The Catastrophising Patient
To catastrophise is to view a situation as considerably worse than it actually is (Oxford Dictionary). There have been three mechanisms of catastrophizing detailed in literature. These are:
- Rumination: compulsively overthinking one thought/issue
- Magnification: making an issue/problem bigger or more exaggerated
- Helplessness: lacking the ability to help oneself
Working in healthcare, it is very common to come across a catastrophizing patient who believes that their condition is the worst thing to ever happen to anyone, ever. It isn’t difficult to pick a catastrophizing patient. They will say things like:
- ‘I have done my back in. It’ll never be the same again.’
- ‘My friend did the same injury and she needed surgery.’
- ‘Apparently if my disc breaks anymore I could be paralysed!’
When educating practitioners on how to best manage their patients with co-morbid mental illness or patients who tend to catastrophize about their injury, I refer to the 4 R’s:
Learn the signs and how to recognize a patient who is struggling psychologically with their condition.
Refer to appropriate practitioner. In most cases, this will be either a general practitioner or psychologist.
When communicating with these patients, respect the fact that they are suffering mentally as well as physically.
Educate, communicate, evaluate, demonstrate, motivate, set goals and plan.
Here are a few additional tips to help you better manage a catastrophizing patient…
- Educate the patient on their on condition and what to expect from physiotherapy
- Avoid strong, fear evoking words
- Encourage patient not to stress and that their recovery is in their hands
- Educate patient on aggravating and easing factors
- Focus on what they can do rather than what they can’t
- Use motivational interviewing
- Slowly introduce safe movements into home exercise program
- Use distraction techniques or creative ways to get patients to move more
- Try not to talk down another profession/professional for giving less than ideal advice previously
If you need any more advice or you think that your practice would benefit from an in-service in Mental Health Physio, I can be contacted at firstname.lastname@example.org.