Catastrophizing means that a person fixates on the worst possible outcome and treats it as likely, even when it is not. Therapy and medications can help people reduce or stop catastrophizing.

Catastrophizing is a type of cognitive distortion. Some examples of catastrophizing:

  • “If I fail this test, I will never pass school and be a total failure in life.”
  • “If I don’t recover quickly from this procedure, I will never get better, and I will have a disability my entire life.”
  • “If my partner leaves me, I will never find anyone else, and I will never be happy again.”

Doctors also call catastrophizing “magnifying” because a person makes a situation seem much worse than it is.

Catastrophizing may worsen both physical and mental health outcomes. For example, people with chronic pain who catastrophize may experience more severe pain.

This article will explain what catastrophizing is, its causes, management strategies, and more.

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Catastrophic thinking or worry is repetitive, negative thoughts that focus on the worst possible outcome of a situation. This may occur even when the “catastrophic” event or situation is not actually likely to happen.

Mental health experts may use cognitive behavioral therapy (CBT) to help a person address their catastrophic thinking. CBT promotes mindfulness of catastrophic thinking, recognizing one’s actions, and managing and correcting irrational thinking.

Six tips to accomplish this include remembering and making use of the following techniques. These can help to manage the condition:

  • Acknowledging that unpleasant things happen: Life is full of challenges as well as good and bad days. Having one bad day does not mean all days will be bad.
  • Recognizing irrational thoughts: Catastrophizing often follows a distinct pattern. A person will start with a thought, such as “I am hurting today.” They will then expand on the thought with worry and anxiety, such as, “The pain is only going to get worse,” or “This hurting means I’ll never get better.” When a person learns to recognize these thoughts, they are better equipped to handle them.
  • Knowing when to stop: To cease the repetitive, catastrophic thoughts a person may have to say aloud or in their head, “Stop!” or “No more!” These words can break the stream of thoughts and help a person change the course of their thinking.
  • Thinking about another outcome: Instead of thinking about a negative outcome, focus on a positive or even a less negative option.
  • Offering positive affirmations: When it comes to catastrophic thinking, a person has to believe that they can overcome their tendency to fear the worst. They may wish to repeat a positive affirmation on a daily basis.
  • Practicing excellent self-care: Catastrophic thoughts are more likely to take over when experiencing fatigue or stress. Getting enough rest and engaging in stress-relieving techniques, such as exercise, meditation, and journaling, can all help a person feel better.

According to a 2020 review article, there is little agreement about what catastrophizing even is, let alone what causes it. There are several potential reasons for catastrophizing:

  • Depression: Having depression may cause a person to ruminate on negative emotions, causing them to catastrophize.
  • Anxiety: High anxiety may increase a person’s risk of catastrophizing.
  • BIS-BAS dysregulation: The behavioral inhibition system (BIS) and behavioral approach system (BAS) are two theoretical systems people use to regulate impulses and anxiety. Differences in these frameworks may help explain why some people catastrophize and some do not.
  • Interoceptive sensitivity: This means that a person more readily notices small changes in their body, such as sensations of digestion or changes in heart rate. People with high interoceptive sensitivity may notice these changes and catastrophize them.
  • Trauma: Some previous studies have found that childhood trauma may induce catastrophizing and anxiety sensitivity. Experience of previous traumatic or unsettling events may make a person feel they are more likely to happen in the future.
  • Obsessive-compulsive disorder (OCD): OCD is a mental health condition in which a person experiences repetitive, unwanted behaviors and compulsions. One study found that OCD is linked with catastrophizing, as a person with OCD may fixate on the possibility of a negative emotion or experience.

Anxiety is closely linked to catastrophizing.

People with anxiety experience heightened fear and preoccupation with danger or threats. For example, they might worry about an upcoming test, going out alone, or social situations.

All people feel nervous sometimes. However, anxiety disorders cause intense anxiety that interferes with daily life.


The primary difference between anxiety and catastrophizing is that sometimes, anxiety can play a useful role in a person’s life. For example, anxiety can help a person protect themselves from dangerous situations. However, catastrophizing usually has no benefits.

Having catastrophic thoughts can fill a person’s mind with unnecessary emotions that take time and thoughts away from reality. While both anxiety and catastrophizing can be harmful, anxiety may be beneficial in some circumstances.


People with depression may ruminate on negative emotions, causing them to catastrophize. When a person experiences prolonged feelings of hopelessness, they may catastrophize and imagine the worst-case scenario.

Pain catastrophizing

“Pain catastrophizing” is obsessing over and worrying about pain, feeling helpless when they experience pain being unable to put worries or thoughts of pain aside.

A 2019 study reports that pain catastrophizing was highest among study participants with generalized pain. This is chronic pain affecting one or more parts of the body.

Additionally, a 2020 review emphasizes that catastrophizing may increase the intensity of pain and make it more disabling. However, some advocates, especially in the chronic pain community, argue that the term stigmatizes people living with pain and may dismiss their lived experiences.

Most people experience fear and worry at some point. However, if a person constantly fears the worst, they may need to address their catastrophic thinking.

If a person has an underlying medical condition, such as depression, a doctor may prescribe antidepressant medications to help.

Examples of antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs): These increase the amount of the neurotransmitter serotonin in the brain. They can be the first-line treatment for people with depression. However, they may also aid in a variety of anxiety disorders. Examples include fluoxetine (Prozac) and paroxetine (Paxil).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): These medications increase the amount of serotonin as well as norepinephrine in the brain. Examples of these include duloxetine (Cymbalta) and venlafaxine (Effexor).
  • Tricyclic antidepressants (TCAs): These drugs include amitriptyline and nortriptyline (Pamelor). Doctors do not prescribe TCAs very often today because of their undesirable side effects.
  • Atypical antidepressants: Examples include bupropion (Wellbutrin, Aplenzin) and trazodone.

Sometimes, a doctor will initially prescribe one type of medication that may not be effective in reducing both depression and catastrophizing. In this case, the doctor may prescribe another medication.

For people with anxiety, a doctor may prescribe antidepressants or anti-anxiety drugs such as:

  • Beta-blockers: These can help ease physical anxiety symptoms such as rapid heart rate and sweating.
  • Benzodiazepines: These fast-acting anti-anxiety medications work in about 30 minutes and can help a person feel calm and sleepy. However, they are potentially addictive.
  • Buspar: This is a mild anxiolytic or anxiety-reducing drug that takes about 2 weeks to work.

Mindfulness means being present and grounded in the current moment rather than fixating on the past or future.

In some cases, it can help with mental health issues such as depression. For example, mindfulness-based cognitive therapy (MBCT) may help prevent depression relapse.

A 2020 study found that mindfulness reduced anxiety and stress among nurses. Another 2018 study of women with fibromyalgia found that some types of mindfulness could moderate pain sensitivity and catastrophizing.

When thoughts spiral, also known as “spiraling,” it is essentially a series of negative, overwhelming thoughts that can lead to catastrophizing.

When people feel they are spiraling, they can practice mindfulness using grounding exercises. Try breathing deeply, remaining present in the moment, and noticing small details of one’s surroundings — sights, sounds, smells, and sensations.

Learn more about mindfulness strategies.

Catastrophizing is a common behavior that affects many people during times of stress. It does not necessarily signal a mental health condition. However, if it becomes a chronic habit or interferes with daily life and functioning, it may be a sign of depression or anxiety.

A psychotherapist can help a person manage catastrophizing thoughts, and a doctor can help refer a person to the right treatment professional.