Cognitive Assessment and Case Formulation 161
summary anD ConClusionIn this chapter we presented a cognitive case conceptualization perspective that is based
on the cognitive model of anxiety (see Chapter 2). Although this framework will be
applicable to all anxiety cases, it will require some modification for each of the specific
anxiety disorders. Case formulation plays an important role in cognitive therapy for
all psychological problems. For the anxiety disorders assessment begins with clinical
diagnosis and administration of standardized questionnaires. It is important that pres-
ence of anxious and depressive symptoms be assessed. Utilizing interview methodology,
self- monitoring forms, and direct observation, the clinician gathers information on the
immediate or automatic cognitive, physiological, and behavioral responses that charac-
terize the initial fear program. This is followed by assessment of more deliberate cogni-
tive and behavioral coping strategies that are intended to terminate the anxious episode
but instead inadvertently contribute to its long-term persistence. Particular attention
is given to automatic and intentional responses that have a safety- seeking function.
The assessment will culminate in a specification of the threat and personal vulnerabil-
ity appraisals generated when the individual is an anxious and a nonanxious state.
This detailed cognitive formulation should lead to the development of specific treatment
goals that will guide the intervention process. A Quick Reference Summary is provided
in Appendix 5.12 to assist the clinician in applying our cognitive perspective on assess-
ment and case formulation in clinical practice.