Generalized Anxiety Disorder 433
Th e r a p i sT: Clare, you have suggested one possible outcome of the mammogram, that
it is positive indicating that you have cancer. What do you think is the probability
that the test is positive?
cL a r e: I think it is probably 50/50.
Th e r a p i sT: That sounds very high but it sounds like you are saying there is a 50%
chance the test will be negative.
cL a r e: Well, I suppose, but all I can think about is the 50% chance that it is positive.
Th e r a p i sT: I understand. But what if you are overestimating the chance of a positive
test result and underestimating the chance of a negative outcome? What effect will
that have?
cL a r e: I suppose it will make me feel more anxious and worried.
Th e r a p i sT: That’s right. This kind of thinking will increase your worry and yet it’s
not going to change the outcome of the test. It really is a very unproductive way of
thinking. So let’s see if we can change it.
cL a r e: How can I do that?
Th e r a p i sT: Well, one thing would be to very intentionally train yourself to pay closer
attention to the positive or safety aspects of this situation. You could begin by
getting some information on the real likelihood that the mammogram result will
be positive. You could also survey family and friends to see how many have had
negative results or false positive results and never had cancer. You could then
practice reminding yourself of this information whenever you start to worry about
cancer. I’m not saying this will magically reduce your worries, but gradually over
time you will get better at thinking about cancer in a more balanced fashion. You
can’t change the fact there is always uncertainty about cancer for everyone but you
could correct how you think about this uncertainty. Would you like to give this a
try?
cL a r e: Sure, it sounds like a good idea.
Before leaving the issue of safety cue processing, it must be emphasized that the
objective of this intervention is to counter the client’s tendency to be overly focused on
processing the threatening aspects of situations. The therapist does not try to persuade
the client that the worst outcome is unlikely to happen. For example, the therapist
can not try to persuade Clare that her mammography results will be negative. Instead
Clare is being taught to intentionally process safety cues in order to counter her exces-
sive emphasis on thinking that the test will indicate she has cancer. Obviously safety
signal processing can not change the fact that a positive test result is a distinct possibil-
it y.
Clinician Guideline 10.22
In cognitive therapy chronic worriers are taught to effortfully process the positive or safety
cues of a worry situation to correct their tendency to overlook positive aspects of a worry
issue.