My Therapist Says

My Therapist Says Think of the Best-Case Scenario

Instead of focusing on worst-case outcomes that are already highly unlikely, why not consider the total opposite?

Illustration: Kate Dehler

When the pandemic hit, my biggest fear was losing my job. I struggled to think about other things, but my mind kept repeating the same chorus ad nauseam: I’m going to lose this gig, the best one I’ve ever had. I’m going to lose this job, and I won’t be able to find anything else because I can’t work on the level at which other people work, and I’m going to become an emotional and financial drain on my husband, and I’m going to gain weight, and the lines in my forehead are going to get deeper, and I’m going to lose the friends I’ve managed to cultivate, just like I always do.

My tendency to focus on the worst possible (and in many cases, impossible) outcome of an event, known as “catastrophizing” or “fortune-telling,” is an emotional crutch I’ve leaned on for most of my life. It pops up constantly: My editor is going to hate this story and will never want to work with me again; that slightly awkward statement I made at the park with a friend pissed her off, and she’s going to break off our friendship; and, of course, those relentless, toxic, body-related fears that sometimes feel like a permanent fixture of my psyche.

I’ve been seeing my current therapist for a couple years now, and she has guided me through some difficult circumstances better than any therapist or psychiatrist I’ve had in the many years I’ve been seeing them. But a few weeks ago, when I once again brought up my terror and conviction that I was going to lose my job, she mentioned I try something that in many ways felt like a revelation: When I think about the worst-case scenario, why not consider the best-case scenario alongside it?

I was astonished.

You’re focusing on outcomes that are already highly unlikely, she continued. You may as well give equal space to more positive scenarios. What would the best-case scenario be related to your job?

The thought seemed so preposterous, so ridiculous, that I had never contemplated it. Any best-case scenario was so far-fetched that it was pointless to consider, so I had trouble answering. What would be my best-case scenario?

The time it took for me to consider what I want was a distraction from my usual thought pattern of focusing on what I fear. It’s only the latest of many tools my therapist has given me to counter my negative thoughts. One of my favorites, though it’s a bit time-consuming, is the ABCD model, which guides an anxious person through challenging and reevaluating their negative thoughts. But what I like about the best-case scenario thought process is that it’s simple. Also, it’s fun. Thinking about getting a raise, or selling my novel and someday winning awards for it, isn’t only a diversion from my tendency to focus on the negative; it’s also a pleasure. The hope and joy I get from thinking about these things make me more likely to stick with the method in the future, which is crucial because catastrophizing is not simply being a Negative Nancy. It can have really serious consequences.

If I’m going to fantasize about anything, it’s much healthier for it to be the fun dream that someday I’ll win a big award than the devastating nightmare that I’ll lose everything and become an abject failure.

Shari Jager-Hyman, PhD, a clinical psychologist and researcher at the University of Pennsylvania Perelman School of Medicine, studies risk factors and treatments for self-harm and related disorders. In her 2014 study about the link between cognitive distortion and suicide, her team found that those who attempted suicide were more likely to be “fortune tellers,” or have a tendency to predict negative outcomes for themselves. The study concluded that treating these cognitive distortions may be especially critical for preventing suicide attempts.

I have struggled with suicidal ideation my entire life. Though I don’t have a depressive disorder, my anxiety can reach such intense peaks, with such frenzied rumination on how everything has always and will forever continue to go wrong, that death feels like the only way out. Lifestyle changes like working with an amazing therapist, finding a healthier job, and exercising have made a massive difference in how my anxiety manifests and how I’m able to deal with it. Even still, I find myself occasionally sliding into that old habit of catastrophic thinking. It’s comfortable there, familiar, a form of mental self-harm that if not addressed can get quite literally dangerous.

“Anxious people have the tendency to become hyper-focused on signs of threat or danger,” says Jager-Hyman. When you’re totally focused on how things can go wrong, you’re not as capable of seeing signs of things going well. “Some research suggests that experiencing lack of control over negative outcomes during early significant life events may lead to certain beliefs about the self and the world,” such as telling yourself that the world is a dangerous place, that nothing will ever work how you want it to, or how you have no control over the world around you. For some people prone to this kind of thinking, because the much-feared outcome is, in reality, not very likely to occur, it may begin to feel as if the worry itself prevented it from happening, says Hyman. This encourages negative thinking to become a pattern.

I have one particular thought genre in which it can feel as if my anxious thoughts themselves will prevent my feared outcome. I cling to my ludicrous terror of weight gain, afraid that letting it go will mean I’ve lost control.

So now, when I’m struck with catastrophizing about my weight, I counter it. What’s the best-case scenario? That I become comfortable with my body at any size. Now, when I think about how I’m certainly, without a doubt, going to enrage my editor with my terrible draft, I think about an outcome that would make me feel happy and accomplished: causing my readers to feel moved and transformed after reading my work. Now, when I stare into my AlphaSmart word processor each evening feeling as if I’ll never finish that piece of crap draft, I also think about how incredible it would feel to have my manuscript go to auction. Jager-Hyman says it’s not as simple as replacing a negative thought with a positive one; rather, it’s about teaching yourself that there’s a wide variety of possible outcomes and that the most likely one is probably somewhere in the middle.

It’s not especially likely that I’ll crater my career with a bad manuscript, nor that I’ll someday win a Pulitzer. It’s probably something between those two. But if I’m going to fantasize about anything, it’s much healthier for it to be the fun dream that someday I’ll win a big award than the devastating nightmare that I’ll lose everything and become an abject failure. One makes me smile, and one, sometimes quite literally, makes me want to die. It’s going to take practice, but with every attempt at focusing on a positive outcome after considering the negative one, it’ll feel a little easier and more natural. Maybe someday I won’t consider worst-case scenarios at all. Who knows? It would be the best possible outcome.

If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1–800–273–8255 or text HOME to 741741 to reach the Crisis Text Line. In emergencies, call 911 or seek care from a local hospital or mental health provider.

I’m a columnist for OneZero, where I write about the intersection of health & tech. Also seen at Elemental, The Atlantic, VICE, and Vox. Brooklyn, NY.

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