Cognitive Assessment and Case Formulation 149
Appendix 5.7 provides a checklist of 34 behavioral and emotional coping responses
that pertain to anxiety. We suggest the therapist go over the checklist as part of the clini-
cal interview since most clients should be quite aware of their coping responses when
anxious. Also most anxious individuals probably have not considered the perceived
effectiveness of their coping and its effects on the intensity and duration of anxiety.
Therefore some probing and questioning may be necessary in order to obtain this infor-
mation.
From this assessment one should be able to specify in the case formulation which
maladaptive coping strategies are frequently associated with anxiety and their perceived
effectiveness, the relative effectiveness of any adaptive strategies that the client already
employs, and the overall level of confidence or helplessness felt in dealing with anxiety.
This will also provide the therapist with clues about behavioral changes that may be
targeted in treatment. However, it is also likely that this checklist assessment must be
complemented with questions about coping responses that may be unique to the specific
anxiety disorders. Also many of the strategies listed in Appenditx 5.7 could be stress
management responses. Therefore it is important that clients be asked to focus on activi-
ties employed directly in response to their anxiety and not activities they use to relieve
general stress, improve mood state, or enhance their overall sense of well-being.
Clinician Guideline 5.9
Use Appendix 5.7, Behavioral Responses to Anxiety Checklist, to assess how often various
behavioral and emotional coping strategies are used to control anxiety. Highlight the role of
these strategies in the persistence of anxiety in the case conceptualization.Deliberate Safety- Seeking Behavior
White and Barlow (2002) define safety behaviors as “those actions that a patient engages
in to help him or her feel more secure or protected” (p. 343). The focus of safety behav-
iors is to feel secure, safe, which has the obvious benefit of reducing feelings of anxiety
(see Chapter 3, Hypotheses 2 and 7, for further discussion).
It is important to clearly identify in the case formulation the main safety- seeking
responses whether they are more automatic and habitual in nature or more consciously
mediated, deliberate coping responses. By this point in the assessment much of this informa-
t ion h a s a l re ady b e e n c ol le c t e d f rom i nd iv idu a l s’ s el f- mon itor i n g of t hei r re sp on s e s i n a n x-
ious situations (i.e., Situational Analysis Form, Apprehensive Thoughts Self- Monitoring
Form) or from the previous evaluation of coping strategies (i.e., Behavioral Responses to
Anxiety Checklist). The cognitive therapist can go back over these forms and select out
responses that often occur when the person is anxious. For each response the following
questions should be asked to assess the safety- seeking function of the response:
••“I notice from your form that you often do X [state actual response] when you
feel anxious. To what extent do you feel safer or more secure after you have done
this? [e.g., How much safer do you feel going to the mall with a friend versus
going to the mall alone?]”