My last post was about self-efficacy, which is the belief that you can do certain things to improve your health. Now, let's look at the opposite of self-efficacy - catastrophizing.
What is catastrophizing? It's the distorted believe that nothing is going to improve your health. When someone with a chronic illness like fibromyalgia or chronic fatigue syndrome catastrophizes, they're essentially giving up all attempts at trying to manage their illness. It's no surprise that catastrophizers don't do as well as those with good self-efficacy.
Catastrophizing is similar to something called "learned helplessness," in which people may try a few treatments, find that they aren't 100% effective, and decide that nothing will ever work for them. They have trouble focusing on what small improvements the treatments may have offered, and including more treatments that, eventually, add up to being fairly effective.
While it's easy to see how these things could hold back your progress toward feeling better, with these conditions in particular it's hard to know where to draw the line between catastrophizing and being realistic. Someone who's been sick for a decade or more may very well have tried just about everything that's available without much success. Should that person keep jumping on every new bandwagon, hoping this time it will work? Or should she (or he) just throw in the towel?
If you've given up on treatments, take an honest look at your mindset and talk to someone about it - someone close to you, your doctor, your support group or online forum - to get other opinions on whether you've developed an inaccurate view of things that's keeping you from improving your health. If you find that you are catastrophizing, it might be a good idea to see a mental health counselor about it.
- Learn more about how catastrophizing & learned helplessness can hinder your treatment, and what skills you may need to learn: Develop Coping Skills
Do you have experience with catastrophizing? How has it impacted you? Have you been able to turn it around? Do you think it's reasonable or realistic to give up on finding successful treatments? Leave a comment below!
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This makes some sense, albeit common sense, but I think it’s still rooted in the different ‘CFS’ definitions used by the psychiatric lobby and biomedical CFS researchers.
What I mean by this is studies that have dealt with ‘castrophizing’ in CFS have been psychological studies most likely done in England or the Netherlands using the Oxford criteria, which have been criticized since their inception almost twenty years ago for being too inclusive as to the types of patients included.
Indeed, one of the co-authors of the ‘Oxford’ criteria has described them as follows: “British investigators have put forward an alternative, less strict, operational definition which is essentially chronic fatigue in the absence of neurological signs [but] with psychiatric symptoms as common associated features.” David AS. Postviral syndrome and psychiatry British Medical Bulletin 1991; 47:4:966-988.”
What happens as a result of this is that patients who view their condition as being psychological have a better prognosis than those who view it as being biomedical in nature.
However it has nothing to do with the patient’s beliefs, because more than likely the patients beliefs are absolutely correct. Some of the patients in these ‘Oxford’ studies have fatigue as a result of anxiety disorders, PTSD, depression, etc., which CAN be helped by psychosocial therapies, while others have the actual organic disease process known as CFS, which CANNOT be cured by ‘talk therapy’.
John,
While it’s true that much of the psychological studies of CFS have talked about catastrophizing, the research I used to write the article this post links to was actually U.S. research done on several rheumatological conditions — rheumatoid arthritis, osteoarthritis and fibromyalgia (which, in these studies, was treated as a physiological condition.)
Sadly, because of the political battle over how to classify these conditions, especially ME/CFS, it’s hard to talk about the psychological impact of having FMS or ME/CFS, or how our attitudes and beliefs can impact our health. A person with any chronic illness wrestles with the same psychological issues stemming from illness, and can potentially face the same psychological barriers to treatment and management.
I agree completely that it’s a travesty to suggest that ME/CFS can be cured by talk therapy. Anyone who suggests that, IMO, is chosing to ignore research to the contrary. However, we need to recognize that every person – physically healthy or not – has a psychological makeup that helps determine how they deal with difficult situations. Some deal with them better than others. I know people who catastrophize about all kinds of things (their weight, finances, jobs, relationships, etc.), and I’m certain that if one of them were to develop FMS, ME/CFS, or any other chronic illness, they would catastrophize about that as well.
If we ignore how illness impacts us psychologically, and how our own psychological make up plays into our approach to disease management, we’re doing ourselves a real disservice.
I truly thank you for your easy-to-read but informative posts on this topic. It’s nice to see continuous and topical coverage too, as you do, rather than just yet another article in the news feeds about how chronic fatigue is a silent illness, etc. (as necessary as such awareness-raising is).
As far as this post, however, my experience has been that the less I listen to people offer their remedies and get my hopes foolishly up to the extent I still can, and even the less I try to ardently search for cures (and the more I engage in meaningful work (usually light computer work) of some kind), the better off psychologically I am.
Granted, chemotherapy also left me more irritable (not to mention fatigued), than I had been earlier, but in the case of chronic fatigue, I think learned helplessness is actually the most adaptive solution for me. If there are no research-proven remedies out there (actually, the one I have seen, on 50mg of dark chocolate a day, does help me a great deal, even though any more than that and the caffeine interferes with my sleep), then becoming absorbed in finding a solution, when that pursuit can often just be more depressing where the thought of the illness compounds its effects, is just counter-productive–unless perhaps you enjoy the topic, and have energy and the willingness to be faced with it and study it, etc. (I’m feeling like “Red” in the film “Shawshank Redemption”: “Hope is a dangerous thing. Hope can drive a man insane”.) I just hope medical researchers and family members with chronic fatigue don’t take this learned helplessness approach. Believe me, as a former would-be over-achiever myself, I would like nothing better than to be able to take ownership, etc., but my experience has proven that letting it go (with the occasional foray into the news/research) is sadly the best way for me to go.
Catastrophizing unfortunately is common for many health problems. Even our current economic woes are inspiring new converts. But whether it’s a tough illness like Fibromyalgia, Chronic Fatigue Syndrome or something else, one of the best references I’ve ever found to explain the subject of catastrophizing and provide ways to overcome it is Jon Kabat Zinn’s Full Catastrophe Living. Find it easy inside the Amazon store at http://www.healthmattersshow.com. Thanks for providing more good information, Adrienne. Cinda Crawford
I have had fibro for 5 looong years. There were times when I just plain gave up, but the blackness around me when I did was so deep, I had to keep trying. Nothing ever worked 100%, meds, vitamins, acupuncture, massage and ionic detoxification therapy, and hypnotherapy. But together, they have had a cumulative effect, and today I’m doing amazingly well. I hope “they” come up with something definitive for this condition, I resent losing so much precious time to something that barely has a medical definition.
Gotta love those who take a forum and turn it into their own publicity show…thanks Cinda (not).
I don’t catastrophize, but I do know that depression and anxiety over waiting for my diagnosis took over. But, they are separate issues. Medication and therapy helped me with the depression, but it never cured the Fibro. From what I understand, depression is common among CF/Fibro sufferers.
Understanding the difference and how to treat them both is key.
Balance,
Please be kind to your fellow posters – Cinda is a friend of mine and we both believe that networking with other sites helps all of our readers find the information they need.
Thanks!
Adrienne,
I’ve struggled with the psychological effects of a chronic illness, but to some extent, I think this is normal. I struggle to admit that at times, I do get depressed – doctors treat this as something that needs to be medicated. I accept this as a normal part of being diagnosed with a life-changing illness. I think that the medical community needs to acknowledge that there is a grief process associated with a chronic illness diagnosis and try to “normalize” the experience for the patient rather than trying to medicate away the “psychological symptoms.”
I wish they would make it OK to talk about how we feel rather than applying a label and treating us differently because now we are “depressed.” I say that part of the PROBLEM is just that – we get treated differently. Our physical complaints become less believable and we get second-guessed.
I struggle with expectations. I am currently re-reading a few books that helped me out in the beginning – talking about the emotional aspects of having fibromyalgia. I think next time I will be more prepared to assert myself at the doctor’s office.
Heather
I agree with Heather, to be “depressed” is probably pretty normal and should it be medicated. I don’t think so unless it approaches clinical depression which is chemical in nature and needs medication. All the things I do for myself every day-meditation to de-stress, a bit of exercise that I can handle, watching my nutrition, paying attention to my body when it lets me know eating too much meat Hurts me, ditto sugar; all this things make me feel somewhat better, improve my mood and make life so much better. For me, stress is a killer, so I de-stress daily. I am 70 years old and have had fibro and Chronic fatigue symptoms since I was an infant as reported by a mother who had the same symptoms. I was in a severe auto accident at 3 months. I was diagnosed in 1995 and retired on SS disability due to Fibro in 1999 at 59. Retirement helped with the symptoms because I had a stressful job. My pain level and fatigue go up and down depending on the stress in my life. But life is good and I’m glad to be alive. I spend my days doing what makes me comfortable and happy. Nothing could be better.