Anonymous | 17 May 2021
“You have an anxiety disorder.” The first time I heard those words I felt relief wash over me. This wasn’t normal. The panic attacks, the low self-esteem, the wish to disappear from existence. Now it had a name, and I started to believe I could manage it.
The first time I experienced a panic attack, I didn’t know that’s what it was. I was in my late teens and was upset about a relatively minor problem. Dad had two tickets to an event, but Mam was struggling to get time off work to go. Dad’s solution was to give the tickets back, not once thinking of asking if I wanted to go instead. I lay awake that night, unable to fall asleep, trying to work out why Dad would rather not go at all than ask me to join him. Very quickly this spiralled out of control and I’d convinced myself that Dad didn’t love me. I’d done something wrong. I wasn’t good enough. I didn’t deserve to be loved. My chest was tight. I was short of breath. Silently I sobbed apologies for not being enough, whilst at the same time not understanding what I had done wrong.
Several years later, I now know that this was a classic case of catastrophic thinking. Catastrophising was defined in 1962 by Albert Ellis as a “tendency to magnify a perceived threat and overestimate the seriousness of its potential consequences” (Gellatly & Beck, 2016). To use a more common saying: making a mountain out of a molehill. In the mid-60’s, Aaron Beck developed Ellis’ ideas to propose a theory of depression, where patients hold exaggerated beliefs leading to misinterpreting situations as more negative than they actually are (Beck, 1963, 1964). This was also applied to anxiety disorders by Beck and expanded by David Clark in the 1980’s (Beck, 1986; Clark, 1986).
Sufferers of anxiety misinterpret both internal and external sensations as far more serious than they are in reality. A common example of this, within a panic disorder, is misinterpreting non-lethal pain as an imminent threat to life. Now, I believe it would be very difficult to find anyone who hasn’t experienced pain in the chest or head and not had at least a passing thought that they were experiencing a heart attack or brain aneurysm (especially after googling your symptoms). However, usually these thoughts pass, and you realise you had jumped to a worst-case-scenario conclusion (and need to stop believing everything you read on the internet). You then take a painkiller and move on with your life. For a person with a panic disorder this scenario can play out very differently. The belief that the pain in your head is due to an aneurysm becomes exaggerated. You cannot see that this is probably not the case, and you have jumped to an unlikely conclusion. Fear starts to set in and the only thing you can think about is the pain and how you are convinced a blood vessel has burst. You will die. You are unable to stop the escalating anxiety and experience a full-blown panic attack.
How catastrophic beliefs result in panic and other forms of intense anxiety can be thought of as a positive feedback loop; a cycle that once triggered, keeps triggering itself (Gellatly & Beck, 2016). An initial event (pain in your head) induces catastrophic beliefs (the brain aneurysm). This then leads to interpretive bias where the situation can only be terrible (“this pain means I will die”), reaffirming the catastrophic belief. Attentional bias also occurs, where only threatening information is taken in (the fact the headache is painful and ignoring that it’s not a “thunderclap headache” characteristic of a burst aneurysm (NHS, 2018)) and this reinforces the interpretive bias. Attentional fixation supports the attentional bias by forcing focus solely to the threat (the headache) so the situation cannot be re-examined. Physical symptoms of anxiety, such as chest pain or shortness of breath, occur from which new catastrophic beliefs form, kicking off the entire cycle again. Fixation also occurs on these physical symptoms, bringing the attentional and interpretive bias towards them. In this way, a single event inducing a catastrophic belief triggers a cycle of anxiety and panic that is difficult to break.
Why do some, but not others, fall victim to this cycle of catastrophic beliefs is not clear. Why can some people realise that the initial thought that they may be in a life-or-death situation is ridiculous and move on with their lives, whilst others spiral into panic? As is often the case with neurological disorders, the answer appears to be a combination of nature and nurture (Meier & Deckert, 2019). Various genes and mutations have been linked with anxiety disorders, but how it manifests is also influenced by the environment and individual experiences.
To help those prone to suffering from catastrophic beliefs, cognitive tools have been developed to promote ‘de-catastrophising’ (Knaus & Carlson, 2014; Whalley, 2017). It’s well known that acceptance is the first step towards recovery, and the same is true for catastrophic beliefs (Knaus, 2012). Accepting that you experience catastrophic thoughts and not placing blame on yourself is a crucial step towards breaking the cycle. Stopping and reflecting on these thoughts can help you see the bigger picture. Ask yourself what’s actually happening here? Is the leap you’ve made logical? Or are you fixating on something awful yet unlikely? Breaking out of this cycle of blame and judgement is not easy and may require professional help to guide you through de-catastrophising techniques.
When I think back to my first encounters with catastrophic beliefs, I still feel shame and embarrassment that something so small and inconsequential caused such drastic feelings of inadequacy, and I don’t expect those feelings to ever go away. Even back then, I knew this incident was not worth the pain I was experiencing and even recognised the situation itself was a privileged one to be in (which just added to the guilt). However, in that moment I felt it represented a much larger defect. I was unlovable for reasons I couldn’t fathom. Over the following years, relatively minor issues continued to spark panic attacks and only reinforced my low self-esteem and low confidence. I came to believe that this was just how I was. It became my defining personality trait. I experienced sustained periods of anxiety, believed it would never get better, and maybe the only thing to do was end it all. It was at this point, years after my first attack, I finally realised this wasn’t normal and I needed help.
Understanding what is going on in my head has helped me to recognise when I am catastrophising. I can remind myself that the situation is not as bad as I think. I can take the first step towards shedding (at least some of) the blame and judgement. It’s not an easy path and I often fall off it. I still sometimes believe this is all I could ever be. But knowing there’s a reason behind it, knowing these theories came from observations of others, helps remind me I am not alone. I don’t judge others on their mental health, so why should I judge myself? I will not be defined by anxiety. I will not let others define me by it. I refuse to be only this. I am so much more.
Editors: Matt Higgs and Steliana Yanakieva
References:
Beck, A. T. (1963). Thinking and Depression. I. Iidiosyncratic Content and Cognitive Distortions. Archives of General Psychiatry, 9, 324-333. https://doi.org/10.1001/archpsyc.1963.01720160014002
Beck, A. T. (1964). Thinking and Depression. II. Theory and Therapy. Archives of General Psychiatry, 10, 561-571. https://doi.org/10.1001/archpsyc.1964.01720240015003
Beck, A. T. (1986). Cognitive Approaches to Anxiety Disorders. In B. F. Shaw, Z. V. Segal, T. M. Vallis, & F. E. Cashman (Eds.), Anxiety Disorders: Psychological and Biological Perspectives (pp. 115-135). Springer US. https://doi.org/10.1007/978-1-4684-5254-9_7
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470. https://doi.org/10.1016/0005-7967(86)90011-2
Gellatly, R., & Beck, A. T. (2016). Catastrophic thinking: A transdiagnostic process across psychiatric disorders. Cognitive Therapy and Research, 40(4), 441-452. https://doi.org/10.1007/s10608-016-9763-3
Knaus, W. J. (2012). Anxiety and Exaggerations: Get relief from amplifying possibilities into catastrophes. Psychology Today. Retrieved 18/06 from https://www.psychologytoday.com/gb/blog/science-and-sensibility/201211/anxiety-and-exaggerations#:~:text=Worry%2C%20anxiety%2C%20stress%2C%20and,Fortunately%2C%20catastrophic%20thinking%20is%20correctable.
Knaus, W. J., & Carlson, J. (2014). The Cognitive Behavioral Workbook for Anxiety : A Step-By-Step Program. New Harbinger Publications. http://ebookcentral.proquest.com/lib/cardiff/detail.action?docID=1832191
Meier, S. M., & Deckert, J. (2019). Genetics of Anxiety Disorders. Curr Psychiatry Rep, 21(3), 16. https://doi.org/10.1007/s11920-019-1002-7
NHS. (2018). Overview Brain Aneurysm. https://www.nhs.uk/conditions/brain-aneurysm/
Whalley, M. (2017). Psychology Tools For Overcoming Panic (1 ed.). Psychology Tools.
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