Cognitive Therapy of Anxiety Disorders

270

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 7.3

Response Prevention Record

Name: Date:

Instructions: Keep a record of your daily response prevention practice sessions using this form. be
sure to record the initial and endpoint “urge to engage in response” and anxiety level.

Date

and

Time Describe Response That Was Prevented

Initial

Urge to

Engage in

Response

(0 –100)

Initial

anxiety

(0 –100)

Endpoint

Urge to

Engage in

Response

(0 –100)

Endpoint

anxiety

Level

(0 –100)

List “blocking strategies” used for response prevention: