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When a catastrophe occurs, it can be natural to begin to see the world through a catastrophic lens, constantly waiting for the other shoe to drop and expecting more bad things to happen. Many people experience this shift after the loss of their loved one. They may find that they encounter intrusive, catastrophic, and negative thoughts that they cannot and do not know how to control.

The following activities can help clients learn to harness these kinds of thoughts and find ways to diminish and cope with them. Revisit and repeat them as often as necessary in session, and consider asking clients to repeat them outside of session too. They not only act as a means for coping with painful intrusive and catastrophic thoughts, but they also help support your clients’ efforts to externalize thought patterns and to modify their behavior toward self-care.

Create a Plan for Intrusive Thoughts

Intrusive thoughts are unwanted thoughts that appear in clients’ minds, often without warning and repetitively. These thoughts are a very common part of the grieving process, but they are often unwelcome and can be distracting, disturbing, or distressing. Helping clients to consciously turn toward these thoughts and to create a plan to cope with them can help to free clients from their oppressiveness.For instance, you may have them become aware of their intrusive thought, get to know the thought, and then help them develop an action plan for when they occur:

1. Describe the thought.
2. List the symptoms and behaviors that come with this thought.
3. Describe the way this thought is irrational.
4. Choose an activity to redirect away from the thought.
5. Choose a self-care technique.

De-Catastrophize

When clients catastrophize, they exaggerate a problem and assume the worst possible outcome will come to pass. As with intrusive thoughts, catastrophic thoughts are a common form of grief anxiety. They often arise as a manifestation of health anxiety, and your clients may report that they cannot free themselves from fixating on worst-case scenarios. By supporting clients as they identify their worries and the potential consequences of their worries coming to pass, you help them begin to uncover their inherent resilience.

You can help your clients manage catastrophic thoughts by questioning the thoughts and then correcting the distortions:

1. What are you worried about?
2. How likely is it that your worry will come true? Give examples of past experiences or evidence to support your answer.
3. If your worry does come true, what is the worst thing that could happen?
4. If your worry does come true, what is most likely to happen?
5. If your worry does come true, what are the chances you’ll be okay . . . in one week? In one month? In one year?

Challenge Negative Thoughts

When clients grieve, they may find themselves overwhelmed by or otherwise fixated on negative thought patterns. They may repeatedly assume the worst about others, about themselves, or about their environments. Negative thoughts can be a coping mechanism—they help to set expectations as low as possible and to prepare for the worst. However, negative thoughts are not typically realistic thoughts, and when clients are overwhelmed by negative thoughts, they are unable to feel or to process other important emotions associated with grief. It can be difficult to break this pattern of negativity. In their initial efforts, some clients find that they are unable to consider neutral or positive outcomes. Push your client to challenge their negative thoughts, including whether the thought is based on fact or opinion and what evidence they have that the thoughts are true. Clients can begin to practice reflecting on the utility of their negative thoughts, as well as on the relationship between their negative thoughts and external reality. Introduce the questions from the Challenging Negative Thoughts worksheet ()in session, and then ask them to use it out of session when they feel negative thoughts arise.

Use Positive Self-Talk and Affirmations

Positive self-talk can be an antidote to negative, intrusive, or catastrophizing thoughts. In fact, affirmations can also help quell other forms of anxiety. By helping clients identify and articulate positive statements, you can help them begin to learn—or relearn, subsequent to their loss—to self-soothe. These are statements that bring grieving clients comfort and that they will feel comfortable repeating when their grief anxiety manifests. Have your client try a few affirmations out until they find a few that work best for them. You may offer:

• It’s okay not to feel okay.
• This feeling won’t last forever.
• I have dealt with hard things before.
• I can do hard things.
• These are thoughts, not facts.
• I am safe.
• I am supported.

For more activities, worksheets, guiding questions, and meditations, check out my new book, . No one will journey through life untouched by loss, but we as therapists can serve as steady companions for clients as they navigate this difficult terrain.