How not to catastrophize
I spent this past week in Disney World with my husband’s family. While there was plenty of walking, it was the amount of standing and slow strolling that my body was less used to. After the second day, my right foot decided it was quite unhappy. There was a sharp pain in the middle of the ball of my right foot, and when I woke up that third morning, I was limping.
I was pissed. My brain immediately went to: “GREAT. This is probably the beginning of Morton’s Neuroma (nerve inflammation in the ball of the foot), this is going to take forever, I’m not going to be able to run and I was just getting back into it, I still have two more days of being on my feet, I don’t have a different pair of shoes, how am I going to avoid the foot, I’m going to f*** up my left side because of compensation, UGH.” I said that to myself about 3 times faster than you just read it. It was my immediate reaction, and it has a name: catastrophization. That name is used in pain science research to label the behavior described as “the tendency to magnify the threat value of the pain stimulus and to feel helpless in the context of pain, and by a relative inability to inhibit pain-related thoughts in anticipation of, during or following a painful event.” (source)
Catastrophization is a factor that influences our pain. It is one (of many) inputs into our system that tend to encourage the output of pain. What this means is, the more one anticipates the consequences of their pain and mentally closes the door on potential solutions, the more likely one is to stay in pain.
In that thought loop I had above, I magnified the threat value of my pain by immediately assuming I had Morton’s Neuroma which I knew if fully developed would take some time off my feet to heal. I anticipated the consequences by thinking about how I wasn’t going to be able to run when I got back to Brooklyn — something I’d been trying to kickstart myself back into after some time off. I further anticipated the consequences of future pain issues from compensatory patterns I hadn’t even had the chance to perform yet! I felt helpless because I had two more days on my feet and no other shoes. All of these thoughts took place within maybe 10 seconds.
You might be thinking, but she’s the pain coach! Why is she having all those thoughts? Because I’m human, and we all do this to various extents. The education part becomes useful in the behavior that follows.
First, because I know about catastrophization, I’m able to recognize myself doing it and then step away from it for a moment long enough to be able to label it. That doesn’t mean it disappears, but now it has a name and I can easily call myself out. “Hey, you’re catastrophizing, chill out.”
Second, I start to backtrack on my thoughts and tease out fact from anticipatory fiction: Do I have Morton’s neuroma? I actually have no idea. So what do I have? Pain at a level 8 on the 1-10 pain scale. Ok, not great, but it’s not a diagnosis. This is important! Because as soon as we diagnose ourselves, we place limits on how we recover.* Do I actually know I won’t be able to run for a while? No I have absolutely no way of knowing. Do I know that I’m going to compensate my posture? Well, yes I’m pretty sure I’m going to want to off load the foot because the pain is pretty intense when I don’t. Ok, so that means I’m going to cause pain and damage to my body in other ways during the compensation process doesn’t it? No, I have no way of knowing that. I also know and believe that my body is strong and resilient, so why not choose to believe that I can handle a compensatory walking pattern for a little while? Done. What about the shoes? Ok, I don’t have other shoes, but now that I think about it, I DO have other socks! Believe it or not, I think my no-show socks were too tight for my feet, so I can switch out to looser socks that allow my toes to wiggle around in the shoe. What about the two more days thing? Well, it just so happens that my in-laws are kind humans and if I need to take some afternoon rest off my feet because of my pain, there’s a 99.99% chance they will support my needs.
Third, I know what makes me feel empowered and less helpless: using and exerting my body. So I decided to go to the gym in the hotel and ride the spin bike -- something that I knew wouldn’t affect my foot -- and I did interval training which requires me to focus on nothing else but the task at hand which was the perfect distraction.
I started to feel better. I joined the family at the theme park for the rest of the day, sat when I could in the park, and by the end of that day, my foot was at a 4 out of 10 on the pain scale. And after the fourth and last day of Disney, it was at a 1.
The beauty of this process is that you most likely already do this in other parts of your lives. Maybe you get laid off from a job, your flight to your long awaited vacation gets cancelled, or you get into a car accident at a time when you don’t have the resources to deal with it. You might freak out, and then talk yourself into a calmer state that allows you to come up with solutions. If you have kids, this process is probably all too familiar — calm everyone down, put out the fire, and focus on spinning the facts into an upward spiral rather than a downward one.
It all starts with that moment of awareness. The next time you find yourself with a little case of catastrophization, can you pause just long enough to actually hear what you’re saying? I recommend taking 60 seconds to jot your thoughts down. Looking at it on paper makes it real. You might be surprised at what you read, and you might have the humor to chuckle at it and re-route.
keep moving.
*Diagnoses come with A LOT of beliefs that are associated with them. These are subconscious associations and we all have a different recipe of associations depending on who we are and what we’ve experienced. Undoing these associations is challenging and takes lots of time. So in the dire moment, save yourself some time and effort and skip the self-diagnosis.