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Managing aspirations by addressing catastrophic thinking

Updated: Apr 8, 2019

Some patients avoid cosmetic and other elective procedures for reasons that sound a lot like fear of “karma”: "If I do an elective procedure, then something bad is sure to happen – the universe will punish my ambition and vanity."


Dr. Naomi Lawrence says she sees this kind of catastrophic thinking during cosmetic consultations quite frequently:

I see this often among patients who are considering a cosmetic procedure for the first time. One of the things holding them back is a feeling that they may have a bad outcome or that a bad outcome is inevitable because they are getting an unnecessary procedure.


There are many well-known psychological phenomena related to this common patient intuition. For example, omission bias is a common barrier to vaccination: the risks of commission (i.e., risks from getting vaccinated) are instinctively perceived as worse than the risks of omission (i.e., risks from not getting vaccinated).


Other psychological intuitions involved include illusion of control and the just-world fallacy. What to do about it?


Dr. Lawrence, of course, emphasizes to patients that risk and outcomes don’t work that way:

Of course I tell them the simple truth that a bad outcome, while possible, is highly unlikely. And of course I tell them that, no matter what, they absolutely do not deserve a bad outcome. But that kind of simple reassurance is rarely enough.


The more important message seems to be to remind patients of whole premise of your cosmetic business. It’s okay to want to look good. Wanting to look good isn’t always vain. And “natural” isn’t always better. Our faces age in many ways that we don’t like and it’s okay to both prevent those changes with good skin habits, and to undertake some safe, effective treatments if wrinkles or other skin features are bothering us.


As Dr. Lawrence puts it:

We do many things to “put our best foot forward” such as coloring gray hair, dressing in a flattering style, or getting our nails done. Trying to look your best is not tempting fate but rather making sure your appearance reflects your vitality.


Emotional reactions are inherent to human nature. But some emotional reactions, like catastrophic thinking, are not helpful, and are not grounded in fact. Managing those emotional reactions through a thoughtful articulation of your values is very important. Yes, physicians must share facts. But they can also help patients by appropriately sharing their own relevant, well-thought-out values, such as, “It’s okay to want your appearance to reflect your vitality.”

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