Cognitive Therapy of Anxiety Disorders

Cognitive Assessment and Case Formulation 135

This rating scale has been incorporated into a daily situation record form (see
Appendix 5.1) that can be used to assess daily fluctuations in general anxiety.

Beck Depression Inventory–II

The Beck Depression Inventory–II (BDI-II; Beck, Steer, & Brown, 1996) is a 21-item
questionnaire that assesses the severity of cognitive- affective, behavioral, and somatic
symptoms of depression over a 2-week interval. The BDI-II is the third and latest revision
of the original BDI that was published by Beck, Ward, Mendelson, Mock, and Erbaugh
(1961). The second revision of the BDI (Beck & Steer, 1993) has been used widely in
depression research and so most of the psychometric information has been generated on
that measure. However, the BDI and BDI-II are highly correlated (r = .93; Dozois, Dob-
son, & Ahnberg, 1998), so the psychometric findings on the BDI are relevant for BDI-
II. Although the BDI appears to be mulifactorial, the Total Score is most often used in
clinical practice and research (Beck, Steer, & Garbin, 1988). There is extensive research
demonstrating the internal reliability and the convergent and discriminant validity of
the BDI (see Beck et al., 1988, for review; Tanaka- Matsumi & Kameoka, 1986). Indi-
viduals with major depression score significantly higher (M = 26.52, SD = 12.15) than
those with anxiety disorders (M = 19.38; SD = 11.46; see Beck et al., 1996). The cut-
off scores for the BDI-II are 0–13 nondepressed, 14–19 mildly depressed or dysphoric,
20–28 moderately depressed, and 29–63 severely depressed (Beck et al., 1996; see also
Dozois et al., 1998). Given the high co- occurrence of depressive symptoms and disorder
in those with high anxiety, it is recommended that the BDI-II be included in the stan-
dard assessment battery for anxiety. The BDI-II is available from Pearson Assessment
at pearsonassess.com.

Clinician Guideline 5.2

To assess severity of general anxiety symptoms, administer the BAI, CCL, PSWQ, and daily

ratings of average anxiety level. If desired, DASS Anxiety can be included and the HRSA can

be used when clients over- or underreport their level of anxiety. The BDI-II should be added

to assess level of comorbid depressive symptoms. A complete assessment will also include

measures of specific anxiety disorders that are reviewed in subsequent chapters.

fear aCtivation: assessment anD formulation

Based on the cognitive model (see Figure 2.1) in this section we focus on assessment tools
that provide critical information needed to develop a case formulation of the immedi-
ate fear response and its consequences. Experimental research on the immediate fear
response uses information- processing tasks and psychophysiological measures that are
not readily available to the therapist. However, the practitioner can use self- report, inter-
view, and behavioral observation methods that rely on conscious, effortful processing in
a manner that offers valuable information on a person’s immediate fear response.
One of the most basic propositions of cognitive therapy is that schematic content,
which is inaccessible to direct observation or detection, can be inferred from conscious,