepare the meals I love. I should just give up cooking entirely!” This type of thinking is called catastrophizing. The individual predicts and obsesses over a negative event or situation. Then, he or she decides that if it does happen, it will lead to the worst possible outcome. 

“Focusing on pain sensations, ruminating about your pain and feeling helpless make pain worse,” says Claudia Campbell, PhD, associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore, Maryland. “Pain can become all-consuming and can prevent you from doing the things you enjoy.”

Catastrophizing doesn’t just dampen your spirits. “Having these kinds of thoughts increase your level of pain,” Campbell explains. “On the other hand, if you can distract yourself, engage in relaxation exercises or take your mind off the pain, you can reduce the level of pain you experience.”

Worst-case thinking is also associated with poor prognosis outcomes, according to a 2017 study in Arthritis Care & Research that followed 209 patients with rheumatoid arthritis. The researchers found that people with higher levels of pain catastrophizing were less likely to achieve remission when compared with individuals who did not worry about their pain as much.

“If the patient is anxious, depressed or has catastrophic thinking, the feeling of pain will increase because of changes in the central nervous system, “ explains Hilde Berner Hammer, MD, PhD, author of the study and rheumatologist at the Diakonhjemmet Hospital in Norway. Dr. Hammer says physicians should consider pain catastrophizing as a reason for not achieving remission. The anxiety, depression and negative thinking should be dealt with and treated.

It’s also important not to blame yourself if you struggle with these emotions. “Unfortunately, there is a stigma around pain and catastrophizing. But it’s no one’s fault, no one wants to have thoughts that amplify their pain,” Campbell says. “We don’t think that people who catastrophize more only report more pain, but they actually experience more pain.”