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Mindset Matters: How to Gently Stop the Mental Spirals That Accompany Chronic Illness

Living Well

September 15, 2022

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Collage design by Ryan Hamsher; Photo contributed by Natalie Kelley

Collage design by Ryan Hamsher; Photo contributed by Natalie Kelley

by Natalie Kelley


Medically Reviewed by:

Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT


by Natalie Kelley


Medically Reviewed by:

Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT


It’s easy to spiral into negative thought patterns with chronic illness. But with a little self-awareness and reframing, you can start to get your thoughts under control.

Welcome to Mindset Matters — a space to learn about the mental and emotional aspects of living with chronic illness. Mindset Matters is led by Nat Kelley, a certified life and mindset coach, and founder of Plenty and Well. For Nat, mindset work was the missing puzzle piece in her journey navigating ulcerative colitis, and she’s passionate about helping empower others in their journeys.

If you have a chronic illness, I can almost guarantee you’ve gotten stuck in the depths of a mental spiral. Whether it’s anxiety, sadness, fear, or anything else in between, it’s so easy to spiral further and further into the thoughts fueling these feelings.

You can quickly go from moving through your day to laying on the kitchen floor, thinking What am I going to do? My life is over! What if _____ happens?!

Next thing you know, you’ve nose-dived down into the depths of darkness.

I used to spiral almost daily because I had no tools to help myself reframe my thoughts, and I had a fear that by reframing, I would invalidate myself in the process. I found comfort in my spirals.

Before getting into how to reframe spirals, I first want to note that these spiraling thoughts are beyond valid because much of what we fear with chronic illness is so, so real. It could even be a lived experience of ours.

For example, I was hospitalized for an incredibly horrible ulcerative colitis flare in 2018 and spent so much of my energy after being discharged fearing it would happen again. With every bit of pain, every symptom, and every extra fatigued moment, I would go from being in the here-and-now to spiraling into the what ifs.

And the thing is, those fears were valid and they didn’t need to fully consume me. Both can exist at one time.

Being validated in your feelings and thoughts and still recognizing that they’re not rooted in present reality is so important.

So please, give yourself grace and show yourself compassion when you find yourself in a mental spiral. Spirals are already hard enough as they are, and as I just stated, they’re so valid! Getting angry at yourself for spiraling or having repetitive thought patterns will only make it harder. Don’t fight fire with fire.

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Automatic negative thoughts

A lot of the time these spirals stem from what are called automatic negative thoughts (ANTs). The most common types of ANTs are:

  • All-or-nothing thinking: “I have to do it all today or today was a waste.”
  • “Always” thinking: “I will always be this sick” or “I will never have good moments ever again.”
  • Guilt beating (“should’s”): “I should be able to be in school,” “I should be able to work out,” or “I should just say yes and go even though I feel ill today.”
  • Thinking with your feelings without real evidence: “I feel like all of my friends hate me because I have to cancel so often.”
  • Labeling: “I’m lazy” or “I’m not a hard worker” instead of “I’m chronically ill and trying my best.”
  • Fortune-telling (expecting the worst): Feeling one symptom worsening and jumping directly to “I’m headed into the worst flare of my life.”
  • Mind reading (placing thoughts in others’ minds): “They probably think I’m high maintenance because I had to ask so many questions at the restaurant.”
  • Blame (blaming others or your past self for your illness): “If only I had eaten healthier, maybe I wouldn’t have my illness.” (Please remember, you did not cause your illness!)

The first step to help stop our mental spirals is recognizing our own most common thought patterns. This helps you develop self-awareness around your thinking patterns when it comes to your illness.

And without self-awareness, how can we expect ourselves to catch the spirals in action?

Look back over the common ANTs above and think about what your most common patterns are.

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Put your thoughts on trial

Now that you’ve developed more self-awareness, you’re ready to learn tools to help you put the brakes on when you notice a spiral occurring. The first tool is called putting your thoughts on trial.

Follow these steps to try it out yourself:

  1. Write down the spiraling thought you’re having. You can also just think about it, but writing helps disrupt the spiral further.
    • Example: My stomach is in pain, so I’m definitely headed into a horrible flare. What if I’m hospitalized again?
  2. Now, write down credible evidence for the thought.
    • Example: I’ve been hospitalized before and these symptoms were part of that flare.
  3. Then, write down credible evidence against the thought.
    • Example: I’ve also felt this pain before and it hasn’t resulted in hospitalization.
  4. Look at both sides of the evidence and reframe to a more rooted-in-reality thought.
    • Example: Although my fear of hospitalization is valid due to past experiences, I recognize I’m catastrophizing prematurely because I have also felt these symptoms and had it not result in a serious situation.
  5. Focus on nurturing present you by writing down a present-rooted action item.
    • Example: Because I’m feeling this pain, I’m going to take the next few days easy and give myself unconditional permission to rest. And because I’m combatting fear, I’m going to nurture my mind by talking to a close friend and watching my comfort show.

“What if” to “what’s next”

The next tactic is something I created, which is a bit quicker than fully putting your thoughts on trial.

Asking “What if?” is a universal experience for folks with chronic illnesses. And again, although those questions are valid, they aren’t productive. They pull us into a future that we simply cannot predict, causing us to neglect the present version of ourselves.

So in moments where you’re spiraling into “What if?” thoughts, instead ask “What’s next?” Ask yourself: What do I need in the next 5 minutes, 2 hours, day, or week to help me feel better in the now about this situation?

Maybe you were asking yourself “What if these symptoms turn into a full-blown flare?” Instead, you can ask what you need right now to feel better physically and mentally about the situation.

Maybe you realize you need a quick nap to reset, or a bath to calm your body down. Maybe you need to reach out to your doctor to talk through your symptoms or book an appointment for the coming week. Maybe you need a distraction in the form of a Facetime date or an hour or so reading a novel.

Asking “What’s next?” pulls you back to the present so you can nurture your present self. I know pausing the “What if?” thoughts and choosing to ask “What’s next?” can be hard, but keep practicing. With time, it will feel easier.

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Retroactive reframing

Let’s face it — no matter how much you work on your mindset, you’ll sometimes find yourself post-spiral, realizing you weren’t able to employ any of your tools. And that’s OK.

What I suggest in these situations is to do some retroactive reframing. Look back on the thoughts that spiraled out of control and think about how you could have reframed them. This will help you continue developing your mind’s ability to reframe in the moment moving forward.

Retroactive reframing is better than no reframing.

The bottom line

With any mindset work, especially something as difficult as reframing spirals, I want to remind you that baby steps are still big steps. Everyone goes wild for a baby’s first steps, so go wild for your own baby steps as you break old thought patterns and create new ones.

Show compassion and acknowledge your thoughts without judgment. And remember, you are not your thoughts and your thoughts are not reality.

Medically reviewed on September 15, 2022

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About the author

Natalie Kelley

Natalie Kelley, the founder of Plenty and Well, is a chronic illness mindset and lifestyle coach, and the host of the “Plenty and Well Podcast.” After years of symptoms, she received a diagnosis of ulcerative colitis in 2017 at age 21. She then changed paths to discuss life with a chronic illness and provide support for others. After a life-altering flare-up, Natalie realized her purpose ran deeper, and she obtained her holistic health coaching certification. She offers personal coaching to women with chronic illnesses. Her group program, The Path to Empowered Acceptance, helps individuals find acceptance, confidence, and joy on their health journeys.

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