206 ASSESSMENT AND INTERVENTION STRATEGIES
costs and benefits of this approach are written in the lower half of the form. Again the
consequences of most significance to the client are circled. The objective of this exercise
is to emphasize the heavy costs associated with anxious thinking and the immediate
benefits of an alternative perspective. Homework assignments can be constructed to test
out the consequences of anxious thinking and the benefits of an alternative approach.
The therapist encourages clients to practice shifting their focus when anxious from
the threat content to the question “Is this anxious thinking helpful or harmful?” The
therapist emphasizes that repeatedly reminding oneself of the costs of anxious thinking
is another effective way to weaken or deactivate the anxiety program. This intervention
is particularly effective if clients fully realize that anxious thinking actually fuels their
discomfort rather than helping them cope with or avert the perceived threat.
Jeremy suffered for years with GAD. One of his primary worries concerned
finances despite having secure, well-paid employment. He always paid his bills, had
enough money each month to contribute to his investment account, and had never even
approached bankruptcy or financial hardship. And yet Jeremy continually worried that
he was not putting enough into his investments and as a result he would not be prepared
for the possibility of financial ruin. Using the Cost– Benefit Form, we identified Jeremy’s
anxious thought as “I’m not saving enough money to prepare myself for the possibility
of some future financial disaster” (e.g., losing my job and having no income). Jeremy
believed that his worry about saving money had a number of important advantages
such as (1) it forced him to save more each month and so his investments were growing,
(2) he watched his expenses much more closely, (3) he’ll be better prepared to absorb a
financial loss, (4) it ensures that he wouldn’t lose the house or go bankrupt if he did lose
his job, and (5) he feels better about himself when he is saving. Jeremy circled (1) and (3)
as the most significant advantages of his worry.
Exploring the disadvantages of the worry proved more difficult but with thera-
pist guidance the following list was generated: (1) the more he thinks about not saving
enough, the more anxious and tense he feels; (2) once he starts to worry about saving
enough, he can’t seem to stop it, it completely takes over his mind; (3) he hasn’t slept
well because of worry over his savings; (4) there is little enjoyment in his life because
he is constantly worried about finances; (5) he frequently deprives himself of little plea-
sures for fear of spending money; (6) he gets into severe arguments with his wife over
saving and spending money and she has threatened to leave; (7) he feels distant and
uninvolved with his children because of his preoccupation with finances; and (8) he
spends long, frustrating hours each night monitoring his investments. Jeremy indicated
that (1), (3), (6) and (7) were the most important costs associated with his worry over
saving money.
At this point in therapy, Jeremy was still heavily invested in his financial worries.
As a result he had difficulty generating an alternative perspective. Eventually, after con-
siderable discussion, it was agreed that the following way of thinking could become a
goal of treatment. “I am saving enough money for temporary, moderate financial loss
but there is little I can do to guarantee protection against a sustained period of total
financial ruin.” We then discussed a number of advantages to this perspective on his
finances: (1) less anxiety about saving because he no longer needs to amass a huge safety
net of savings, (2) more tolerance for stock market fluctuations, (3) less need to monitor
his investments, (4) more freedom to spend on everyday pleasures and comforts, and
(5) fewer conflicts with spouse over finances because of less attempt to control expen-