Cognitive Assessment and Case Formulation 153
The first question to address is whether the client worries when anxious and, if so,
what is the worry content, its frequency, and its persistence. The therapist can expect
worry content to broadly fit within the main anxious concerns of the client. For exam-
ple, in panic disorder the worry is about disturbing bodily sensations, whereas in social
phobia worry about performance in social settings and the evaluation of others are
dominant.
Appendix 5.8 presents the Worry Self- Monitoring Form A that can be used to assess
any worry content associated with anxious episodes. This can be given as a homework
assignment or the cognitive therapist could complete the form in the therapy session
based on anxious situations identified on the Situational Analysis Form or the Apprehen-
sive Thoughts Self- Monitoring Form. The purpose of the Worry Self- Monitoring Form A
is to collect qualitative information on any worry themes that may play an important role
in the persistence of the worry. This worry content will provide useful information for
cognitive interventions the therapist will employ later in treatment. It is also important
to determine how often the client worries when anxious and the duration of the worry
episode. Worry that is frequent and lasts for 1–2 hours has a very different treatment
implication from the occasional bout of worry that is dismissed within a few minutes.
In Chapter 3 we discussed a number of negative consequences associated with worry
that may account for its pathological effects on anxiety (e.g., heightened sensitivity to
threat information, increased sense of personal vulnerability, an increase in unwanted
intrusive thoughts, an escalation in negative emotions, cognitive/emotional avoidance,
and ineffective problem solving). However, most individuals will not have sufficient
insight into the negative effects of worry to allow collection of this information from a
homework assignment. Instead the therapist could use the worry episodes recorded on
the Worry Self- Monitoring Form A as the basis for questioning that explores the nega-
tive consequences of worry. The following is a therapy excerpt based on a client with
social phobia who was anxious about interrupting his supervisor to ask an important
question:
Th e r a p i sT: John, I notice from the Worry Self- Monitoring Form that you were par-
ticularly anxious on Friday about having to go to your supervisor’s office to ask an
important question about a project you were trying to finish. You rated your anxi-
ety as 80/100 and the first apprehensive thought was “he is going to be so angry
that I am interrupting him with such a stupid question.”
Jo h n: Yeah, I was really upset about this situation. These kinds of things really bother
me. I find I get so anxious.
Th e r a p i sT: It appears that you spent approximately a half hour worrying about this
before you went and then you were worried most of the day afterward that your
supervisor was angry with you for interrupting him. You’ve written that before you
asked the question you were worried mainly about his angry reaction (i.e., would he
be abrupt with me), whether you would be able to make yourself clearly understood,
and whether you would understand your supervisor’s response. Afterward you kept
replaying the conversation in your mind to determine whether you sounded stu-
pid or not. Furthermore, you worried about your supervisor’s opinion of you and
whether this would reflect negatively on your year-end performance evaluation.
You’ve also written that you were worried that others overheard the conversation in