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Living with Pain: Depression and "Negative Fortune Telling"

no regrets

Chronic pain and depression sometimes co-occur.  It has been estimated that 30-50% of people with pain also report feelings of depression. While severe pain can be a trigger for depression, feeling depressed can make pain worse. Depression makes it more difficult to cope with pain,  harder to feel hopeful, and is often a barrier to activity. For many depressed people, antidepressants, cognitive behavior therapy, or a combination of both have been found to be effective treatments. If you feel you may be depressed, these therapies, or others, may help you too. Tell your doctor if you think you need help. But, one thing you can do right now to begin to manage your depression, is to take a look at how you think.

The Role of Thinking in Depression
How you think plays an important role in depression and in chronic pain management. One type of thinking that is often associated with depression is called “Negative Fortune Telling”. This kind of thinking involves making negative predictions about the future, often with little or no firm evidence. When you are depressed, the future can look terribly bleak. You may predict that things will not work out for you and that you will always feel bad. You may feel certain that your pain problem will never get resolved or that you will not be able to cope. You may assume the worst, and you may feel helpless. In a sense, pessimistic beliefs can give you a “hope phobia.” You may be afraid to hope for a good future, so you may give up. Here are some examples of Negative Fortune Telling.

  • “I'm going to turn down all of the holiday invitations. I won't be able to handle any of it.”
  • “I'll never find a doctor who can help me.”
  • “What’s the use? It’s hopeless anyway.”
  • “Trying to get back to work will be a disaster. I just know it.”
  • “My family doesn't understand my pain and never will. I give up trying to explain.”
  • “I'll never be able to be as athletic as I used to, so there's no use trying.”
  • “I am dreading going to physical therapy. It won't do any good.”

If my examples sounded like how you sometimes think, then you may have developed the habit of using Negative Fortune Telling. It is common for people who are depressed to think this way on a regular basis. But, Negative Fortune Telling can create a “self-fulfilling prophecy” – what you fear actually comes true, partly (and unwittingly) by your own doing.  It is a scientific fact that our expectations can influence what we do, which then can affect how things actually turn out. If you always expect the worst, you are stacking the deck against yourself, needlessly.

I am not saying you should be unrealistically hopeful.

I am saying that hope when combined with good problem-solving and planning  — is one of the best natural antidotes to depression. If you fear hope itself, you are robbing yourself of an important tool in keeping your spirits up, and in being motivated to make improvements in your life. How can you tell if you use “Negative Fortune Telling?” Here are a few hints:

  • You find yourself dreading the future, since you “know” things will be bad.
  • You disagree with others about the future; they see hope where you do not.
  • You use words or phrases that suggest a bleak future, such as “It’s no use”, “Things will never get better”, “Why bother trying?”, or “It will never change”.

I hope you will take a look at how you have been thinking. When you find yourself making bleak predictions, stop for a moment and ask yourself if the evidence supports your predictions or is there room for hope? Then, try to come up with a more realistic assessment and some possible solutions, alternatives, or coping strategies.

About the Author. Dr. Linda Ruehlman is a social/health psychologist and researcher, co-founder of Goalistics, and Director of the Chronic Pain Management Program, an interactive site that helps people with chronic pain to manage their pain and live richer, more effective lives.

DISCLAIMER: This blog is provided as an educational and informational resource only. It is not intended nor implied to be a substitute for professional psychological or medical advice.



  1. Sa`ra says:

    I feel that I am living an empty shell of a life right now. Last year I had a 3 level lumbar spinal fusion and decompression. Gloriously, it took one of the three types of pain away completely! It was a grueling recovery and I am still in recovery. At 3 mos out from surgery my 1 pain was completely gone, and the other two types were lightening. This improved for 2 1/2 mos. when suddenly my pain steadily increased again. I am now 14 months out from my surgery and while the one type of major pain is still completely gone, the other two major pains (which go into my legs and feet) are a near constant.
    All of my life I have been an incredibly resilient person and definately a “let’s get into the solution” type of personality. However, I feel beaten. I feel like a ghost (one unable to fly or go through doors-I just ram up against them. Funny but that’s how I feel.) I have done/am doing all that I know to do:

    Pain release meditations daily (currently)
    Massage (weekly current)
    stretches current
    walk current
    Co-Lead a chronic pain support group focusing on solutions
    animal therapy
    lost weight so am now at a healthy weight for my 5’4″ (141)
    take my pain meds and muscle relaxants
    anti-depressants and other meds as perscribed.

    My depression is severe
    My hopes muffled
    My life currently “going through the motions”

    Ideas? Input?
    Thank you.

    • Hello,

      I don’t know whether to congratulate you on your progress or say I am sorry about the steps backwards. So I will say both. I suppose I hear your frustration and depression the loudest, especially in the context of all of the actions you have taken to combat your pain. I see two things missing from your list. If you are doing these and just didn’t mention them, let me know and let’s go back to the drawing board. First, your ghost analogy speaks most strongly to me. It suggests to me that despite all you are doing to manage your pain, you don’t feel engaged in life, just in pain management. Do you have some goals you are working on in addition to dealing with your pain? Take a look at my blog about goals As I noted in the blog, goals don’t need to be big to make a difference. Working towards some endpoints gives hope. The other thing that seems absent from your list is someone to talk to about how you are feeling. Have you tried therapy? A good cognitive behavior therapist may help you to turn the corner. Best wishes! Thanks for sharing. Linda

      • Sa`ra says:

        I so appreciate your feedback! Yes, I have read through and decided on two goals after reading your Goal setting information. One, is to re-connect with my clinical therapist and work on some of my pain/depression issues. My second goal is to connect with others more consistently. As my pain increases I strongly tend to isolate, which I am aware is not helpful. So I committ to connecting with others a minimum of two times per week.

        Thank you for your help! I feel a little less alone because of my reaching out, your taking the time to reach back. I so appreciate your kindness!

        • Hi,
          Thanks for writing back. I am so glad that you have found something helpful here. Let me know how you do with your goals. Chronic pain makes it too easy to slip out of the habit of connecting with others consistently. Reconnecting does make a difference. Good luck! – Linda

  2. Emily says:

    I have been in severe chronic back and leg pain for 12 yrs after a work injury. I have tried to maintain a positive attitude and laugh at all the horrendus things that were happening instead of crying. But after a few yrs of constant pain that I’m told will be there all my life, after losing all my friends, after dealing with worker’s comp. for 12 yrs I jut feel like I can’t deal with this anymore.I’ve been trying to get disability for 2 yrs and am still waiting for a hearing date so I’m broke, lonely, depressed , anxious and don’r see an end to this. I’m told this is the way I’ll be for the rest ofmy life. Talking to a therapist does’t help pay the bills since I can’t work anymore, doesn’t get your friends back who are getting married and having kids and don’t have time for you. Worker’s comp. controls your treatment. At some point coping goes out the window and you you feel like you just can’t take this anymore and nothing is going to change. Worker’s comp. won’t allow any more treatments, It’s not negative thinking – it’s just the way things are.

  3. Emily says:

    This is in addition to previous statement – I feel like I have been repeatedly beaten down. Every time I deal with 1 problem and feel like things are better then something else happens that hits me and beats me down again until it gets very hard to cope and be positive. You get hit with so many bad things that finally it’s hard o get up again and get out of bed to face the next day and it’s challeges.

    • Hello Emily,
      I am sorry that you have been through so much. It must be difficult to get back up each day. I hope you will still keep trying. A good therapist can help you to learn to cope with all that has been happening. He or she can help you figure out how to make a future even though you have severe pain. It can be done. There is still hope. I wish you the best. Linda

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