Our mind is programmed to worst-case thoughts. Worst-case thoughts might be protective in times of danger. They also make symptoms worse and limit capability. The influence of worst-case thoughts is greater when we tend to fix on our thoughts and regard them as facts. The inability to rethink misconceptions is unhealthy.  

In one study, greater psychological inflexibility was associated with greater pain intensity and less upper extremity capability both directly and indirectly (1). Catastrophic thinking, but not depression or anxiety, mediated these associations. 

In another study, participants who scored high on both cognitive fusion (the tendency to regard thoughts as facts) and catastrophic thinking about pain reported greater pain intensity and upper extremity incapability (2). 

In a third study, both cognitive intrusion of pain and catastrophic thinking partly and independently mediated the relationship between pain intensity and pain interference (3). 

In a fourth study, greater ability to be nonreactive to inner experiences and greater mindfulness were associated with both lower pain intensity and greater upper extremity-specific capability (4).   

In a fifth study, we found that an increase in fear avoidance was associated with a decrease in physical function but not with pain intensity among injured athletes (5). 

In a sixth study, Type D personality– the joint tendency toward negative affectivity (NA) and social inhibition (SI)– was associated with greater incapability due to pain (6). 

The opposite of cognitive fusion and inflexibility is self-efficacy, or the ability to move towards adaptive and accommodative thoughts. In one study of people recovering from a lateral ankle sprain, we found that greater self-efficacy was associated with fewer symptoms and greater capability, with the severity of the sprain having little influence (7). 

In another study, greater satisfaction with life (another protective psychological factor) decreased the influence of catastrophic thinking on the relationship of pain intensity and pain interference (8).

In another study, greater general physical activity and greater ability to pursue activity in spite of pain were associated with better upper extremity capability and lower pain intensity in older adults, but adherence to the Mediterranean diet was not (9).

References

1. Talaei-Khoei M, Fischerauer SF, Lee SG, Ring D, Vranceanu AM. Pain Catastrophizing Mediates the Effect of Psychological Inflexibility on Pain Intensity and Upper Extremity Physical Function in Patients with Upper Extremity Illness. Pain Pract. 2016 Oct 14. Doi: 10.1111/papr.12494. [Epub ahead of print] PubMed PMID: 27739246.
2. Özkan S, Zale EL, Ring D, Vranceanu AM. Associations Between Pain Catastrophizing and Cognitive Fusion in Relation to Pain and Upper Extremity Function Among Hand and Upper Extremity Surgery Patients. Ann Behav Med. 2017 Feb 17. doi: 10.1007/s12160-017-9877-1. [Epub ahead of print] PubMed PMID: 28213633.
3. Talaei-Khoei M, Ogink PT, Jha R, Ring D, Chen N, Vranceanu AM. Cognitive intrusion of pain and catastrophic thinking independently explain interference of pain in the activities of daily living. J Psychiatr Res. 2017 Apr 14;91:156-163. doi: 10.1016/j.jpsychires.2017.04.005. [Epub ahead of print] PubMed PMID:28433860.
4. Beks RB, Mellema JJ, Menendez ME, Chen NC, Ring D, Vranceanu AM. Does Mindfulness Correlate With Physical Function and Pain Intensity in Patients With Upper Extremity Illness? Hand (N Y). 2017 Mar 1:1558944717697429. doi: 10.1177/1558944717697429. [Epub ahead of print] PubMed PMID: 28719992.
5. Fischerauer SF, Talaei-Khoei M, Bexkens R, Ring DC, Oh LS, Vranceanu AM. What Is the Relationship of Fear Avoidance to Physical Function and Pain Intensity in Injured Athletes? Clin Orthop Relat Res. 2018 Feb 14. doi:10.1007/s11999.0000000000000085. [Epub ahead of print] PubMed PMID: 29480885.
6. Talaei-Khoei M, Mohamadi A, Fischerauer SF, Ring D, Vranceanu AM. Type D personality in patients with upper extremity musculoskeletal illness: Internal consistency, structural validity and relationship to pain interference. Gen Hosp Psychiatry. 2017 Sep 27;50:38-44. Doi: 10.1016/j.genhosppsych.2017.09.005. [Epub ahead of print] PubMed PMID: 28992609.
7. Briet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury. 2016 Sep 9. pii: S0020-1383(16)30446-6. doi:10.1016/j.injury.2016.09.016. [Epub ahead of print] PubMed PMID: 27659849.
8. Talaei-Khoei M, Chen N, Ring D, Vranceanu AM. Satisfaction with life moderates the indirect effect of pain intensity on pain interference through pain catastrophizing. J Consult Clin Psychol. 2018 Mar;86(3):231-241. doi: 10.1037/ccp0000283. PubMed PMID: 29504792.
9. Hermanussen HH, Menendez ME, Chen NC, Ring D, Vranceanu AM. Predictors of Upper-Extremity Physical Function in Older Adults. Arch Bone Jt Surg. 2016 Oct;4(4):359-365. PubMed PMID: 27847850; PubMed Central PMCID: PMC5100453.