Cognitive Therapy of Anxiety Disorders

386

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 9.2

Social Situation Estimation Form

Name:

Date:

from

to:

Instructions:

The following form is used to record your estimates of the likelih

ood and degree of negative consequence associated with daily

social experiences that involve feelings of anxiety or distress. It is import

ant 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

(rate likelihood & expected severity of negative outcome

from 0–100)

actual Event Exposure

(rate

likelihood & expected severity of negative outcome from 0–100)

Post-Event Outcome

(rate likelihood & expected severity of negative outcome

from 0–100)

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Likelihood rating = outcome rating =

Note:

For likelihood ratings, 0 = “I think there is no cha

nce the negative consequence that I fear will occur in this si

tuation”, to 100 = “I am certain the negative consequence

will occur in this situation.” For outcome ratings, 0 = “t

here is no negative consequence to this situation”, to 100 = “

an intolerable, worst case scenario is expected in this

situation”