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Catastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders

Norman Web

Norman Cotterell, Ph.D.
Beck Institute for Cognitive Behavior Therapy

Beck and Gellatly (2016) propose that catastrophic thinking is a central feature in psychopathology. Such thinking magnifies both the immediate and eventual consequences of any perceived threat. A variety of disorders can be conceptualized as such: Clients magnify external threats (accidents, attacks, arson) but most notably misinterpret and magnify perceived internal threats. Sensations, thoughts, and emotions are seen as signs of immediate physical or psychological catastrophe.

For example:

  • Panic -- immediate catastrophic consequences of an unexpected physical sensation: "If my heart races, I’m dying.” “If I feel lightheaded, I’m about to faint.”
  • Social Phobia -- catastrophic misinterpretations of the social consequences of anxiety: "If people see me sweat, I’ll be judged, shunned, rejected or shamed."
  • Agoraphobia -- catastrophic beliefs about the consequences of anxiety: "If I panic, I’ll be trapped."
  • Specific phobias -- catastrophic beliefs about a feared object or situation: "If I get on an airplane, I won’t be able to handle the anxiety.”
  • Health anxiety -- catastrophic consequences of an unexpected physical sensation, or image: "If my chest hurts, I have heart, lung, or infectious disease. If the doctor sends me for tests, it means I’m seriously ill."
  • Obsessive compulsive disorder — Catastrophic misinterpretation of an intrusive thought: "If I think something unacceptable, it means I myself am unacceptable. Thinking it is as bad as doing it."
  • Posttraumatic Stress Disorder — Catastrophic beliefs about the reoccurrence of danger: "If it happened before, it’s likely to happen to me again.” “Flashbacks mean danger."
  • Pain — Catastrophic beliefs about pain and its consequences: "If I’m in pain, it is unsafe to move, and I must stop my activities.”
  • Traumatic Brain injury — Catastrophic misinterpretations of post concussive symptoms: "If I have a headache, my brain injury is getting worse."

Beck and Gellatly regard such thinking as an essential ingredient in the development and maintenance of these anxiety disorders. They identify 6 essential ingredients of a cycle that fuels them: Catastrophic Beliefs ("I’m having a heart attack, I’m dying,") triggered by a Precipitating Event (heart palpitations) results in both Anxiety Symptoms (shortness of breath, dizziness, feeling out of control) and an Interpretive Bias ("If my chest hurts, I’m having a heart attack"). These, in turn trigger an Attentional Fixation ("There’s no other way to look at this!") and an Attentional Bias ("I really need to pay close attention to my chest.") And these attentional factors serve to refuel the anxiety, the interpretative bias, the catastrophic beliefs and each other.

Beck and Gellatly propose taking catastrophizing into account would be useful in the diagnosis, prediction, prevention, and treatment of psychopathology. Future research and exploration will answer such questions as: Which catastrophic beliefs differentiate which conditions? Who is susceptible to developing such beliefs? How do we educate people to promote resiliency against such beliefs? What interventions will best enable clients to counter these beliefs?

Although they point to catastrophic beliefs as the key essential factor, other factors may serve as points of interventions. Decatastrophizing enables clients to test the validity of catastrophic beliefs through exposure to the sensations. Therapists use panic inductions, for example, to alter the misinterpretation of symptoms. Other techniques, such as cognitive reappraisal, may ameliorate attentional fixation by providing more plausible ways to account for symptoms. Various in-office procedures may modify attentional bias by directing focus to breathing, to objects in the office, or to sounds inside and outside the building. This model may serve as a way to conceptualize the problem and identify where interventions work.

Beck, A.T. & Gellatly, R. Catastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders. Cognitive Therapy and Research, 2016, pp. 1-12.