Journal of Psychosomatic Research, Vol. 47, No. 5, pp. 439–447, 1999 Copyright  1999 Elsevier Science Inc. All rights reserved. 0022-3999/99 $–see front matter S0022-3999(99)00044-6 AN EXPERIMENTAL STUDY OF INFLUENCES ON THE PERCEIVED LIKELIHOOD OF SEEKING GENETIC TESTING: “NONDIRECTIVENESS” MAY BE MISLEADING PAUL M. SALKOVSKIS, RUTH DENNIS and ABIGAIL L. WROE (Received 10 December 1998; accepted 20 May 1999) Abstract—It has been suggested that decision making involves the implicit weighing up of those advan- tages and disadvantages of possible options considered relevant at the time the decision is made. If this is so, the information that people have most readily available at the time of the decision would influence the decision outcome. The study reported here experimentally evaluates the effect of manipulating the issues on which individuals focus as a way of investigating subtle directive influences. Participants (n = 104) were interviewed about their anticipated likelihood of opting for testing for hereditary hemochro- matosis. All participants were given standard information about hemochromatosis, including a descrip- tion of the disorder as causing progressive damage over many years and an explanation that treatment is most effective if begun before the age of 30 years. Individuals were randomly allocated to groups ac- cording to age group (30 years and under, or over 30 years) and gender. Those allocated to the positive group were then encouraged to focus on positive aspects of the previously given information by consider- ing the extent to which statements applied to them, whereas the negative group focused on negative as- pects. The control group focused on an unrelated disease. Analyses of variance indicated that the focus- ing manipulation affected the likelihood of opting for testing. This effect interacted with age of respondent: in participants over 30, the positive group ratings of likelihood of testing increased, whereas in the negative group they decreased; in participants 30 and under, both the positive and negative groups showed an increased desire to be tested. The control group did not alter significantly. The relevance of these findings to “nondirective” approaches to genetic counseling is considered.  1999 Elsevier Sci- ence Inc. Keywords: Decision making; Hemochromatosis; Pretest counseling; Nondirectiveness. INTRODUCTION As the emphasis in medicine shifts toward empowering the patient, people are in- creasingly expected to be involved in making complex and potentially far-reaching decisions concerning their personal health. The development of predictive health screening (particularly, but not exclusively, genetic testing) is facing people who were not previously aware of personal medical risks with the need to make a deci- sion about whether to seek or whether to undergo screening. This means that healthy individuals are being confronted with decisions about testing that include potentially serious practical and psychological implications [1]. Oxford Health Psychology Group, University of Oxford Department of Psychiatry, Warneford Hospi- tal, Oxford, UK. Address correspondence to: Paul M. Salkovskis, Oxford Health Psychology Group, University of Ox- ford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. Phone: +44-1865-226475; Fax: +44-1865-226234; E-mail: paul.salkovskis@psychiatry.ox.ac.uk. 439