Generalized Anxiety Disorder 427
Differentiating Productive and Unproductive Worry
In his self-help manual for worry Leahy (2005) noted that teaching individuals with
chronic worry how to distinguish productive from unproductive worry is a critical treat-
ment ingredient (see also Davey, 1994; Davey et al., 1992). Table 10.6 presents the main
elements of productive and unproductive worry based on Leahy’s discussion.
Clients should be taught early in cognitive therapy how to distinguish productive
worry from unproductive (i.e., pathological) worry. Given the intensive assessment of
worry, clients should be well aware of their pathological worry even during the first
couple of sessions. So the challenge is to make clients more aware of their productive
worry. It is likely they have not even considered the possibility that at times they may
engage in productive worry. Using guided discovery, the cognitive therapist can ask
clients to tell how they coped with various daily concerns or personal strivings that did
not elicit excessive worry. A list could be made of productive worry and pathological
worry experiences along with a brief description of how the client handled the problem
in a productive or unproductive fashion. Learning that they engage in both productive
and unproductive worry will reinforce what was learned in the education phase: that
chronic, pathological worry is caused by how you worry and not the fact of worry. Also
more realistic worries imply a different treatment approach than that taken with chronic
worry. If the client’s primary worries more closely match the profile of productive worry,
than the main treatment approach would be problem solving and development of an
action plan. Worries that are more pathological will require the full cognitive treatment
package described in this chapter.
In our case illustration Rebecca exhibited predominantly pathological worry, with
occasional instances of more realistic or productive worry. Despite her worry about her
work performance, she rarely worried excessively about making the sales projections
table 10.6. Characteristics of pathological and productive Worry
Pathological worry. Productive worry
••Focused on more distant, abstract problems. ••Focused on more immediate, realistic problems.
••Person has little realistic control or influence over
the situation.••Person could exercise some control or influence
over the situation.
••Greater focus on negative emotion associated with
worry situation.••Greater focus on problem solving the worry
situation.
••Cannot accept any solution because it can not
guarantee success.••Can try out and evaluate imperfect solutions.••Relentless pursuit of safety and certainty of
outcome.••Willingness to tolerate reasonable risk and
u ncer taint y.
••Exaggerated and narrowed processing of the
potential threats in a situation with a tendency to
catastrophize.••A broader, more balanced processing of the
negative, positive, and benign potential outcomes
in a situation.
••Perceived helpless to cope with the worry
situation.••Higher level of self-efficacy in coping with worry
situation.
••Associated with high levels of anxiety or distress. ••Associated with low anxiety or distress.Note. Based on Davey, Hampton, Farrell, and Davidson (1992) and Leahy (2005).