Work with catastrophizing by following the feared scenario through to the end. The therapist does not deny that something bad could happen; instead, the client is helped to ask, "and then what?" until they discover either that the scenario is unlikely, or that they would have ways to cope even if it happened. Probability is then examined separately.
Step-by-step guide
- Ask the client to name the feared outcome concretely.
- Ask: "If that happened, what then?"
- Let the client describe the next step in the scenario.
- Repeat "and then what?" for three to five rounds.
- Help the client notice whether the final outcome is survivable or manageable.
- Discuss coping resources and a plan.
- Estimate the realistic probability of the feared outcome.
When to use
- Generalized anxiety with "what if" thinking
- Panic disorder and fear of dying from panic
- Social anxiety and fear that everyone will laugh
- Health anxiety and catastrophic interpretation of symptoms
- Phobias with imagined catastrophic outcomes
Key phrases
Let's assume the worst-case scenario happens. What would happen next? And after that?
Follow-up questions
How likely is this, from 0 to 100?
If it did happen, what would help you cope?
Has this happened before? What actually happened then?
Alternative phrasings
Worst case, best case, and most realistic case: what are all three?
Could this be terrible and still survivable?
Warnings
- ⚠️ Do not use as blunt reassurance; the client must examine the chain themselves.
- ⚠️ Watch arousal level in panic and trauma work.
- ⚠️ Do not rush to probability before the client feels understood.
- ⚠️ If the feared outcome is realistic, move to coping and problem-solving rather than disputation.
Source: Beck & Emery, 1985; Clark, 1986
Materials are informational and educational and summarize publicly available scientific sources. They are not medical or psychological advice, are not intended for self-diagnosis or self-treatment, and do not replace consultation with a qualified professional.