430 TREATMENT OF SPECIFIC ANXIETY DISORDERS
between- session exposure task (see below). The purpose of the within- session worry
induction exercise is (1) to teach clients how to engage in worry exposure, (2) to provide
empirical evidence that worry is more controllable than assumed by the client, and (3)
to help the client learn that worry is less anxiety- provoking and uncontrollable if worry
suppression efforts cease.
Before initiating worry induction it is necessary that the catastrophic outcome or
“worst-case scenario” associated with the primary worry concern is fully articulated.
As a verbal– linguistic phenomenon, worry may function as an avoidance of emotional
processing of fearful imagery (Borkovec, 1994). For this reason the catastrophic out-
come may take the form of an image. To determine the catastrophic outcome, the cogni-
tive therapist can employ a variant of the catastrophizing interview (Davey, 2006; Vasey
& Borkovec, 1992) in which the therapist continues to ask, “What is it that worries you
most about [a previously mentioned worry outcome]?” until the client can no longer
respond. A full description of the worst-case outcome should be provided so that clients
have a worry catastrophe script that can be referred to during their worry exposure
sessions.
After generating the catastrophizing script, the cognitive therapist and the client
work collaboratively in session developing a decatastrophizing plan (Craske & Barlow,
2006; Rygh & Sanderson, 2004). This involves writing out a hypothetical response if
the worst-case scenario actually came true. The therapist can state “Let’s come up with
some ideas, a plan on how you would cope with this catastrophic outcome if it actually
happened to you.” The decatastrophizing plan is written down underneath the catastro-
phizing script and given to the client for future reference. The client should be asked,
“How disturbing does the worst-case scenario seem in light of your potential coping
plan?” For further discussion of decatastrophizing see Chapter 6.
Worry induction and decatastrophizing are illustrated in the case of Clare, a mid-
dle-aged woman with GAD who worried about her health. Recently she had a consult
with her family physician because of worries that she might have breast cancer. Her
physician ordered a mammograph which only intensified Clare’s worry about cancer.
To determine her “most feared outcome,” the therapist conducted the following cata-
strophizing interview:
Th e r a p i sT: Clare, what worries you about having a mammography test?
cL a r e: I’m afraid that the result will be positive.
Th e r a p i sT: And what worries you about a positive mammogram result?
cL a r e: It will turn out that I have breast cancer.
Th e r a p i sT: And what worries you most about having breast cancer?
cL a r e: That I’ll need chemotherapy and possibly a mastectomy.
Th e r a p i sT: What worries you most about these treatments for cancer?
cL a r e: That I’ll get real sick from the chemo, lose my hair, and end up with a disgust-
ing body.
Th e r a p i sT: What worries you most about the effects of the treatment on your body?
cL a r e: That my husband will divorce me because I am so ugly, I’ll hate myself, and
become severely depressed.