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Doctors at Work Podcast.

Episode #55

How to stop catastrophising

Mat Daniel

11/01/2024

Have you ever found yourself worrying about possible disastrous outcomes, even though in reality they would be most unlikely? Thoughts going round and round? Emotions taking over rational thinking? Worried about the next on call, or feeling unable to progress certain practical procedures? Then you might have been catastrophising. Harry Glasstone tells me that in catastrophising emotions take over, and instead of being rational and considered, we obsessively focus on the worst possible outcomes. But whilst considering a range of outcomes is no bad thing, in catastrophising emotions take over control our actions more than rational thinking. He tells me how to identify when you might be catastrophising, and that the key to getting out of it is to convert emotional responses into logical approaches.

You can also watch the show at https://youtu.be/ktHaL3zrg8Q?feature=shared.

Harry Glasstone is an accountant and life & business coach.  He has run his own business for the past 20 years and more recently has developed his coaching practice to support clients in achieving their goals and objectives, acting as an accountability coach or supporting their future planning.  He is also a presenter on Virgin Radio Pride. You can find him on Twitter  @hglasstone, Insta  @harryglasstone, Linkedin  https://www.linkedin.com/in/hglasstone, or his website harryglasstone.co.uk. His Virgin Radio Podcast (Matt & Harry) is at https://play.acast.com/s/virgin-radio-pridecast

Podcast Transcript

[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Now, have you ever found yourself worrying about disastrous outcomes, even though in reality they are most unlikely? Thoughts going round and round in your head? Emotions taking over rational thinking? Maybe you’re worried about the next on call, you can’t sleep the night before panicking about what might happen.

Or perhaps you’re unable to progress certain practical procedures because you’re worried about what might go wrong. Then you might have been catastrophizing. Harry Glasstone in this episode tells me That in catastrophizing emotions take over and instead of being rational and considered, we obsessively focused on the worst possible outcomes.

Whilst considering a range of outcomes is no bad thing, in catastrophizing, the emotions take over control of our actions, more than rational thinking. He tells me how to identify when you might be catastrophizing and tells me that the key to getting out of it is to convert those emotional responses into logical approaches.

Welcome, Harry. Tell me a little bit about yourself.

[00:01:19] Harry: I have been an accountant for the last about 20 years running my own practice and about three years ago, I retrained as a transformational life and business coach so that I can help people not only with their accountancy work, but also with changes that they want to make in their lives. And I also present a program on Virgin Radio Pride with my partner focusing on relationships.

[00:01:43] Mat: And Harry, I found you because I saw you talking about catastrophizing and I thought what a great topic. What is catastrophizing?

Catastrophizing is a mindset where people tend to Predict the worst possible outcome in a situation, no matter how unlikely it may be.

[00:02:01] Harry: And it tends to snowball. So if you think of a snowball going down a mountain, it keeps on collecting snow and catastrophizing is the same principle. Something small happens and you think the worst and the worst and suddenly it becomes this insurmountable problem that you don’t know how to deal with.

[00:02:15] Mat: And where does it come from?

[00:02:18] Harry: Catastrophizing can probably be rooted in lots of different things. Sometimes it’s a learned response. Sometimes it’s something that happened in your childhood that makes you think the worst of things. It could be as a result of a trauma. It could be a protective mechanism, always providing for the worst so that you’re never disappointed with something or never hurt by something.

And also as humans, we tend to. We tend to focus on negatives often rather than positives. And so in any situation, we always think what’s the worst that can happen first, rather than thinking about the logical outcomes of any particular circumstances or any particular situation.

[00:02:55] Mat: Can I just rewind a little bit, because you said it, it might serve a protective function that, you know, if you assume the worst.

You won’t be disappointed. That kind of seems a bit almost counterintuitive to think that catastrophizing might actually serve a positive function. Can you tell me a little bit more about, why it might have evolved or why it might be a useful response that humans have?

[00:03:18] Harry: If you don’t want to be disappointed in something you’re, and you’re always thinking the worst possible outcome is going to happen, then you’re going to almost be pleasantly surprised when something happens that isn’t as bad as you thought it was going to be.

And let me give you an example. A few weeks ago, there was a problem with my car with a tire. And I thought, oh my God I’m going to have to replace the axle. There’s something wrong with the car. It’s going to cost me thousands. I’m going to be without the car for a week.

And when I went to the garage, They just needed to replace the tire. It took an hour. But I lay awake the night before thinking, Oh, I need the car for this and for that and for the next thing it served no purpose. At the end of the day, I had no idea what was wrong with the car. And it turned out to be something very little, but, and so when I found that out, I was like that’s all it is, it’s a very, it’s a very small problem rather than the thing that I’ve created in my mind.

That was. That was a huge potential problem.

[00:04:06] Mat: So it’s it is catastrophizing then, it sounds like it can be a good thing, but at the same time, it’s also a bad thing.

[00:04:14] Harry: Yeah, I think people use it. I’m not sure it is a good thing. People use it as a mechanism. I think people use it as a mechanism to protect themselves.

And so when something happens, they feel better about it. But in reality, if possibly if you thought about things in a different way, you wouldn’t get all worked up about it. And you’d still come to the same outcome. Okay. And so it may be a protective mechanism, but I’m not sure it’s a good protective mechanism.

I think there are probably better ways to deal with things. Okay.

[00:04:40] Mat: Because instead of people being, rational and recognizing, this is what, this is the stuff I can influence. This is what’s likely to happen. And, and yes, maybe there needs to be some planning for a possible worst case scenario but, rational planning instead of that people then get wound up and they get caught up in, you said, snowball where, you know, something that, that was probably never going to be an avalanche ends up being an avalanche.

And then it turns out that it wasn’t an avalanche anyway.

[00:05:08] Harry: Absolutely. And the whole thing about catastrophizing, it causes anxiety. It causes you not to sleep. It affects the way you operate. And all of that is unnecessary. If you can if you can find a way of not going down that path but dealing with a particular situation in a way that’s not going to cause you anxiety and not going to cause you not to sleep all night and therefore operate the next day on a zombie.

[00:05:27] Mat: And I think this happens a lot in people’s clinical careers. And I hear that. Sometimes often in people that are early on in their careers, before, before they’re on call or before they, they, cover emergencies, the kind of the unpredictable side where people do get, people often get, worried and worked up.

And as you say, they don’t sleep the night before, or they feel ill going in. I hope you’re enjoying the show. If you are, please click subscribe so you will be notified when new episodes come out. This podcast is part of my mission to help doctors create successful and meaningful careers.

You can be part of that mission too, by forwarding this show to any one person who you think might benefit from listening. Thank you. Now on with the show. And the other time I also see it is when it comes to people’s operative skills. That that, that, that somebody, say when somebody’s training and there’s a Maybe that there’s something that didn’t go quite well or, there was a, there was something that they didn’t do in the way that they would have wanted to do.

And then that, that extrapolates from, this is a step that I haven’t learned and, and I’m learning in a safe environment. I’ve got a supervisor that watches me, that trains me, that delegates to me appropriately. So it rolls out from being, I’m learning in a safe environment, and this is something I haven’t yet mastered, but I will, into, I’m a terrible surgeon, I can’t do this operation, I can’t operate, I’m never going to be able to do that.

So it sounds like, they would be examples of catastrophizing based on what you’ve talked about.

[00:07:01] Harry: Absolutely. And Matt, maybe I’ve got a question for you, which is, as a surgeon, sometimes things don’t go right. And in a particular point in time, you potentially have to think of a range of possibilities of what could happen in that particular circumstance.

And you almost have to catastrophize to come to an answer as to what you’re going to do next. What’s the worst thing that could happen because of the bleed. And but I think in that situation, and correct me if I’m wrong, experience kicks in rather than emotion. And you look for a solution that’s going to work in that particular circumstance, is that right?

[00:07:32] Mat: I think so. And it’s I’d start by saying that the things are things often don’t go as they should be. That’s the reason why, I’ve trained for decades to get where I am is so that I can handle those things. Yeah, because, every human being is different.

Every patient is different. And yes, there are some things that are always the same. But it’s quite often that the patients are not the same, they have different things they respond differently. And yes, again, if you end up being emotionally involved, that something’s not going the way that you, that it should be, if you’re emotionally involved, that’s going to be a disaster, isn’t it?

Yeah. Whereas, as you, whereas maybe the way that I do it, or the way that I think. The way that I think is done well is somebody who detaches from emotions and say, okay, it’s not going quite as planned. What’s my plan A? What’s my plan B? What’s my plan C? What’s my plan D? Where can I go for help?

What else I can do? What are my choices? So you need. You need, actually, the last thing that you want is emotions. Yeah, you, what you, the last thing you want is emotions and thinking, Oh my God, this is terrible. What you want is clarity to say, all of these are my options.

These are my choices. These are my friends. This is what I could do. This is where I could go to. This is what I’ve seen done. This is what other people have done. This is what I’ve read about. You want that big picture but with clarity to pick from a menu of possible. Futures rather than emotions is the last thing that you want.

[00:08:59] Harry: And I think you’ve hit the nail on the head there with catastrophizing. Catastrophizing is all about emotion, right? It’s and the theory about how to overcome catastrophizing is to put logic into the picture, right? Perhaps I can talk a little bit about how I think people should stop catastrophizing or how people can go about stopping to catastrophize.

And the first thing you have to do is when you’re catastrophizing is realize that you’re doing it. And say, hang on a second, this doesn’t make any sense. I’m taking something very small and blowing it out of proportion. I need to stop and do something right and in a lot of the reading I’ve done about testifying they often say what you should say to yourself out loud is stop.

because that’s like a trigger to read to say, hang on, I realized, I’m catastrophizing here. I need to stop and do something else. And then what is the something else is that. You need to challenge what you’re thinking and assess whether it’s true or not and find rational ways of finding the different answer to the problem that you that’s causing you the catastrophizing and there are lots of different ways to do it.

But the first thing that always people need to do is take a reality check and say, stop this. This is just my emotions getting carried away. And what I need to do is rather than think the worst is going to happen. And in many cases, the worst is such an unlikely situation, right?

That any rational person looking down on the situation would go. That’s never going to happen. But when you’re in the situation, it doesn’t feel that like that. And so you actually have to say stop this. This is just crazy. I need to have a look at this, look at the problem and look at a bunch of different answers that might potentially happen.

And also I maybe need to go away and research or find the probability of each of those things happening to calm myself down and realize that yes the very outside chance may happen, but as a point, 0.0, 1% chance of that happening, whereas there’s a 92% chance of something else happening and I should rather focus on that rather than the thing that’s most unlikely to happen.

[00:10:49] Mat: If I go back to, to, to the beginning of that, ’cause you said the first thing you’ve got to do is you’ve got to realize. That what you’re doing is catastrophizing and you’ve got to call it out and stop yourself. How would somebody know that they’re catastrophizing?

[00:11:02] Harry: I think you probably feel it, right? It’s you starting to get anxious about something, your thoughts are going wild about that particular thing. And if you can see yourself doing it, that’s when you call yourself out, right? And I’ve noticed myself doing it. And it’s hard to do it, it takes practice. To say to yourself, stop, this is just not going in the right direction.

But it’s just a matter of watching what you think, when you, when these thoughts start going wild in your mind, that’s when you know that’s, that you’re catastrophizing, right? That you’re thinking about the wildest possible answer to something that may never happen.

[00:11:37] Mat: Yeah, no I recognize that sort of thoughts going around and, I think for me often it’s I’m going to say for me it’s catastrophizing is when I’m wanting to eat rubbish. So I say, okay, what’s going on? I don’t normally eat this junk. So why does this rubbishy food all of a sudden seem attractive? I know somebody else who says they get the pressure behind their eyes.

They feel. They feel it but yeah, but that, thoughts going round like a whirlwind of emotions and panics, and in different things. Yeah, but quite difficult to get yourself out of that though, I think.

[00:12:11] Harry: It is, and sorry, another clue as always. If you’re thinking what if what if that and what if that and what if that and what if that’s when you’re catastrophizing because the what if so all being created in your mind, right? Yeah. And the other thing people have to recognize is that the physical well-being will determine. A lot of the time we’ll enhance whether they’re catastrophizing or not.

If you’re tired, if you’ve had a bad day, if something’s happened in your life, that’s made you a bit down, you’re potentially more likely to catastrophize. Then if you’re feeling bright and perky in a particular day, because on those days, you’re more likely to have a rational thoughts about something.

Then if you’re really down or low or tired.

[00:12:49] Mat: So actually, this sounds super important then for doctors, because if I go back to that first example of people being on call, when they’re in long shifts, so you know, they’re on call, all weekends or whatever, and inevitably people be tired and often they won’t have had food.

And there’ll be multiple demands, it’s a real, it’s physically and mentally really challenging time and from what you’re saying that’s a perfect setup for catastrophizing then.

[00:13:15] Harry: Absolutely, absolutely. And there are lots of different ways to combat catastrophizing.

It’s very circumstantial. One of the ways people often say is to journal your thoughts, right? Because often when you write things down on a piece of paper, or when you say them out to somebody, they sound very different to what’s Buzzing around in your head all day long, right? But if you’re on call, you can’t suddenly go off and journal.

So that’s not a potentially not an appropriate situation for that situation, but there are other ways of dealing with it. So what you do is you can do something like using a best friend test or what I call a best friend test, right? If your best friend came to you with a problem, the same problem, as a, as an outsider, what would you tell them? So another junior doctor came to you and said. This case is presented to me right now. I’m totally flustered. What should I do? What would you tell that best friend? As an outsider. So you can do the same thing to yourself, or you can go to your best friend or the other doctor and ask them the question, and say, I’m totally panicked about this particular case. What should I do? And either internally as a, in your own mind, as a best friend or going to somebody else That allows you to calm the situation down and to take an outsider’s perspective on, on what’s going on. And so all these catastrophizing thoughts suddenly get squashed because logic is coming into the picture, right?

And you’re saying, there’s no emotion here. I’m dealing with somebody else’s case. What should I do? Or going to somebody else and offloading on them and they’ll come back to you with the logic and say, That’s emotion and that’s logic, that’s what you should do. Some of the other techniques are just things like breathing or mindfulness, right?

So stop, take a breath, let your body relax for a second and then go back to the thought and think about it from a different perspective. Or in a mindfulness is all about the moments. So just take a moment and experience the moment and then go back to whatever’s bothering you and see if coming in calmer.

It changes the way you think about something.

[00:15:05] Mat: I have to say, when on call or even when operating there’s always more time and opportunity to take time out and think than people realize. Yeah, because people think that I have to be present every single minute and everything has to be done this second.

And the reality is that’s actually quite rare. Because almost always you can get a couple of minutes or five minutes to take time out to think. So I think, for anybody listening I would say that there’s almost always the possibility of taking five minutes much more often than we think.

The pressure to be available now, that often comes from the inside rather than from the outside. Yeah. So that kind of, that would be my. My observation, not always, as you say, it’s not always appropriate, but more often than not, it is quite possible to take five minutes, even if it’s in the middle of an operation or the middle of a busy on call, and I really like the idea of going and talking and asking somebody else.

For help, because that’s also, I think that that’ll help the person that’s asking for help, but also the person that is being asked it normalizes the idea that we talk to each other about the challenges that we face, because, if all of us think, Oh, I have to be perfect, I can’t ask for help, I must be able to handle this by myself.

I must know everything. Then everybody else thinks Matt’s got his shit all together. And yeah. I really know what he’s doing and I’m the only person who’s struggling with this. Yeah, and the reality is we’re all struggling with these things. Yeah, so the more that we go and ask and talk to each other, then the more it normalizes to say that actually, these are problems that all of us face.

Yeah, and none of us are perfect and none of us have all the answers. And if we do go and talk to each other about the challenges that, that. That’s firstly, that’ll resolve the issue that’s been asked question about. But also it’ll normalize the idea that we go to each other for help and that we help each other out.

And that’s a really powerful message to send out there.

[00:16:54] Harry: Absolutely. And the other thing is people shouldn’t forget about what they’ve done in the past, right? You’ve overcome difficult situations in the past. So think back about. What process you use to overcome that situation. And again, this goes back to logic versus emotion, right?

Think back about the last time you had a case that you didn’t know what to deal with. They didn’t know what to do with, right? How did you deal with that? Did you go and ask somebody else? Did you look it up on, did you research the situation? What did you do to find a solution to that problem?

Because you must have found a solution to that problem. Even if the solution was. getting somebody else involved who’s more experienced than you to help you solve the problem, right? Because that was a good strategy in that particular situation. And maybe that’s the same strategy you need to use now, rather than having these emotional catastrophizing thoughts in your mind.

And the other thing that, that springs to mind in that situation is mindfulness. And mindfulness is this. Thing that sometimes people don’t understand, right? It’s all about just getting present in the moment. So that you’re not worried about all the future and the noise and all the other things going around you.

And there’s some very simple techniques to be mindful. And one of them is just to look around you and name five things that you see, four things you can touch, three things you can hear, two things you can smell, one thing you can taste. Notice your breath and your breathing and your diaphragm.

And that takes two minutes, right? But it actually centres you to a place where You’re a bit calmer than where you were two minutes ago, and you can then go out and do the next thing or face the next challenge that you’re trying to deal with.

[00:18:21] Mat: If I, again, if I take myself to the workplace, if I see people around me how would I recognize that the people around me are catastrophizing?

[00:18:31] Harry: I think it’s stress, anxiety, panic. Those are the things that you can see in other people. Because if you look at, if I look at myself and if you look at yourself when you’re catastrophizing, those are the things you feel, right? You’re emotional. You’re uptight and if you can see that in other people, you can see it in yourself as well.

And if you do see people like that acting like that, you can reach out and say, is everything all right? Because what might happen is they might be catastrophizing about a particular situation. And you might be that best friend in that particular case where they can say, this is what I’m worried about.

And you can go, hang on, let’s look at this logically and see if we can find a solution together. Ultimately it’s particularly in that environment, it’s a team effort, right? No one expects you to operate as an island. You’ve got people around you that can help, right? So rather than going down a path where you’re panicking and catastrophizing, just reach out to somebody or be that person that other people can reach out to stop themselves from going down that path.

[00:19:29] Mat: What about patients? Because I think all of us will also have patients that, that catastrophize. So you know, what might, if you what tips would you give to a doctor in, when it comes to managing a patient that’s catastrophizing?

[00:19:43] Harry: Catastrophizing patients is interesting because I’ve seen some research that says that patients recover better if they’re not catastrophizing than if they are catastrophizing.

And so it’s interesting that has a, this, the psychology has an impact on the physical. As a doctor, as a patient, let me go as a patient because I’ll always be a patient, right? I’m not a doctor. I’ll always testifies about anything when I go to a doctor, right? I’ll go to a doctor and I think that the worst possible outcome is going to happen, right?

Automatically, no matter what the situation is. And so I guess as the doctor, your role is to notice that, see if that’s happening and try and find ways of reassuring me that I’m not going to die. It’s just a little thing on my hand that needs to be removed or whatever the case may be.

And giving people information so that they can stop catastrophizing. Remember to stop catastrophizing. It’s all about logic, right? So you need to try and take emotion out of the situation. And so giving people information and giving them an understanding of what’s going to happen, giving them a range of possibilities that’s going to happen without saying this is definitely going to happen to the worst case situation.

It allows them to integrate that information into their thinking and to not catastrophize about something. And if they are catastrophizing, it’s almost helping talk them down. If I can use that terminology from understanding why they’re catastrophizing and trying, giving them information to try and give them information so that.

So that they can minimize that anxiety and minimize that fear. At the end of the day, I think most patients are going to be fearful and anxious going to a hospital, going to a doctor, right? And it’s finding ways of helping them minimize those emotions.

[00:21:21] Mat: So it’s about reassuring with facts and knowledge.

And trying to step out of emotion, or maybe, there’s a little bit of emotion involved in reassurance, but there is the emotional reassurance comes from sharing, facts, figures, statistics, knowledge, objective stuff rather than wild ideas about what might happen.

[00:21:43] Harry: Yeah.

And I think also what’s really important Is allowing people to verbalize what they’re thinking, right? Because as a patient, you can throw a lot of stats and numbers at me and it’s not potentially, it’s potentially not going to reassure me. But if you said to me, what’s worrying you, how do you feel about that?

Then, as I said earlier, even just by verbalizing something, the thought that’s buzzing around in your head suddenly doesn’t become the same thought when you say it aloud to somebody else. And a lot of the anxiety then goes, because what. You realize that what you’re saying maybe doesn’t make sense, right?

Always it’s overstating the situation. And oftentimes it’s just allowing people to talk and to say what they’re feeling and what they’re thinking and then reassuring them based on that.

[00:22:26] Mat: It’s interesting that verbalizing it go, going back to doctors, you talk about people journaling is I somebody did the research studies and what they got is they got doctors to do an audio journal.

Yeah. So not writing down stuff, just dictating. And I can see how that would achieve what you’re saying is, there’s all these thoughts in my mind and let’s get them out there. And then you think, this sounds ridiculous. Yeah. Or probably you’re going to think when you’ve written it down or whether you dictated it to yourself, you okay.

I can’t even, I can’t even verbalize what’s going on in my mind. Cause it doesn’t translate into language. Cause of course, emotion, isn’t it? It’s not words. It’s emotion. Yeah. Yeah.

[00:23:05] Harry: Yeah. And we talked a little bit about a situation where someone was operating on the floor of a hospital.

At the end of a shift, you’ve also got all that stuff that you’ve dealt with in a shift that exactly as you say, you could just on your way home to a verbal journal of what’s happened in the day. And that helps you dump a lot of information out of your mind and Onto your journal and you can either look back on it and learn from it or just remove all that stress and anxiety just by, by out, getting it out through your mouth, right?

And suddenly all those strange thoughts that are buzzing around your head, I did this wrong and I did that wrong. And the next thing suddenly doesn’t seem so big. And it also gives you a steer onto things that you potentially need to do. So I got this wrong. What do I need to do? So that doesn’t happen again.

And because then in the future, I won’t catastrophize about it because I will learn from the situation that I’ve had today, or I’ll improve my knowledge, which means the next time I can go hang on, I did that the last time, or I’ve learned that from after the last thing from somebody else.

I know how to deal with this today. I don’t have to catastrophize about it.

[00:24:06] Mat: And I probably even go one up from learning from it, which would be telling everybody else about the mistake and what you’ve learned, because then, other people learn from your mistakes as well. And other people realize that everybody’s human and it happens to everybody.

And if we, if all of us pull our mistakes and our learning together then there’s more learning that goes round, isn’t it? And instead of next time thinking. I’m the first person this has happened to, then I go, yeah, it’s happened to so and this is how they dealt with it. And I’m, I’m one step ahead already in terms of dealing with the issue.

[00:24:37] Harry: Well, that’s it. And verbalization is so important. Even if you said, if you’re speaking to yourself, this is not good. How am I going to deal with this? What did I do the last time? Asking yourself verbally the questions, because it’s as if somebody else’s asking you the question, you can answer them rather than things buzzing around in your mind, because that’s, it’s just, isn’t healthy for that to happen and you catastrophize because of it, right?

Those thoughts just buzz around and keep on adding to each other.

[00:25:00] Mat: Yes. Yeah. Okay. Maybe I’ll bring us to a close, Harry, if I can ask you, what would be your top tips for doctors at work?

My top

[00:25:09] Harry: tip for doctors at work would be let’s call it, I like to call it the ICAN strategy, right? I C A N identify if you’re catastrophizing.

So stop yourself by doing it. Say something like stop, realize that you’re doing it, challenge and assess what you’re thinking, and say, does this seem rational? How do I deal with it? Can I speak to somebody else? How do I find a different solution and then find a new outcome, right? So find a different solution to the thing that you’re catastrophizing about.

So rather than thinking of the worst case scenario, use a bit of logic, take out the emotion and think of what is the actual situation that’s likely to happen. So identify challenge, assess a new outcome. I can. And if you can start practicing that and it doesn’t come naturally you’ve got to practice, right?

The biggest thing is identifying when you’re catastrophizing because then you can take the logical steps from there to, to stop doing it. And it’s a process you learn to get better at it as, as you go along.

[00:26:07] Mat: That’s a great framework. Thank you very much, Harry. Okay.

[00:26:09] Harry: Thank you very much.

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