Cognitive Therapy of Anxiety Disorders

162

From Cognitive Therapy of Anxiety Disorders: Science and Practice by David A. Clark and Aaron T. Beck. Copyright
2010 by The Guilford Press. Permission to photocopy this appendix is granted to purchasers of this book for personal
use only (see copyright page for details).

aPPENDIX 5.1

Daily Anxiety Ratings and Situation Record

Name: Date:

Instructions: Use the rating scale below to record a number from 0 to 100 that indicates the
average level of anxiety you experienced during the day. In the far right column briefly describe any
situations that you found particularly anxiety provoking on a particular day.

0 50 100

“Absolutely no anxiety,

totally relaxed”

“Moderate or usual level

of anxiety felt when in

anxious state”

“Extreme, panic-stricken

state that is unbearable

and feels life-threatening”

Day of the

Week/Date

Rating of average

anxiety Level

(0 –100)

Provoking Situations

(Note any situations that increased your anxiety

during the day)

1. Sunday


2. Monday


3. Tuesday


4. Wednesday


5. Thursday


6. Friday


7. Saturday