Cognitive Assessment and Case Formulation 157
on worry, and the Cognitive Responses to Anxiety Checklist (Appendix 5.9) is available to
assess deliberate thought control strategies.Threat Reappraisal
This final aspect of case conceptualization is a culmination of all the assessment activi-
ties that have been described previously. As clients consciously and deliberately reflect
back on their anxiety when in a safe and relaxed context, what is their evaluation of
the threat and their ability to cope? Appendix 5.10, the Anxious Reappraisal Form,
can be used to explore with clients their threat and vulnerability cognitions when feel-
ing anxious and then their evaluation of the threat and personal vulnerability when
calm, not anxious. One would expect that when anxious the thinking should be biased
toward exaggerated threat and underestimated ability to cope, whereas during periods
of no anxiety the person’s threat evaluation would be more realistic and self- confidence
elevated.
The Anxious Appraisal Form should be used as a clinical resource in the therapy
session to help the therapist explore and then record the client’s anxious and nonanxious
appraisals rather than assigned as a homework exercise. The cognitive therapist should
point out the differences between the client’s thinking when anxious and not anxious.
It should be emphasized that the client is capable of thinking in a more realistic fashion
about her anxious concerns when in a calm and relaxed state. This means that the goal
of therapy is to help clients learn to generalize their more realistic thinking about the
threat and their ability to cope to their most difficult anxious moments. In this way the
information obtained on the Anxious Reappraisal Form can be used to define one of the
primary treatment goals of cognitive therapy for anxiety.
Clinician Guideline 5.13
Use the Anxious Reappraisal Form (Appendix 5.10) to assess clients’ ability to generate a
more realistic reappraisal of threat and personal vulnerability during periods of no anxiety.
This can be used to highlight the biased, exaggerated nature of their thinking when anxious.
Shifting to the more realistic appraisal that is evident in low anxiety should be a stated goal
of treatment.Case formulation of anxiety: a Case illustrationCognitive Case Formulation
We conclude this chapter with a case illustration to demonstrate how the clinician can
utilize the theory- driven assessment perspective described in this chapter to arrive at
an overall cognitive case conceptualization of anxiety. Although we have described
a very detailed cognitive approach to assessment and case formulation, it should be
obvious from the following case presentation that much of the critical information can
be obtained from the clinical interview, self- monitoring forms, observation of anxiety
within the session, and standardized diagnostic interview and questionnaire measures.
Thus it is reasonable to expect that an initial cognitive case conceptualization can be