138 ASSESSMENT AND INTERVENTION STRATEGIES
table 5.1. interview questions for assessing Different types of situational triggers in anxiety
Type of situational
triggers Clinical questions
External situations,
settings, objects
•• “Have you noticed whether there are certain situations or experiences that are
most likely to cause you to become anxious?”
•• “Are there some situations that cause only mild anxiety or occasionally cause
you to be anxious and other situations that cause more extreme levels of
anxiety?”
•• “Can you tell me about the last time you were in each of these situations and felt
anxious.” [Therapist probes for a full account of anxiety-provoking situations by
obtaining examples from client’s immediate past.]
•• “Have you noticed whether there is anything about a situation that might make
the anxiety worse?”
•• “Is there anything about a situation that might ease your anxiety?”
•• “How often do you experience these situations in your daily life?”
•• “Do you try to avoid the situation? How much does this interfere in your daily
life?”Interoceptive
(physical) cues
•• “When you are in an anxious situation, have you noticed any changes in how
you feel physically?” [Therapist could mention a few of the most common signs
of hyperarousal if client needs prompting.]
•• “Have you noticed whether any of these physical sensations occur before you
start feeling anxious?”
•• “How often do you get these physical sensations when you’re anxious? Are some
always present whereas others are only present occasionally?”
•• “Which of the physical sensations is felt most strongly when you are anxious?
Which of the sensations do you notice first when you’re anxious?”
•• “Have you noticed whether you feel more anxious once you are aware of a
physical sensation?” [e.g., client might feel more anxious about sudden increases
in heart rate.]
•• “Have you ever had the physical sensation (e.g., chest pain) occur unexpectedly
when you were not anxious? Can you recall an example of when this happened?
How did you feel after noticing the sensation?”
•• “Do you take special precautions to ensure that you don’t experience a
particular physical sensation?” [e.g., client might avoid time pressures because
wants to maintain state of calm and avoid feeling tense.]Cognitive cues •• “Have you ever had a thought, image, or impulse about something quite
weird, unexpected, even disturbing, suddenly pop into your mind?” [Therapist
might have to give examples or provide client with a list of common unwanted
intrusions to prompt self-report of intrusions.]
•• “When you are entering an anxious situation [therapist states specific situations],
do you recall having any sudden thoughts or images pop into your mind?”
•• “Do any of these unexpected intrusive thoughts involve things that are totally
out of your character or that would cause you considerable embarrassment or
dreaded consequences?”
•• “How upset do these thoughts make you feel?”
•• “Have you ever felt concerned that something might be wrong with you or
that something bad could happen because of the intrusive thought, image, or
impulse?”