444
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 10.3
Worry about Worry Self-Monitoring Form
Name:
Date:
from
to:
Instructions
: This form should be completed during episodes of daily worry. T
ry to complete the form as close to the worry episode as possible in
order to increase the accuracy of your remarks.Date and Duration of Worry
Primary Worry Concern
[b riefly
describe your worries including the worst
outcome you are thinking about.]
Negative Thoughts about the Worry
Episode
[What are you thinking is so
awful or bad for you about having this
worry episode?]
Positive Thoughts about the Worry Episode
[What are you thinking might be
positive or beneficial for you about having
this worry episode?]
Extent of
Worry about
Worrying
[Rate 0–100]
*
*Note:
Rate extent of worry about worrying associated w
ith present episode from 0 (“not at all worried that I am worry
ing”) to 100 (“extremely worried that I had another worry
episode”)