Cognitive Therapy of Anxiety Disorders

Cognitive Assessment and Case Formulation 129

information is obtained in the course of conducting a diagnostic interview. A diagnostic
interview is important to case conceptualization and treatment planning because:

••It provides detailed information on the presenting symptom typology, frequency,

and severity.

••Key cognitive processes in the anxiety disorders are often assessed.

••Situational triggers and coping strategies, especially avoidance responses, are

evaluated.

••Level of distress and impact on daily functioning is determined.

••Precipitating factors, symptom development, and course are delineated.

••Competing symptoms and other psychological processes that might complicate

treatment are identified.

Two key questions must be settled before conducting a diagnostic assessment in
cognitive therapy. Is it really necessary to spend the extra time doing a structured or
semistructured clinical interview, or would a traditional unstructured interview suffice?
Which is the best structured diagnostic for the anxiety disorders? Experts agree that
structured or semistructured interviews must be used to establish diagnostic status in
clinical research (Antony & Rowa, 2005). This is because structured interviews are
significantly more accurate in determining a valid diagnosis than unstructured clinical
interviews (Miller, Dasher, Collins, Griffiths, & Brown, 2001), and they have greater
interrater reliability (Miller, 2001). Miller (2002) determined that the diagnostic impre-
cision of traditional unstructured clinical interviews was in large part due to incomplete
data collection. Because semistructured interviews force the clinician to assess all key
diagnostic symptoms, this error in data collection is overcome.
Despite the diagnostic superiority of semistructured interviews, they are rarely used
in clinical practice (Antony & Rowa, 2005). This is because semistructured interviews

Diagnostic

Information

Symptom

frequency

and severity

Personal

(idiographic)

data

figure 5.1. Three aspects of assessment for anxiety.