Catastrophizing, defined as an exaggerated negative mental set, has consistently shown a negative impact on outcomes in patients with chronic pain and illness.
However, the factors that drive this cognitive distortion remain unclear.
Who gets to decide which “cognitions” are “distorted” when they are related to personal values?
In an effort to elucidate the underlying mechanisms, researchers led by Joan M. Romano, PhD, evaluated 2 models in the context of chronic fatigue, a chronic disabling condition often accompanied by pain.
Published in the March issue of the Journal of Pain, the study tested predictions from
- the cognitive behavioral model (CBM) and
- the communal coping model (CCM)
with respect to catastrophizing, solicitous responses, and pain and fatigue behaviors
“In a cognitive-behavioral model, catastrophizing is an appraisal that a situation is beyond one’s ability to cope, and therefore leads to negative emotions and poorer coping.
The communal coping model views catastrophizing as a strategy used to elicit social support from others,”
According to Dr Romano, both models have received much attention in recent years, but make different predictions regarding the relationships among catastrophizing, illness behaviors, and solicitous responses from significant others.
CCM suggests a social, goal-oriented process behind catastrophic thoughts, with pain behaviors communicating patient needs. Catastrophizing in this model is therefore influenced by perceptions of available support, including solicitous responses.
In contrast, the CBM suggests that catastrophic thoughts occur when patients are faced with events or situations that exceed their capacity to cope, causing them to feel greater distress and, subsequently, to display more pain and illness behaviors. While the presence of others may elicit expressions of distress, their support is not the primary driver of catastrophizing in this model.
Romano JM, Molton IR, Alschuler KN, Jensen MP, Schmaling KB, Buchwald DS. Reported pain and fatigue behaviors mediate the relationship between catastrophizing and perceptions of solicitousness in patients with chronic fatigue. J Pain. 2016;17(3):328-335.
Romano JM, Jensen MP, Schmaling KB, Hops H, Buchwald DS. Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses. J Behav Med. 2009;32(6):558-569.