Interstitial cystitis is a condition that ebbs and flows. Symptoms can be better some days and awful on other days. I have gone for months at a time with my IC symptoms mostly controlled through diet and medication and then suddenly a flare hits out of nowhere.
I cannot even begin to count the number of times the pain has started, and I’ve thought things like: “I am never going to feel well again. I might as well just resign myself to always being miserable.”
Sound familiar? If so, you may struggle with catastrophizing, which means that you spiral quickly to the absolute worst-case scenario when an unknown situation arises. It may not happen in every situation, but researchers have found that more often than not, it goes hand-in-hand with chronic pain.
In fact, there is a specific type of catastrophizing known as “pain catastrophizing” because of how often they go together. Pain catastrophizing can happen in chronic pain patients who develop the attitude they won’t get better and become afraid to try things for fear of making their pain worse.(10)
The vicious cycle continues in that catastrophizing reduces how well your body handles pain and makes you more susceptible to feeling pain, according to a study from 2009.(1)
Last year, Another study looked specifically at how depression and coping behaviors affect IC/BPS. Researchers found that patients who catastrophized were more focused on their illness and reported higher levels of pain.(2) And, unsurprisingly, those patients also reported higher levels of depression.(2)
Those aren’t exactly encouraging statistics, but before you start spiraling down the catastrophizing path, know that you aren’t just doomed to catastrophize, be depressed and have more pain. There are ways to cope with catastrophizing and help stop it in its tracks.
1. Stay in the present.
One of the things that can get out of control quickly with catastrophizing is assuming you know what the future holds. You are ready to predict what the outcome will be and how poorly it will go. But the truth is, we can’t predict the future. Staying focused on the present helps counteract that tendency.
The past can also cause issues when you focus on the negative events of the past. Ruminating is obsessively thinking about and over-analyzing the same situation.(3) Ruminating can cause depression and go hand-in-hand with catastrophizing. Ruminating on the past doesn’t change it having happened or make it better.
Use techniques like focusing on your breathing, distracting yourself with a funny movie or book, meditating, praying or consciously observing the world around you to stay in the present.(3)
However, you can also use the past in positive ways. Think back to other times you have assumed the absolute worst outcome would happen and you were proven wrong. Chances are there are many more times you assumed something would go horribly wrong and it didn’t.(4)
2. Find support from others.
Isolating yourself is never a good thing. We need people! Whether you have people in person or online or both, find healthy connections and sources of support. Sometimes when our thoughts start spiraling out of control, what we need most is not only a compassionate friend but someone who will gently steer us back onto the right path.(4)
Another benefit to talking through your feelings with someone close to you is that saying something out loud helps you get a better perspective on the topic. Other people can be good at helping us stay grounded in reality when our thoughts get carried away.(4)
3. Wrangle your thoughts.
Though you may be predisposed to catastrophize, have anxiety or worry, there are some ways you can take control of your thoughts. If you’re struggling with catastrophizing, psychologist Linda Blair recommends setting aside a half hour a day to worry.(5) During that half hour, write down your specific worries and concerns. Next to each, write a percentage from 0 to 100% how distressed you feel. From there, write down the possible explanations for what you’re worried about. For this step, you can do some research and draw in external sources. Then reassess how much the concern is worrying you.(5) This process helps you start to think rationally about what you are worried about.
Another way to wrangle your thoughts is to work on identifying when you are catastrophizing. Just the simple step of recognizing that your thoughts are getting out of control can help you get them back under control.(6) It goes back to the whole idea that you have to recognize there is a problem in order to fix it.
Once you identify those irrational thoughts, any time they creep in, tell yourself to stop – either in your head or out loud.(6) You may have to tell yourself to “stop” or “no more” many times over, but eventually you will start shifting your thought patterns away from these harmful thoughts.
To help wrangle your thoughts, also take a look at where you are exaggerating. It can snowball from thinking that one thing is going to awful to thinking that your whole life is awful.(7) Instead, work to be specific about what is going wrong and what is going right. What’s going wrong might be you had to miss a family event because you’re flaring. What’s going right, however, may be that you’re surrounded with a loving, caring family who will continue to check in on you. Making yourself shift to positive thoughts really is helpful.
No matter what, don’t forget that your thoughts don’t define you.(7) With catastrophizing, it’s a slippery slope once your thoughts get on a roll to also start chastising yourself for catastrophizing and having anxiety. And then that makes you even more anxious. It’s a vicious cycle. Just like you are more than your bladder, you are also more than your thoughts. Remind yourself that everyone has negative thoughts sometimes and you’re neither alone nor crazy.
5. Take care of yourself physically.
One of the best ways to help manage catastrophizing is by getting enough rest. Getting good sleep can be challenging for IC patients, but it’s vital! (Check out “How to Get Better Sleep with IC”.)
The more sleep-deprived you are, the worse everything seems.(7) We get more irritable and don’t think as clearly when we are tired. It not only makes us grumpy with others, but it also affects how we perceive the world. When we are exhausted, our thoughts are more negative.
That isn’t just true anecdotally. In 2012, researchers found a significant link between fatigue and catastrophizing by looking through decades of research. They concluded that the more a patient catastrophized, the more likely they were to be fatigued and vice versa.(8)
Along with rest, taking care of your body in other ways is also important. Doing something physical can help reduce anxiety. Of course high impact exercise isn’t usually ideal for IC patients, but going for a walk, taking a hot bath, doing deep breathing exercises, chopping vegetables, stretching or just moving in general can help keep you connected to the present and get you out of your head and thoughts.(7)
Also remember that our bodies like routine, so maintain a structured schedule as much as possible. Get up and go to bed at set times. Eat meals at a set time. Finding and maintaining a routine that works for you helps you feel better physically and mentally. People struggling with depression are often inconsistent with their patterns of eating and sleeping, which can end up making their symptoms worse.(3)
6. Think about what you’d tell a friend.
When you start to catastrophize, stop and think about what you would tell a friend who came to you saying the very things you’re saying to yourself. If you think about what you’d tell them, chances are you will give them more grace and more encouragement than you are giving to yourself.(5) Sometimes getting out of ourselves and doing what we’d advise others to do is just what we need!
7. Set realistic goals.
One of the challenges in dealing with both a chronic illness and catastrophizing is feeling like everything is out of your control and you can’t do the things you want to do and feel like you ought to be doing. That can lead to more negative thoughts and take your mental health down the wrong path. Instead, set a few simple, attainable goals that are SMART: Specific, Measurable, Attainable, Rewarding and Time-Limited.(3)
When you achieve those goals, celebrate them, even if that just means congratulating yourself in your head. Find a way to acknowledge the positive things in your life and that you are able to do.
8. Change your environmental influences.
Just like the food and beverages we put into our body affect our physical health, so do the things we put into our heads. When you are having a particularly rough time, be careful of what you are watching, reading and/or listening to. The same is true for the people you are involved with. If a person or other source is encouraging your catastrophizing by being negative, find ways to avoid them.(3)
Instead of going to lunch with a person who is negative, opt to go to dinner with a friend who lifts you up. Take a break from your social media news feed when it’s making you feel disconnected and sad. Watch television shows or movies that are funny instead of stressful. It doesn’t have to be that way forever or for always, but you need to be vigilant about what is getting into your head when you are having a hard time.
9. Pay attention to your feelings.
Of course you notice when your bladder is flaring and you may even notice when you start catastrophizing. But you also need to pay attention to whether its good friend depression is moving in as well. The two often go hand-in-hand. Symptoms of depression, such as low-energy and feelings of hopelessness, can make you more prone to catastrophizing. Identifying and treating depression is also very important.
You can cope with depression in a few ways, including staying connected to others, doing something you enjoy and making healthy decisions.(9) Make sure you are eating well and staying as active as you can.(9)
When you notice yourself going down a path of negative thinking (overgeneralizing, jumping to conclusions, labeling in a negative way, etc.) stop and think whether there is a different way to look at a situation or if you’d think of the situation differently if you weren’t feeling depressed.(9)
10. Don’t be afraid to ask for help.
Sometimes no matter what you do or try, you just can’t shake your feelings of catastrophizing and/or depression. Research shows that catastrophizing affects the physiology of the brain.(10) In fact, researchers have found that catastrophizing seems to alter our brain’s responses to pain, increasing the pain we feel.(1) So, if there is a physiological component, it makes sense that sometimes there may need to be a physiological treatment as well.
If you’ve worked on self-help strategies and still find your catastrophizing and/or depression getting worse, it is definitely time to talk with your doctor. Researchers who looked at the impact depression and catastrophizing have on IC pain recommend that doctors assess patients for such issues as part of their pain management regiment.(2)
- Quartana P, et. al. Pain catastrophizing: a critical review. Expert Rev Neurother. May 2009 Volume 9, No. 5.
- Muere A, et. al. Depression and coping behaviors are key factors in understanding pain in interstitial cystitis/bladder pain syndrome. Pain Manag Nurs. Oct. 2018 Volume 19, No. 5.
- Gardner A. Depressed? 12 mental tricks to turn it around. Health.com. March 29, 2013.
- Edberg H. How to stop catastrophizing: 7 helpful steps. PositivityBlog.com. May 15, 2019.
- Blair L. How to stop catastrophizing: An expert’s guide. The Guardian. Dec. 29, 2017.
- Nall R. How to stop catastrophizing. Medical News Today. Feb. 8, 2018.
- Bonior A. 5 ways to stop catastrophizing. PsychologyToday.com. Nov. 16, 2016.
- Lukkahatai N. Association of catastrophizing and fatigue: a systematic review. J Psychosom Res. Feb. 2013 Volume 74, No. 2.
- Smith M, et. al. Coping with depression. HelpGuide.org. Updated June 2019.
- Ferguson S. Catastrophizing: what you need to know to stop worrying. HealthLine.com. Feb. 1, 2019.