Catastrophic thinking about pain: A critical appraisal highlighting the importance of the social context and balance

Abstract

Numerous research studies have shown that endorsing a catastrophic interpretation about pain is associated with deleterious outcomes, such as higher levels of distress, pain intensity and disability for the person in pain. The fear-avoidance model has been found to be useful in explaining these associations by stressing that heightened feelings of distress and behaviour aimed at reducing or avoiding pain might be adaptive in an acute pain context but can become maladaptive when the pain becomes chronic. Pain is rarely a private event and the communal coping model underscores that the heightened pain expression in people endorsing catastrophic thoughts about pain could have a social, communicative function of eliciting empathic responses in others. However, these models are not all-encompassing. In particular, neither of the models takes into account the growing evidence indicating that catastrophic thinking in observers can also impact their emotional experience and behaviour in response to the other’s pain. Moreover, the context of multiple goals in which pain and pain behaviour occurs is largely ignored in both models. In this article we present an integrative perspective on catastrophic thinking that takes into account the social system and interplay between different goals people in pain and observers might pursue (e.g., school/work performance, leisure, social engagement). Specifically, this integrative perspective stresses the importance of considering the bidirectional influence between catastrophic thoughts in the person experiencing pain and observers. Furthermore, the importance of balance between pain-relief and other important goals as well as in the level of catastrophic thoughts in understanding the maladaptive influence of catastrophic thinking will be underlined. Clinical implications and future research directions of this integrated perspective are discussed.