134 ASSESSMENT AND INTERVENTION STRATEGIES
Penn State Worry Questionnaire
The Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec,
1990) is a 16-item trait measure that assesses the propensity to worry as well as the
intensity of worry experiences without reference to specific worry topics (Molina &
Borkovec, 1994). The items are rated on a 5-point Likert scale from 1 (“not at all typi-
cal”) to 5 (“very typical”), with items 1, 3, 8, 10, and 11 reverse scored. Although there
is some debate over the factorial structure of the PSWQ (Brown, 2003; Fresco, Heim-
berg, Mennin, & Turk, 2002), only the Total Score is normally interpreted. The PSWQ
has high internal consistency, test– retest reliability, and correlates with other self- report
worry measures but it does have lower convergence with measures of general anxiety
(Brown, Antony, & Barlow, 1992; Davey, 1993; Meyer et al., 1990; Molina & Bork-
ovec, 1994). Group comparisons indicate that individuals with GAD score highest on
the PSWQ, followed by other anxiety disorder groups and major depression who have
similar elevated scores that are significantly higher than nonclinical controls (Brown et
al., 1992; Chelminski & Zimmerman, 2003). A PSWQ cutoff score of 45 can be used to
identify pathological worry or GAD in a treatment- seeking population (Behar, Alcaine,
Zuellig, & Borkovec, 2003), although a higher cutoff score (62 or even 65) is needed
to differentiate GAD from other anxiety disorders and possibly even depression (e.g.,
Fresco, Mennin, Heimberg, & Turk, 2003). Given that worry is prominent in most
anxiety disorders (and depression), we suggest the PSWQ be included when assessing
general anxiety. A copy of the PSWQ can be found in Molina and Borkovec (1994) or
Appendix B of Antony et al. (2001).
Daily Mood Rating
In clinical practice daily idiographic ratings of general anxiety level can be a very useful
metric for tracking fluctuations in subjective anxiety. For example, Craske and Barlow
(2006) suggest that individuals complete a Daily Mood Record in which overall anxiety,
maximum anxiety, overall physical tension, and preoccupation with worry are rated on
a 0 (none) to 100 (extreme) scale at the end of each day. This can be augmented with
single ratings on more specific symptom dimensions that may be more indicative of the
person’s particular anxiety disorder such as ratings on average worry about having a
panic attack in panic disorder or mean daily social evaluative anxiety in social phobia.
It is important that the cognitive therapist also assess changes in general anxiety as
part of an evaluation of treatment effectiveness and for identifying situations that trig-
ger anxiety. These data can be useful for suggesting issues that need to be addressed in
therapy. We have found a 0 to 100 single scale most helpful in capturing the day-to-day
changes in general anxiety (see Figure 5.2).
0 50 100
“Absolutely no anxiety,
totally relaxed”“Moderate or usual level
of anxiety felt when in
anxious state”“Extreme, panic-stricken
state that is unbearable
and feels life-threatening”figure 5.2. Daily mood rating scale.