Pain Catastrophising: How ACT Helps You Step Out of the Spiral
If you live with chronic pain, you may recognise this pattern:
A small increase in pain appears.
Your mind immediately jumps to “This is never going to end.”
“I won’t cope.”
“My body is getting worse.”
Before long, anxiety rises, muscles tense, activity decreases, and pain escalates further.
This experience is known as pain catastrophising, and it is one of the strongest psychological predictors of pain severity, disability, and emotional distress in people living with chronic pain.
The good news is that this is not a personal failing — and it is something that can be worked with.
What Is Pain Catastrophising?
Pain catastrophising refers to a pattern of thinking in which pain is interpreted as overwhelming, threatening, or unmanageable.
It often includes:
Magnification: “This pain means something is seriously wrong.”
Rumination: Constantly thinking about pain and symptoms.
Helplessness: “There’s nothing I can do to cope with this.”
From a nervous system perspective, these thoughts are not irrational — they are threat-based predictions aimed at protecting you from harm.
Unfortunately, they can end up intensifying pain rather than reducing it.
Why Catastrophising Makes Pain Worse
When the brain perceives danger, it activates the body’s threat system.
This leads to:
Increased muscle tension
Heightened attention to bodily sensations
Elevated stress hormones
Reduced pain inhibition
In other words, the brain turns the volume up on pain to keep you safe.
Pain catastrophising keeps this system switched on, creating a self-reinforcing loop:
pain → fear → tension → increased pain → more fear.
This fear–pain cycle is one of the reasons why constantly fighting pain can paradoxically increase suffering, a concept explored further in ACT for Chronic Pain: Why Fighting Pain Often Makes It Worse.
Why “Positive Thinking” Isn’t the Answer
Many people are told to “stay positive” or “think differently” about their pain.
While well intentioned, this approach often backfires. Trying to replace catastrophic thoughts with positive ones can feel invalidating — and usually doesn’t work when pain is intense.
Acceptance and Commitment Therapy (ACT) takes a different approach.
ACT does not aim to eliminate difficult thoughts.
Instead, it helps you change your relationship with them.
ACT and Cognitive Defusion: Stepping Back From the Spiral
In ACT, pain catastrophising is understood as cognitive fusion — being caught inside painful thoughts as if they are absolute truths.
ACT teaches cognitive defusion, which means learning to notice thoughts as thoughts, rather than facts or commands.
For example:
“This pain is unbearable” becomes
“I’m having the thought that this pain is unbearable.”“I won’t cope” becomes
“My mind is telling me I won’t cope.”
This small shift creates space. The thought may still be there, but it no longer has the same power to drive fear and behaviour.
From Control to Choice
ACT does not ask you to stop catastrophising.
It recognises that the mind will continue to produce threat-based thoughts when pain is present.
The work becomes:
Noticing the thought
Allowing it to be there
Choosing how to respond anyway
Instead of asking, “Is this thought true?”
ACT asks, “Is following this thought helping me live the life I want?”
This shift moves you from automatic reaction to intentional choice.
Rather than organising life around avoiding pain, ACT encourages people to reconnect with what matters to them — an approach discussed in Living a Meaningful Life Despite Chronic Pain: An ACT Perspective.
What This Looks Like in Real Life
When people begin working with catastrophising using ACT, they often notice:
Less panic during pain flares
Greater ability to stay engaged with daily life
Reduced avoidance and withdrawal
Increased confidence in their ability to cope
Pain may still fluctuate — but it no longer dictates every decision.
ACT Works Alongside Medical Care
It is important to be clear: addressing catastrophising does not mean pain is imagined, exaggerated, or “all psychological.”
Pain is real.
ACT simply works with the brain–mind–nervous system loop that shapes how pain is experienced.
This approach complements medical treatment rather than replacing it.
You Are Not Broken — Your Mind Is Doing Its Job
If you notice catastrophic thoughts when pain flares, it does not mean you are weak or failing.
It means your brain is trying to protect you — just in a way that is no longer helpful.
ACT offers skills to step out of the spiral and respond with greater flexibility and self-compassion.
I offer ACT-informed psychological treatment for people living with chronic pain, both individually and in groups. If this approach resonates, you’re welcome to contact me to explore whether it may be helpful for you.
By Dr Michelle Beukes-King
