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Chapter 5
Cognitive Assessment
and Case Formulation
Our Age of Anxiety is, in great part, the result of trying to do today’s jobs
with yesterday’s tools.
—Ma r s h aL L McLu h a n (Canadian academic and author, 1911–1980)Sharon is a 52-year-old single woman who worked as an information technol-
ogy consultant for a large advertising firm. She had been employed with this
firm for 10 years, and her job involved daily contact with a large number of
employees who requested her assistance whenever they experienced problems
with their computers. Thus her job required many daily one-to-one interac-
tions with individuals at their workstations dealing with their computer and
network problems as well as meetings with senior managers whenever there
were questions about information technology.
Sharon decided to finally seek treatment for what she described as a “life-
long struggle with anxiety.” She indicated that her main problem was height-
ened anxiety whenever she engaged in social interaction with work colleagues.
She reported only mild anxiety outside the work setting and so never before
considered treatment until 6 months ago when she experienced a significant
increase in her work setting anxiety level. She declined pharmacotherapy from
her family physician and instead agreed to see a psychologist for psychotherapy.
Before offering Sharon a course of cognitive therapy, there were a number of
questions about her anxiety that needed to be addressed. What was the nature
of her anxiety disorder and what were her primary anxiety symptoms? What
external or internal cues triggered her anxiety? What were her automatic anx-
ious thoughts and exaggerated appraisals of threat and personal vulnerability?
Was she highly intolerant of anxiety and hypervigilant for certain symptoms
of anxiety? How did she try to cope with her heightened anxiety? Were worry
and avoidance prominent responses to anxiety? How did she interpret her fail-
ure to control anxiety? These are a few of the questions that were addressed
during Sharon’s assessment sessions that led to an individualized cognitive case
formulation that is presented at the end of this chapter.