Here’s a small secret: Distress is a shared experience.
Everyone can experience intense pain, worry, or sadness if they didn’t have the right protective factors at the right time.
Over time, psychologists and other mental health professionals have identified several common patterns that cause various types of worry, sadness, and other problematic emotions.
Here’s another thing we’ve found: Many individuals can resolve their own difficulties once they see what the core issue is.
Common patterns of distress include catastrophisation, a thinking pattern where catastrophes are inferred from discrete episodes.
“If you fail your exams, your life is over”
That quote summarises what catastrophisation is: Inferring future catastrophe from a specific circumstance.
This is endemic in Singapore from a young age.
One of my acquaintances, a child psychologist, once told me that they see the most number of cases during exam seasons and kids as young as Primary 5 can be suicidal because “I failed my exam so my life is over”.
This is one of many systematic negative biases that we may experience under marked distress.
These biases are called ‘cognitive distortions’ and they become problematic because they often feel so true, and so painful, that we begin to think it's true forever and everything in life is over.
Deep in pain, information that supports the catastrophisation is more easily noticed, remembered, and recalled.
You might recall a time when you were so distressed that all you could think or focus on was how ‘everything is over’.
This is how catastrophisation feels.
Your friends may have tried to ‘talk you out of it’.
Sometimes, it can hurt even more because it sounds like they’re saying, “it’s not that bad” or “pull yourself together”.
It hurts because it makes you feel that they don’t understand how deep the pain is and doesn’t really give you a way out.
In hindsight, we all remember that the PSLE exam (or O levels, or A levels, or university exam, or performance evaluation) was not the end.
It sure felt like it then but we grew out of it once we (1) encountered or found information that suggested otherwise and (2) made the link to our catastrophic feelings.
This is not an intellectual exercise – it works because these two insights provided a corrective emotional experience.
Here’s a fictional example of some of the clients I’ve seen:
John is a 70-year old man who consulted doctors at a local hospital for bloatedness and abdominal pain without organic cause. His gastroenterologist did not find an organic cause and noticed that John was quite anxious. John’s doctor then referred him to a psychologist to see if there were contributing psychological factors.
History
John’s had several serious illnesses as he aged. In his 40s, John had a fall with a lingering neckache. The doctor later said that he had a displaced vertebra that could paralyse him. Urgent surgery saved him but left an intense, unresolvable, and recurring pain if he walked for too long. He had to be on painkillers for the rest of his days.
In his 50s, John experienced a heart attack and collapsed during a family dinner. He recalls the sudden pain, breathlessness, and the frightful look of his entire family hovering over him. He underwent emergency surgery where three stents were placed in the arteries surrounding his heart.
In his 60s, John fell while coming down some wet stairs and hit his head. He recalls feeling dizzy and breathless when he landed before blacking out. He felt like he was actually dying and thought, “this is it”. John recovered quickly without major injuries but now experienced strong anxiety about his health.
Psychological Consultation
John reported that episodes of anxiety were reliably followed by bloating and abdominal pain. These episodes occurred several times daily. By now, his wife always escorted him on trips out of the house. She was startled whenever he experienced gastric symptoms and her reaction made him even more fearful.
As a first step, John’s psychologist explored his mental and emotional experience of these situations. John reported that everyday stressors (e.g. Rushing to gatherings, paying bills) reliably led to gastric symptoms that made him anxious (9 out of 10 intensity) because he is “going to die” (felt to be 10/10 true).
This is the catastrophised belief and John’s non-verbal body language was remarkably agitated as he discussed this. His wife’s alarmed reaction only amplified his fear. These episodes reportedly occurred several times a day. John also expressed some concern about seeing a psychologist, wondering if this meant that the doctor thought that he was ‘crazy’.
Psychoeducation
The psychologist explained how stress and anxiety could send signals from the brain to the nervous system in his gut and cause the symptoms he experiences.
It was especially understandable given his history of frightening medical incidents: Anxiety serves to tell us about dangers we need to address. Sometimes, it can become excessive and make us worry about dangers that are false alarms.
In John’s case, the false alarm was his gastric symptoms. They did not signal the presence of a fatal disease.
The psychologist then explained how it’s important to complete a one-week ‘symptom diary’ to accurately confirm and address all situations that trigger this pattern. The symptom diary recorded the time/day of each bout of gastric symptoms, the situation John was in, his thoughts and feelings, response to those thoughts/feelings, and how those responses made him feel.
Outcome
John returned later with only two episodes on the symptom diary. He was pleasantly shocked and said, “I really tried hard to find the situations but didn’t find much”. Of the events that he did record, John noticed that the feelings were <5/10 in intensity. He realised that it was “more important to take care of my feelings” and that he was not actually going to die. Importantly, he was smiling and discussing this calmly. The way he discussed the issue corroborates the sense of resolution he reported.
How This Applies To You
Here’s how John’s experience can map onto yours:
- Replace John’s ages and medical events with your own significant distressing events
- Replace his wife with a friend whose reactions worsen your pain
- Replace “I’m going to die” with your own worries about catastrophic failure or disappointment in life
- Read out that narrative to yourself
Chances are that you’ll feel a tinge of apprehension and avoid this exercise on your own. If you feel this, or imagine someone close to you who might if they were to read their own catastrophic narrative, you’ll have felt what John is going through. Despite the difference in the content of your worries, the process is remarkably similar and catastrophisation is learnt.
You can resolve your anxieties like John has. The resolution occurred because he was (1) motivated and (2) offered support to (3) explore his feelings and information that suggested that the catastrophisation may not be true. The exploration helped him recognise that the learned belief – as understandable as it was given his medical history – was not as bad as he thought. This was his corrective emotional experience.
You see, the symptom diary John did was not intended to be a treatment. The treatment was meant to take the form of Cognitive Behavioural Therapy where we would systematically explore his feelings and information that challenges the catastrophisation. John was an insightful man and used the information in his diary to challenge the catastrophisation on his own.
He is not alone in this. With a few bits of information, a minority of my clients were able to resolve their own worries despite living with them for decades. You may be able to do so as well if you notice the catastrophisation and consider if it makes sense in your present, not your past.
If you’re still stuck, don’t wait for decades before seeking professional help. No one benefits from that. There are psychological services to suit any price point these days so come forward and find your own corrective emotional experience.
You can be at peace with yourself
Further Reading
Common cognitive distortions: https://psychcentral.com/lib/15-common-cognitive-distortions/
What is Cognitive Behavioural Therapy: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/
