Cognitive Therapy of Anxiety Disorders

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aPPENDIX 5.3 (page 2 of 2)

2. Briefly describe anxious situation:

Record level of anxiety in situation (0–100 scale):

Checklist of physical sensations experienced in situation:

Physical Sensation

Intensity of Physical Sensation

[Use 0–100 scale defined below]

anxiousness about

Physical Sensation

[Use 0–100 scale defined below]

Chest tightness

Elevated heart rate

Trembling, shaking

Difficulty breathing

Muscle tension

Nausea

Lightheaded, faint, dizzy

Weak, unsteady

Feeling warm, sweaty

Dry mouth

Rating Scale Instructions: Intensity of Physical Sensations Scale, 0 = barely felt the sensation;
50 = strong sense of the sensation; 100 = dominant, overwhelming feeling.

Anxiousness about Physical Sensations Scale, 0 = not at all anxious about having the sensation;
50 = considerable concern that I am having this sensation; 100 = feel intensely anxious, panicky
that I am having this sensation.