Cognitive Assessment and Case Formulation 133
Lovibond & Lovibond, 1995a). For example, DASS Anxiety correlates .81 with the
BAI and DASS Depression correlates .74 with the BDI in student samples (Lovibond
& Lovibond, 1995b). In addition, individuals with panic disorder score significantly
higher on DASS Anxiety than patients with major depression but those with OCD,
social phobia, GAD, and simple phobia do not score higher than the major depression
group (Antony, Bieling, et al., 1998; Brown et al., 1997). A shorter 21-item version
of the DASS was developed by Antony, Bieling, and colleagues (1998) and has psy-
chometric characteristics comparable to the original 42-item DASS. Although DASS
Anxiety and Depression are moderately correlated (r’s ~ .45) in clinical samples and
DASS Anxiety has a predominant emphasis on autonomic arousal and fear (Antony,
Bieling, et al., 1998; Brown et al., 1997), it is a promising measure. The DASS-42 is
available in Appendix B of Antony et al. (2001) or it can be downloaded directly from
http://www.psy.unsw.edu.au/dass. The manual and scoring template can be ordered from
the same website.
State–Trait Anxiety Inventory
The State–Trait Anxiety Inventory (STAI—Form Y; Spielberger, Gorsuch, Lushene,
Vagg, & Jacobs, 1983) consists of two 20-item scales with one scale assessing state
anxiety (“how you feel right now, that is, at this moment”) and the other measur-
ing trait anxiety (“how you generally feel”). With its emphasis on current state, the
STAI State scale has greater clinical relevance for tracking the effectiveness of cogni-
tive therapy. Although the STAI has good reliability and convergent validity with other
anxiety measures, its ability to distinguish anxiety from depression has been questioned
(Roemer, 2001). For this reason we believe there are other anxiety symptom measures
that provide a clearer assessment for the cognitive therapist. The STAI—Form Y can be
purchased from Consulting Psychologists Press, Inc.
Cognitions Checklist
The Cognitions Checklist (CCL; Beck, Brown, Steer, Eidelson, & Riskind, 1987) com-
prises a 12-item anxiety subscale (CCL-A) and a 14-item depression subscale (CCL-D)
that assesses the frequency of negative self- referent anxious and depressive thoughts
along a 5-point scale ranging from 0 (“never”) to 4 (“always”). The content of CCL-A
revolves around themes of uncertainty and an orientation toward the future (Beck et
al., 1987), with the majority of items (71%) focused on anxious thinking about physical
or health- related concerns. Both subscales have good internal consistency, and factor
analyses reveal the expected loadings of CCL items on separate anxiety and depression
dimensions, especially in clinical samples (Beck et al., 1987; Steer, Beck, Clark, & Beck,
1994). Although CCL-A and CCL-D are moderately correlated, each subscale is more
highly correlated with its congruent than incongruent symptom state (Beck et al., 1987;
D. A. Clark et al., 1996; Steer et al., 1994). In clinical practice the CCL-A provides an
estimate of the frequency of anxious thoughts, especially the physical or health concerns
of most relevance to panic disorder. Individuals with anxiety disorders typically score in
the midteens or higher on CCLA (Steer et al., 1994). A copy of the CCL can be obtained
from the Center for Cognitive Therapy, Department of Psychiatry, University of Penn-
sylvania Medical School, Philadelphia, PA.