Cognitive Therapy of Anxiety Disorders

387

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 9.3

Self-Consciousness Rating 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?)

Extent of Self-Focus

(rate extent of focus on yourself from 0 = no self-focus to 100 =completely

self-absorbed)

Target of Self-Focus

(list specific

physical sensations, thoughts, images, verbal expressions, or behavioral actions of which you were intensely aware in the

social situation)

Negative Consequence

(describe

any negative impression that you

might have made on others )