The relationship between perceived risk, thought intrusiveness and emotional well-being in women receiving counselling for breast cancer risk in a family history clinic

Objectives. This study was designed to assess changes in perceived risk, cognitive intrusions and distress in women undergoing counselling for familial risk of developing breast cancer. Design. A longitudinal design in which 90 consecutive women attending a family history clinic were asked to indicate their concerns before counselling and then again 3 and 6 months post‐counselling. Method. Questionnaires included measures of thought content and intrusiveness, cancer specific distress (Cockburn, De Luise, Hurley, & Clover, 1992), a Visual Analogue scale (VAS) of perceived risk, and the Hospital Anxiety and Depression (HAD) scale (Zigmond & Snaith, 1983). Results. Sixty‐nine women agreed to take part in the study, with 49 completing all three sets of questionnaires. Before counselling, thought intrusiveness and HAD depression scores accounted for 69% of the variance in the measure of cancer specific distress. Women who dropped out of the study before the post‐counselling assessments reported higher levels of intrusiveness at baseline than those who completed the study. Perceived risk was only moderately related to actual risk post‐counselling and increases/ decreases in thought intrusiveness correlated positively with increases/decreases in both perceived risk and distress. Conclusions. Psychological distress is related to levels of perceived risk, a relationship which may be mediated by thought intrusiveness. It could be more appropriate for genetic counselling services to provide strategies for managing intrusiveness of worries rather than attempting to modify risk perceptions.