Navigating Negative Thoughts: 9 Tips for Managing Pain and Spiraling Thoughts in Endometriosis

Pain can sometimes be influenced by a phenomenon known as “catastrophizing”. Catastrophizing is an unconscious cognitive pattern backed by verifiable processes in the brain. It is not about exaggeration but rather a distinct way the brain processes situations, including future and present pain, as more intense and severe than they are. This process often manifests as a spiral of negative thoughts.

Biologist Tina Schlüter explains it as follows:

Individuals experiencing this often expect the worst possible outcome and believe improvement is unattainable. For instance, many students worry about their grades, but this concern becomes overwhelming for some. Someone prone to catastrophizing might evolve from this worry a sense of inevitable failure. This can further lead to a belief that they are incapable of making progress, passing exams, finding employment, and even accomplishing anything. Frequently, a feeling of helplessness takes root. The cognitive pattern can magnify pain perception beyond its actual intensity – essentially, the brain accentuates the pain. This process is rooted in learning mechanisms in the brain, not mere imagination. Prolonged rumination also contributes to this amplification. The repetition of negative thoughts reinforces these feelings of helplessness [7]. The positive aspect is that thinking patterns can be addressed, presenting an opportunity to impact pain perception positively.

Why is This Significant for Endometriosis?

Catastrophizing also holds significance in the context of endometriosis.

On one hand, the inherent connection between endometriosis and pain naturally triggers negative emotions. These can intensify within the spiral of catastrophizing, much like the anxiety example previously discussed. This underscores the importance of implementing measures to counteract this spiral and enhance well-being.

At the same time, it is essential to recognize that catastrophizing exacerbates the experience of pain. Thus, breaking free from this spiral becomes doubly crucial!

In 2018, Canadian researcher Allison E. McPeak and her colleagues studied the impact of pain catastrophizing on women with endometriosis [4].

Their study involved 236 patients who had received treatment at an endometriosis center and had an average age of 35. The participants were asked about their health-related quality of life, explicitly assessing how pain influenced various aspects of their lives, including social activities, work, exercise, and sleep.

The research revealed a direct link between heightened pain catastrophizing and diminished health-related quality of life. Notably, chronic lower abdominal pain and menstrual cramps exerted a substantial influence on the quality of life of the surveyed women with endometriosis. Importantly, other potential influencing factors, such as demographic data, depressive symptoms, and concurrent medical conditions, were negligible in this context.

The Significance of Brooding: Unraveling Its Role

Rumination entails a style of problem-focused thinking that fuels catastrophizing. It involves repetitively contemplating a problem without making any progress towards a resolution. This cyclic nature of rumination obstructs the initial strides toward finding a solution and ensnares individuals within an escalating spiral of ominous future scenarios.

Strategies to Counter Catastrophizing

Stop Ruminating: The initial step involves recognizing when you are caught in the rumination loop. Remember, ruminating is a common human experience that we all encounter occasionally. Instead of criticizing yourself, acknowledge its presence. Embrace this awareness as an opportunity for positive change. Once recognized, ask yourself if this mental process propels you forward; if not, take decisive action. Employ distraction, engage in physical activity, or audibly command yourself to stop. Break free from brooding.

Expressive Writing: A practical approach to counteracting catastrophizing is the practice of expressive writing. This technique involves candidly documenting one’s emotions and stresses. Research substantiates its efficacy: a study revealed that engaging in expressive writing for as little as 3 days reduced pain intensity, elevated mood, and decreased daily limitations among women prone to catastrophizing [5].

Boosting Self-Efficacy: Countering the sense of helplessness intrinsic to catastrophizing involves incorporating strategies that enhance your self-efficacy. These measures bolster your confidence in the efficacy of your actions and reinforce your belief in your capabilities [4]. Consider the benefits of jotting down your daily successes – no matter how minor—along with instances when you have received praise or demonstrated strengths. The cumulative effect of both small and substantial achievements is profound. Set aside moments to revisit and expand upon this list. Then, when confronted with catastrophizing tendencies, you can turn to your roster of achievements. You will likely realize that, more often than not, things have transpired favorably, have they not?

Weighing the Pros and Cons: Look at your situation from different perspectives. What factors support your fears, and what aspects challenge them? Consider the example of an exam scenario mentioned earlier:

Catastrophizing thoughts: “The exam will be difficult. I will inevitably fail. I am a failure and will never find a job…”

Alternative thoughts (pros and cons): “I learned a lot and was able to answer all the questions on the mock exam. If I still fail, I can seek help from the tutor and retake the exam. So far, I have somehow passed all exams, although I thought I would fail them each time.” Employ this technique to evaluate and counter your catastrophizing tendencies.

Embracing Positivity: Frequently, our focus naturally gravitates toward our problems and the negatives in our lives. Catastrophizing amplifies this tendency. Yet, regardless of how dire a situation may appear, positive elements and effects may still exist within it. Initially, this notion might seem counterintuitive. How can pain or problems yield positivity? This approach does not seek to trivialize pain or discourage addressing it. Instead, it underscores the truth that challenging situations often contain nuanced dimensions beyond negativity. Consider whether you unearth a modestly optimistic angle or identify constructive outcomes from your circumstances.

For instance: “Yesterday, feeling unwell, I reached out to a friend for help. Surprisingly, she appreciated my trust and the chance to provide support. Our friendship has grown stronger as a result.” Can you find your own examples? Endeavor to cultivate this practice of seeking the silver lining.

Embrace Mindfulness and Acceptance: Engaging in mindfulness practices, such as Mindfulness-Based Stress Reduction (MBSR), has diminished the grip of catastrophizing [1]. Similarly, Acceptance and Commitment Therapy (ACT) can yield comparable outcomes [6]. A noteworthy correlation exists: heightened catastrophizing is often associated with diminished acceptance and mindfulness. Consider immersing yourself in a mindfulness exercise! Consistent engagement with such activities can unveil noticeable transformations in your outlook and experiences.

Psychotherapy: Cognitive-behavioral psychotherapy, in particular, has demonstrated effectiveness in mitigating catastrophizing [8]. If you find yourself grappling with intense challenges and navigating them independently seems impossible, consider seeking professional assistance without hesitation. Engaging in open conversations about your situation often unveils nuanced perspectives, alleviating the perception of despair.

Somatocognitive Therapy: Notably, somatocognitive therapy has exhibited favorable outcomes in addressing catastrophizing [2]. Originating in Oslo, this distinctive pain management approach amalgamates physiotherapy and cognitive psychotherapy principles. This involves several components: (1) heightening body awareness, (2) engaging in specific daily movements and appropriate breathing techniques, (3) providing emotional support and enhancing self-efficacy, and (4) employing manual muscle relaxation and relaxation exercises [3].

Multimodal Pain Management: Lastly, combining different therapeutic approaches within a Multimodal Pain Management framework has demonstrated efficacy in mitigating catastrophizing. According to findings from a review paper, researchers concluded that Multimodal Pain Management represents the most effective intervention for countering catastrophizing [6]. Multimodal pain therapy is frequently recommended for individuals grappling with intense and persistent pain.


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What helps you best to escape the mind spiral? Feel free to tell us in a comment.

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By the way, you can discover mindfulness and acceptance exercises within the Endo-App.

Teresa Götz