Catastrophic thinking can be extraordinarily hard to cope with. Whether it’s dealing with fears about your physical safety, the uncertainty of personal relationships, or the prospect of financial troubles, life can quickly feel far too big and out of control—while the worst-case scenarios, such as injury, financial ruin or the loss of a loved one, can feel like a foregone conclusion. Some examples of catastrophic thinking can include a person thinking that just getting into a car means they will die in an accident; thinking that all relationships are doomed to fail; or that making even a minor mistake at work will lead to being fired, which will then lead to homelessness.
When a person starts treating worst-case scenarios as inevitable, this can lead to avoidance of major life goals, while also worsening physical and mental well-being. In the moment, this kind of thinking can seem logical; often, these thoughts are driven by a person’s personal history, as well as the particulars of how their brain works.
If you’re experiencing catastrophic thinking, it’s important to seek out the help of a trained professional, who can help them manage these thoughts. For some people, however, whether they have a history of trauma or a disorder such as ADHD, managing these catastrophic thoughts can get complicated—and more traditional therapeutic approaches may not be as effective. Here’s what to know about finding the help that works best for you.
A trauma-informed approach can be essential
For people with a history of trauma, these negative experiences will inform and shape their thinking. “Our brains are trying to keep us safe,” says Kate Hanselman, a psychiatric mental health nurse practitioner with Thriveworks. “If you have a history of trauma, your brain is thinking worst-case scenarios to keep you alive.” In this context, a person who has experienced trauma is going to be filtering future experiences through the lens of their lived experiences, where the worst-case scenario can very easily seem like the most probable, logical outcome.
The first step, if you’ve been through trauma, is ensuring the safety of your environment, which may require removing yourself from an unsafe situation. For some people, they may not even recognize that their experiences qualify as traumatic, due to it being normalized. For others, they may still be in an unsafe environment, where the trauma is still ongoing, for which the first priority is to figure out how to get to a safe environment.
Only after a person is safe should the focus shift to processing the trauma, which often includes finding ways of incorporating these lived experiences into your world-view, while still letting you move forward with your life. “Trauma resets our baseline, to either say the world is bad and unsafe, or I am bad or unsafe,” Hanselman says. “A lot of trauma-focused modalities are looking at understanding either ourselves or the world differently.”
Some of the therapeutic modalities that can help with trauma include cognitive processing therapy, which helps patients work through their thoughts and beliefs about a traumatic event; prolonged exposure therapy, which works on gradually exposing a patient to their fears, so that they can work on managing their reactions; and eye movement desensitization and reprocessing therapy, which uses eye movements to help patients reprocess their traumatic memories.
Depending on a patient’s particular needs, which includes what type of trauma they experienced, and whether it was a single, one-time event, or a prolonged exposure to on-going trauma, a therapist might draw on techniques from different types of therapies. “The tools are very similar, but the ways in which they’re implemented and the support for the implementation, that’s what’s going to be different,” Hanselman says.
Conditions such as autism, ADHD or OCD can require a different approach
Another complication for managing catastrophic thinking is if a person has a disorder such as autism, ADHD or OCD. All of these conditions can make catastrophic thinking worse and/or make managing them a lot harder. “Neurodivergent differences, like ADHD particularly, [are] going to lead to some things that worsen the catastrophic thinking process,” says Andrew Kahn, a licensed psychologist, and associate director of behavior change and expertise at Understood.org.
With a disorder like ADHD, a person’s executive functioning is impaired, which affects their ability to plan, prioritize and execute complex tasks. In turn, this impairment can lead to a number of consequences, whether it’s getting bad grades due to struggles with staying focused and organized; getting fired from a job due to an inability to successfully finish complex projects; or dealing with relationship issues due to being absent-minded. These consequences (or the danger of them occurring) can lead to patterns of catastrophic thinking that are very hard to break out of. “If you establish maladaptive patterns for long periods of time, mood functioning is going to dominate your world,” Kahn said. “You’re going to stay in this catastrophic state.”
For someone who does have any of these disorders, and is struggling with catastrophic thinking, the first step is getting proper diagnosis and treatment for their condition, as this will help lessen the predisposition for catastrophic thinking. “If you have ADHD, or autism, or OCD, the earlier and better we diagnose you, the more tools we are going to work on building,” Kahn said.
The second step is going to be seeking out the help of a mental health practitioner who understands some of the ways in which these conditions can affect catastrophic thinking, and which therapeutic tools can be useful.
Alternative therapeutic techniques
Generally speaking, the major therapy for catastrophic thinking is cognitive behavioral therapy, which tends to emphasize engaging with and managing catastrophic thoughts. However, this approach may not work for certain kinds of people.
For example, if a person has been through a major trauma—which is its own real-life version of a worst-case scenario—the process of engaging and rationalizing with their catastrophic thoughts could easily end up being either ineffective at best or harmful at worst. “That’s one of the traps in cognitive behavioral therapy,” Kahn says. For a person who has already been through the worst, rationalizing or engaging with thoughts about this trauma isn’t going to lessen their distress about the experience, and also comes with a risk of invalidating their lived experiences. Instead, they might need to use some different approaches.
One potential strategy is mindfulness-based training, where a person works on learning to recognize and live with their catastrophic thoughts in a way that still allows them to live their life. “I’m going to treat the catastrophic thought like a balloon flying through the sky, where I can’t reach the string to bring it down, so there’s nothing I can do about this,” Kahn says. In so doing, “it permits me the opportunity to practice allowing the thought and experience to live, without having to beat myself up for it, to fight with it, to argue about it, and to try and prove it untrue. If I can allow it to live, and it doesn’t change my experience in some negative way, then over time, the connection can be broken.”
This strategy is often used in acceptance and commitment therapy, which focuses on finding ways of accepting certain experiences that are out of a person’s control, and coming up with strategies for moving forward.