208 ASSESSMENT AND INTERVENTION STRATEGIES
intervention also has a number of other therapeutic benefits such as realigning threat
probability and severity estimates to a more realistic level, increasing a sense of self-
efficacy for dealing with future negative outcomes, and enhancing information process-
ing of safety and rescue features in future dreaded situations.
There are three components to decatastrophizing:
- Preparation stage
- Description of catastrophe (“What’s the worst that could happen?”; “What
would be so bad about that?”) - Problem- solving stage
Timing is everything when using decatastrophizing. Given the level of anxiety and avoid-
ance often associated with “thinking about the worst-case scenario,” other cognitive
and behavioral interventions should be employed as preparation for this form of “ima-
ginal exposure.” Later in the course of therapy, decatastrophizing could be introduced
as a way of confronting “the fears in your own mind.” The rationale and benefits of the
intervention should be explained and the client’s readiness to engage in decatastrophiz-
ing should be evaluated.
Assuming proper timing and preparation, the next step is to obtain a complete,
detailed discussion of the worst-case scenario from the client. Probing questions such as
“What’s the worst that can happen” or “What’s so bad about that” can be used. The
downward arrow technique is often useful for arriving at the dreaded catastrophe. The
client should be encouraged to describe all aspects of the feared catastrophe including
its consequences to self and others (“How would your life change?”), its probability of
occurrence, its severity, and the client’s perceived inability to cope. The therapist should
determine whether the client recognizes any safety or rescue features in the worst-case
scenario. If possible, imaging the catastrophe is a more potent way to obtain the emo-
tionally charged aspects of the worst possible outcome. Ratings on anxiety experienced
while discussing or imagining the catastrophe should be obtained as a way of dem-
onstrating the anxiety- inducing effects of catastrophizing. Having the client provide a
written description of the catastrophe is an effective way to reduce possible cognitive
avoidance that can occur when imagining or even discussing the “worst-case scenario.”
Also the therapist should determine the client’s level of insight into the exaggerated or
irrational nature of the catastrophizing and its effects on anxiety.
After a clear description of the worst-case scenario, a problem- solving approach
to catastrophizing can be introduced as a way to counter this form of thinking. The
evidence- gathering approach can be used to evaluate the likelihood of the worst-case
scenario. A best possible outcome can also be developed as a way of framing the most
extreme negative and positive outcome (Leahy, 2005). A more realistic, middle-of-the-
road, negative outcome can be developed as an alternative to the catastrophe. Together
the therapist and client can work out an action plan that would involve how to cope
with the more realistic negative outcome. This action plan would be written out and the
client encouraged to work on the plan whenever she started to catastrophize.
As an example, Josie had two to three severe panic attacks on a daily basis. She was
hypervigilant about her pulse rate and became very anxious whenever she perceived that
her heartbeat was too fast and possibly irregular. She engaged in catastrophic misinter-
pretation of her pulse rate, believing that she would have a life- threatening heart attack