156 ASSESSMENT AND INTERVENTION STRATEGIES
Lo r r a i n e: This is really hard. I tried not to have the thoughts but it was almost
impossible. I think it was too short. I needed more time to get rid of my anxious
thoughts.
Th e r a p i sT: It is true that I gave you only half a minute. However, many people find the
exercise even more frustrating if I drag it out longer. The important point is whether
or not you were able to stop the anxious thinking.
Lo r r a i n e: Not really. I seemed to be getting more and more anxious the harder I tried
to get the thoughts out of my mind.
Th e r a p i sT: You’ve just made an important point. The harder you try “not to think
about the anxiety, the more you think about it.” I have here a checklist of various
strategies people use to change their anxious thinking. [Therapist passes Lorraine
a copy of the Cognitive Responses to Anxiety Checklist.] Could you look through
this checklist and tell me whether you just used any of these strategies in your
attempt to not think about the anxiety.
Lo r r a i n e: Well, I tried to deliberately not think about the anxiety (item #1), and I kept
telling myself it is stupid to be anxious because I’m sitting here in your office (#6),
and I tried to convince myself that I couldn’t possibly have a panic attack right now
(item #3). None of this seemed to work very well, though.
Th e r a p i sT: From this exercise we’ve discovered a couple of things. First, you’ve reported
that the harder you try to control your anxious thoughts, the worse they get. And
second, you’ve reported a number of different mental control strategies you used to
try and get rid of anxious thoughts. I realize that you’ve just done a “simulation”
because in real life your anxious thoughts and feelings would be a lot more intense
than they were while you were sitting in this office. I wonder how often you might
automatically try to control your anxious thoughts whenever you feel anxious using
the same strategies you reported just now. And I wonder what effect this might have
on your anxiety. I wonder if it makes your anxiety worse or better. Would you like
to find out?
Lo r r a i n e: Sure, I think that would be a good idea.
Th e r a p i sT: Okay, before our next session, could you take a copy of the Cognitive
Responses to Anxiety Checklist that we just used and see if you could capture some
times when you were anxious. Try to focus on your attempts to control the anxious
thinking. Which of these thought control strategies did you use and how effective
were they? Under the “how often” category, just check whether you used the strat-
egy or not. You don’t have to capture all your anxious moments, just one or two a
day. It should take only a few minutes each day to fill out the form. Do you think
that is doable?
Lo r r a i n e: Yeah, I should be able to do this in the next week. I’m still having lots of
a n x iet y.
Clinician’s Guidelines 5.12
Assessment of the nature, frequency, and function of worry and other cognitive control
responses is an important aspect of the case formulation of the persistence of anxiety. The
Worry Self- Monitoring Form A (Appendix 5.8) can be used to obtain clinical information