Managing Catastrophic Thinking in PTSD

Catastrophic thinking is a tendency to expect the worst to happen without considering other possibilities. People with post-traumatic stress disorder (PTSD) often experience cognitive distortions such as catastrophic thinking.

Cognitive distortions are extreme, exaggerated thoughts that don't match up with the reality of a situation. For example, if you were in a car accident, you might have a lot of trouble getting back into your car or driving near the site of the accident. Perhaps when you do, you are overwhelmed by anxiety or thoughts of it happening again.

Catastrophic thinking assumes that the worst will happen. Understandably, focusing on the worst-case scenario leads to a good deal of anxiety and stress.

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How Catastrophic Thinking Develops

Living through a traumatic event destroys positive beliefs that people typically have about the world, such as that they're safe from deliberate harm or, after someone else's traumatic event, that "This can't ever happen to me." Someone with PTSD might fall into catastrophic thinking after exposure to a traumatic event: The trauma is viewed as proof that the worst actually can happen—and seen as a sign that only traumatic events will happen from now on. No other possible outcomes are even considered.

As time goes on, catastrophic thinking develops into a day-to-day coping strategy designed to help ensure that the person will never be placed in a dangerous situation again. But having catastrophic thoughts over and over can be paralyzing, leading to extreme anxiety, avoidance, and isolation. This may have the effect of undermining the coping strategy. How? By bringing back the person's sense of being constantly in danger and not safe anywhere.

How to Manage

The first step in managing catastrophic thoughts is knowing when you have them. Self-monitoring can be an excellent way of increasing awareness of your thoughts and the effects they have on your mood and actions.

Next, take steps to move your thinking away from extremes. Allow yourself to consider other options. When catastrophic thinking starts, it may be helpful to ask yourself these questions:

• What evidence do I have that this thought is realistic?
• What evidence do I have that it isn't?
• Have there been times when I've had this thought and it didn't come true?
• Do I have this kind of thought when I'm feeling okay, or when I feel sad, angry, or anxious?
• What would I tell someone else who was having this thought?
• Is it possible that I'm having this thought just out of habit?
• What might be a different, more realistic thought in this situation?

Asking yourself these types of questions can help you break the habit of catastrophic thinking by learning to be more flexible in considering your options. You'll know you're succeeding when you feel that 1) you're not as anxious as you were before or 2) your anxiety isn't getting any worse.

It may also help if you practice mindfulness about your thoughts, which can help weaken their power over your mood. When you notice that you're having a catastrophic thought, simply view it as just a thought, nothing else—just something your mind does when you're feeling a certain way or are faced with a certain situation. Just a habit.

You may decide to go out and test how well you're managing your catastrophic thinking. Similar to exposure therapy, the idea is to slowly approach the situations that brought up catastrophic thoughts in the past and see what happens now. If you don't have such thoughts, or they aren't as strong and threatening as before, you'll know you're making progress.

Getting Treatment

If you have many catastrophic thoughts, you may find it helpful to discuss them with a cognitive behavioral therapist. Cognitive behavior therapy places a strong emphasis on the thoughts people have and how those thoughts influence their emotions and behaviors.