What to Do When Your Mind (Always) Dwells on the Worst-Case Scenario

Not long ago, a medical student, let’s call him Paul, walked into my shift in the emergency room of a large university and told me that his life was ruined. I’m a clinical psychologist. And for the past 20 years, I have worked — in many capacities — with young adults. I’ve counseled them in private practice. I’ve taught them on college campuses. I’ve given talks at the companies where they work. And this day, I was staffing the emergency walk-in on a college campus.

Paul was sure he had failed an exam earlier that day. Now, he had another in just a few hours and was positive that it was going to be a disaster as well.

“I feel like I’m having a panic attack. I don’t belong in med school. This is a complete catastrophe,” Paul yelled, more at himself than at me.

This reaction is not an unusual one. It’s something I’ve seen time and again throughout my work, and it’s called catastrophizing, or overestimating the likelihood or consequences of our worst fears. It’s the most common reaction we have to uncertain situations. Our brains interpret uncertainty as danger, which is why — in our minds — a typo at work turns into us being fired or a failed test turns into us dropping out of school.

Thanks to our ancient ancestors, our brains are designed to expect the worst. When early humans were wandering the Earth, underestimating what was around the corner (or in the bushes or the forest) could be deadly. This is why the most primitive parts of our brains take a “better safe than sorry” approach to uncertainties, both big and small.

In modern times, it might be easier to think of it this way: Your brain is like a smoke detector. Imagine that you’re sitting at your desk at home and clearing out your inbox when the smoke alarm goes off down the hall. What’s your first reaction?

Aargh! I forgot to take my toast out of the oven.The house is on fire!

In your day-to-day life, uncertainties are like smoke. Your job is to figure out whether the problem is burnt toast, a house fire, or just a false alarm, and respond accordingly.

But this is easier said than done.

Catastrophizing is especially common — really, the most common — among young adults like Paul. That’s because the most uncertain and unsettled years of our lives happen between the ages of 18 and 35. It’s the time when we are picking our college majors, graduating from school, getting our first jobs, perhaps even living on our own in new places for the first time. In addition, research shows that, in our 20s, the prefrontal cortex — or the part of our brains that problem solves during uncertain moments — is still developing. That doesn’t mean young adults can’t cope. Rather, it means that now is a great time to hardwire new habits, such as slowing down and thinking things through.

Walk-in slots in the emergency room I worked in were 15 minutes long, so that was how long I had to help Paul. He had spiraled from being sure he had failed his last test to being certain he would fail his next one to being positive he would flunk out of medical school to imagining his parents would think he is a failure.

He wondered aloud whether I should write a note excusing him from his next exam.

“Let’s try decatastrophizing first,” I said.

Paul and I walked through a few different strategies to help him shift his thinking. Generally, there is no one-size-fits-all. If you ever find yourself in a similar situation, try to pick and choose which ones work best for you.

Stop time traveling. Most of our catastrophes exist in the future. For Paul, it was failing his next text or failing medical school down the line or failing his parents somehow in the end. But mentally transporting yourself to next month or next year is no way to solve a problem in the here and now. Rather, take a deep breath, feel your feet on the ground, and stay right where you are.

“Don’t get ahead of yourself. Don’t go there yet,” I said as Paul’s thoughts raced toward every bad outcome. “Stay in the present and in the room with me.”

Focus on what is. Part of staying in the present is not focusing on “what if” but on “what is.” Catastrophizing is based on fear rather than on facts. I asked Paul to tell me some facts. Had he ever failed a test before? No, he said. What would happen if he did fail? Med students were allowed to take tests more than once, he told me.

“So maybe you won’t fail. And if you do, the worst-case scenario is that you will have to retake the test,” I said with a shrug. “No,” Paul countered. “Worst case is that it keeps happening and I flunk out completely.”

Play out your worst-case scenario. Paul and I talked about what would happen if he did indeed “flunk out completely.” What would he do? “I’d go into research probably,” he said, “which isn’t what I planned. But sometimes I think I like science more than the pressure and the patients,” he chuckled. Even if Paul’s worst-case scenario did come true, his life could go on.

Play out your best-case scenario. Then, I asked Paul to tell me his best-case scenario, making it as extreme and dramatic as the worst-case one he’d conjured up. He joked about earning the highest score on every test and collecting a prize as his fellow students went wild with applause. We shared a laugh as Paul realized that both his best-case and worst-case scenarios were simply childlike fantasies. Reality is almost always somewhere in between.

Go grey. Catastrophizing is a form of black-or-white thinking, with an emphasis on the black. When you’re young, like Paul, it’s easier to fixate on one or the other. But the trick is to hang out somewhere in the middle. Paul and I spoke about how med school would have its ups and downs, and about how there is more than one way to be a student and a doctor, too.

Get more data points. The real cure for catastrophizing is confidence, and confidence comes from experience. What Paul needed most was not for me to write a note excusing him from his test. He needed evidence that he belonged where he was. With every test Paul passed, he could be a bit more confident about the next one. It is normal to feel anxious before a big test. In those moments, Paul needed to be able to remind himself of exams that had gone well.

By the time our 15 minutes were up, Paul and I had made a plan. He would go to a coffee shop to study for a while, and then he would take his next exam. We scheduled a follow-up appointment for the next morning, and I gave him the after-hours emergency number just in case.

Of course, it occurred to me that Paul might indeed fail his exam and perhaps even do something to harm himself or someone else as a result. That was my own catastrophizing, my own smoke detector going off. But based on our conversations, and on my own data points from 20 years of working with twentysomethings, I was confident that Paul would make it through.

The next morning, I was a bit relieved, but not at all surprised, to see Paul in the waiting room. What did surprise me, however, was how different he looked with a smile on his face. Paul told me somewhat sheepishly that he had not, in fact, failed either of his exams, and “all that catastrophizing was for nothing.”

Maybe it wasn’t for nothing, I suggested. Maybe he’d learned something that would help him next time.

“Yeah,” he said, still smiling. “Fears aren’t facts.”

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Meg Jay, PhD, is a Clinical Psychologist and Associate Professor of Human Development at the University of Virginia. She is the author of The Defining Decade: Why Your Twenties Matter and How to Make the Most of Them Now.