In our work with teen patients diagnosed with anxiety and/or depression, we often help them break one habit most adults know about or engage in themselves: catastrophizing.
Consider these common phrases:
Blowing things out of proportion.
Making mountains out of molehills.
Being melodramatic/dramatic.
We use those to clarify what we’re talking about, but those aren’t things to say to a person who’s actively engaged in catastrophizing. It’s like telling someone who’s upset to just calm down. It doesn’t really help, ever. It also minimizes the seriousness of the problem for people whose catastrophizing is associated with a mental health disorder such as anxiety.
So, if catastrophizing – clinically speaking – a is more than making something more than it really is, what exactly is the definition in the context of a mental health disorder like anxiety?
We tell our teen patients that it’s a pattern of thought wherein every outcome a person considers in any given situation is the worst outcome possible. People who catastrophize believe their predictions, and think they’re inescapable, and will definitely happen no matter what they do.
Here’s an official definition of catastrophizing published by the American Psychological Association (APA):
“Catastrophizing is the tendency to exaggerate the negative consequences of events or decisions. People catastrophize when they think the worst possible outcome will occur from a particular action or in a particular situation or when they feel they’re in the midst of a catastrophe in situations that may be serious and upsetting but are not necessarily disastrous. The tendency to catastrophize can unnecessarily increase levels of anxiety and lead to maladaptive behavior.”
That sums it up in black and white. It’s a term first coined by renowned therapist Albert Ellis during the development of a therapeutic technique called rational emotive behavioral therapy (REBT), which is a direct precursor to a technique we use with patients every day,: cognitive behavioral therapy (CBT).
What Do People Catastrophize About?
In our experience, people catastrophize about a wide variety of things in their lives, but most of them fall into three major categories:
Relationships:
For many of us, primary relationships are the most important things in our lives. Catastrophizing in adult relationships may happen when we sense something off with our partner and assume the worst possible outcome. If they’re anxious or on edge, we assume it’s about us, and we assume it’s going to lead somewhere we don’t want, like a break-up or divorce.
In teens, catastrophizing in romantic relationships may happen exactly the same way. However, teens catastrophize about peer relationships more often than adults. This type of catastrophizing may be related to social status, self-esteem, group belonging, and other situations associated with typical teen development. Catastrophizing about these topics can cause serious distress in teens, especially teens diagnosed with anxiety.
Health/Illness/Injury:
In this context, a person who catastrophizes thinks any ache, pain, or physical sensation is the sign of something absolutely terrible. An upset stomach means an ulcer, a tweak in the foot means a broken bone, tingling fingers means a mystery illness, and a headache – rather than the result of dehydration – must mean they have a serious neurological condition, a brain aneurysm, or something worse.
It works the same way in teens. They assign big, sinister meaning to anything they feel in their body, rather than allowing typical sensations to be what they are: typical physical sensations. Aches and pains come and go for all of us, but for a teen who engages in catastrophizing, these everyday occurrences can feel like an exhausting emotional rollercoaster ride.
Work/School:
Catastrophizing in the context of work or school is common, especially for people with clinical anxiety, or even for people who are a little nervous or prone to overthinking. At school, a 9th grader who gets a bad grade on a test might think “Now I’m never going to get into a good college,” while an adult at work who gets constructive feedback on a project or deliverable might think “Oh my god, they hated it, I’m going to get fired.”
For our team of therapists and psychiatrists – and for most people reading this article – it’s easy to see the faulty assumptions in the examples above. They have a clinical name: cognitive distortions. Which brings me to how I help my patients with the problem of catastrophizing.
Tips to Help Your Teen Reduce Catastrophizing
We see catastrophic thinking virtually every day in our teen patients with anxiety. Which makes sense, because one way of understanding catastrophizing is that it’s constant worry about the future – on steroids. To help teens caught in these negative patterns of thought, we use techniques developed in cognitive behavioral therapy (CBT). Tools derived from CBT area effective, evidence-based, and some are tailor-made to address catastrophic thinking.
If you’re the parent of a teen who regularly jumps to the worst possible conclusion – and it causes them serious daily distress – you can help them with the following techniques.
How to Help Your Teen Stop Catastrophizing
1. Reality Check: Challenge the Thinking
In this approach, you get your teen to challenge the validity of their catastrophic thinking by taking them through a quick, stepwise process. Have them:
- Name the thing they’re worried about.
- Rate, on a scale of 1-10, how likely it is that it – the thing they’re worried about – will happen.
- Ask them if the outcome they predict has ever happened before.
- If it rarely happens, or has never happened, ask them why they think it’s likely to happen.
Next, ask them to re-rate the likelihood of the negative outcome. If they still think it might happen because it’s happened before, ask then how they handled it and what the outcome was. If they handled it successfully, they can remind themselves they have the tools to manage. And if it happened before and they didn’t handle it successfully, ask them what they need to handle it more successfully if it happens again.
2. Reframing/Cognitive Restructuring
This approach is similar to the reality check, but it goes one step further. Rather than exposing the lack of a logical foundation for their catastrophic thinking, it helps teens replace the unrealistically negative predictions with realistically positive predictions. Here’s how that can work:
- Your teen worries about going off to college, and the worry crosses over into disruptive catastrophizing. They keep saying two things: “I’m never going to make any friends,” and “I’m going to fail out because I’ve heard college is so hard and I’m really not smart enough to make it.”
- For the first one, help them reframe the thought like this: “I was worried before I started high school, too, but I found a good friend group pretty quickly. That means I can do it again in college – and it probably won’t take too long.”
- For the second, help them reframe the thought like this: “I got into this school, so the admissions committee thought I’d be successful – otherwise they wouldn’t have let me in. That means I’m definitely smart enough, and if I do my work, I probably won’t fail out.”
This is not an exercise in being a Pollyanna or just thinking positive. This is entirely reality-based.
It teaches your teen to appraise their disruptive thoughts through the lens of logic and experience, then restate those thoughts based on facts, rather than possible outcomes with little evidence to support their likelihood.
3. Play it Out: What If?
When we predict the worst possible outcome, we assume the experience of that outcome will be disastrous and miserable. However, the worst possible outcome does not necessarily mean they’ll have a horrible, no good, very bad life. In most cases, it means a temporary, but totally resolvable setback. Let’s take a thought a high school student may have and play it out with What if?
- The thought: “I’m going to fail my chemistry test, which means I won’t get into college, which means I won’t get into medical school, which means I’ll never be a doctor, and my entire life will be a failure.”
- First, take it one step at a time, and address “I’m going to fail my chemistry test.” What if that does happen?
- If it happens, their overall grade will drop. That’s a fact, and it would, indeed, be a bummer. But that’s not the end of the story, and no potential college or med school knows it happened.
- The grade will drop, okay. Next, have your teen answer these questions:
- By how much?
- How long is left in the semester? Are there more tests that can bring up the grade?
- Can you retake the test?
- Does the teacher offer tutoring to help you address the questions you missed, and clear up the concepts you don’t understand?
` This process can help ground them, understand that even if bad things happen, the world will not end, and if and when they do, there are always remedies. And most of the time, the remedies are straightforward and right there, ready for us to take advantage of.
4. Write it Out.
This one is simple. When your teen starts catastrophizing, have them write all the thoughts down. Sometime, seeing them in black and white is all it takes to make them realize that they are, indeed, entertaining thoughts and making predictions that have little basis in reality, and are unlikely to happen.
5. Teach Mindfulness Techniques.
You can sign your teen up for yoga or meditation classes, which will help them manage anxious, catastrophic thoughts in general, or you can teach them the following two mindfulness exercises, which are effective when a teen – or anyone – is caught in a spiraling, escalating pattern of negative thoughts.
- The 3-3-3 Rule. Have your teen gather themselves, then:
- Name three things they can see.
- List three things they can hear.
- Move their body in three places or three ways.
- Grounding in 5-4-3-2-1. Have your teen gather themselves, then:
- Name five things they can see.
- Name four things they can hear.
- List three things they can feel.
- List two things they can smell.
- Name one thing they can taste.
Those two exercises are incredibly effective. Not only do they interrupt the patterns of negative thought, they ground your teen in the here and now, which is the essence of mindfulness, distract them from triggers, and disrupts the fight-or-flight response by activating the parasympathetic/autonomic nervous system.
Empowering Your Teen to Manage Catastrophic Thoughts
The most important thing you can do for your teen in this context is to give them effective tools they can use themselves for the rest of their lives. That’s exactly what those five tips are. They’re simple and easy strategies which, once learned, last forever.
That’s empowering.
They may still catastrophize, but when they do, they’ll have these tools available, right at their fingertips, to ensure the disruptive patterns of thought don’t last too long and don’t take them far astray.
