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.
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,1 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,” Dr Romano, from the department of psychiatry and behavioral sciences at the University of Washington in Seattle, told Clinical Pain Advisor.
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.
What Drives Catastrophizing?
The study included 116 patients with chronic fatigue syndrome (n=111) and chronic fatigue (n=5), originally recruited for an investigation of illness behaviors in chronic fatigue and their relationship with partner responses.2 Mean age was 44.34 y; participants were primarily white (96%), female (93%), and married or living with a partner (71%). Approximately one-third (38%) had part-time or full-time employment and just under a quarter (21%) were receiving disability payments.