Cognitive Therapy of Anxiety Disorders

385

From

Cognitive Therapy of Anxiety Disorders: Scienc

e and Practice

by David A. Clark and Aaron T. Beck. Copy

right 2010 by The Guilford Press. Permission to photocopy

this appendix is granted to purchasers of this book fo

r personal use only (see copyright page for details).

aPPENDIX 9.1

Daily Social Anxiety Self-Monitoring Sheet

Name:

Date:

from

to:

Instructions:

Use the following form to record your daily experiences with anx

ious or distressing social situations that may involve some

performance on your part, an evaluation by others, and/or interpersonal i

nteractions. It is important to complete this form as soon after the social

event as possible in order to maintain its accuracy.Date

Describe Difficult or a

nxious

Social Situation (what

happened, who was involved, where, what was your role?)

anticipation of Event

(duration

and average anxiety level;

0 –100)

actual Event

Exposure

(duration and peak anxiety level; 0–100)

Postevent

Remembering

(duration and average anxiety level; 0–100)

Long-Term

Outcome (rate embarrassment

0 –100)

Note:

Duration refers to the length of time (i.e., minutes

, hours, or days) spent anticipating a social event, being expos

ed to it, or thinking back on it. Estimate the average (or

peak where applicable) level of anxiety on 0 (“no anxiety

”), 50 (“moderately intense”) to 100 (“extreme, panic level”). W

henever a panic attack is experienced in the anticipation,

exposure, or postevent period, record with initials PA. In l

ast column, rate level of embarrassment that remains assoc

iated with the situation from 0 (“none”) to 100 (“the most

embarrassing, humiliating experience in my life”).