Indulge the Catastrophe

Recently, I was working with a client who was doing a fair amount of catastrophizing.  They’ve also been working with me long enough to see my “And how are those thoughts serving you?” coming a mile away.  They’d follow one catastrophic bunny trail of thinking for a few seconds and then say, “Well, but I know it’s stupid to think that way,” and throw out self-serving thoughts for a few more seconds before finding (and following) a slightly different catastrophic bunny trail to follow.  “Hang on,” I interrupted, “What if we just indulged the catastrophe?”

Humans have evolved to take the most minor problem and blow it up into disasters of epic proportions.  The rustle in the trees is not the wind; it’s a saber-toothed tiger ready to pounce and eat us.  (At least that’s what our ancestors who survived to reproduce thought.)  Our medical training has made this negativity bias highly functional.  For me, a patient with pneumonia is rarely just a patient with pneumonia; past a certain point, any uptick on their ventilator settings, and I’m checking to see if we have an oscillating ventilator available and thinking about whether the patient is a candidate for support with ECMO.  When I’m ready for the worst-case scenario, and the worst-case scenario does not happen, my brain learns that bad things won’t happen when I’m overly prepared.  Now, logically, I know that is not true.  But our brains believe irrational things all the time.

The problem with cutting off our catastrophizing is that it creates an open loop that our brains will not let go of.  (This is one of the reasons why toxic positivity doesn’t work, BTW.)  What does indulging the catastrophe look like?  Let’s go to one of my favorites as an example:

Scene:  I’m in the unit, and something goes poorly.  I say something disparaging about the situation that may be taken as unprofessional by specific pairs of ears.

My brain: Well, @#$%.  That will make it back to (insert medical director here).  She’s got enough to deal with, and now she will have to deal with all of the emails from this.  How many of these situations have I been in?  It might make it to (insert division head here).  Ugh, if it makes it to him, it might make it to (insert chief of staff here).  What if they’re all sick of my hissy fits, and I get fired?  OMG, I’m totally going to end up homeless under a bridge.

Fin

Indulging the catastrophe involves taking the worst-case scenario and asking yourself, “So, what?” seven times:

I get fired.  So, what?

I’d probably try to find a pediatric intensivist job at (insert competition across town here).   So, what?

If they didn’t give me a job there, I’d look for a pediatric intensivist job outside of Nashville.  But I don’t know if my partner would want to move out of Nashville.  So, what?

I could stay here and find a primary care job, but that would come with a pay cut.  Maybe my partner only loves me for my money.  So, what?

If my partner only loves me for my money and we get divorced because I can’t be a pediatric intensivist in Nashville anymore, I can get whatever job I want wherever sounds fun.  I could be a barista in Maui.  So, what?

Getting divorced would be a sad and expensive pain.  Moving would be a sad and expensive pain.  So, what?

I’ve been sad while doing expensive and painful things before and have come out of them just fine.  So, what?

So…I’ll be fine.

There’s no magic about asking yourself, “So, what?” seven times.  Usually, when I do this, I can get to “So…I’ll be fine” by the fourth or fifth time.  The point is to keep asking your brain for solutions until you see that you will, in all rational likelihood, be fine.  At the moment, my brain had me homeless and living under a bridge.  When I slowed my brain down, it had the chance to be rational about what I was going through.  Were things going to be difficult?  Sure.  Sad?  Yep.  Even painful?  Absolutely.  But I would be fine.  

The next time your brain is catastrophizing, cut yourself some slack because it’s just doing what it’s evolved to do.  Then, ask yourself, “So, what?” from a place of curiosity.  You’ll be pleasantly surprised how often you see you’ll end up just fine.