Cognitive Therapy of Anxiety Disorders

179

From Cognitive Therapy of Anxiety Disorders: Science and Practice by David A. Clark and Aaron T. Beck. Copyright
2010 by The Guilford Press. Permission to photocopy this appendix is granted to purchasers of this book for personal
use only (see copyright page for details).

aPPENDIX 5.12

Chapter 5 Quick Reference Summary: Cognitive Assessment of Anxiety

I. Conduct Diagnostic Interview (ADIS-Iv or SCID-Iv)

II a ssess Symptom Profile

beck Anxiety Inventory (cutoff score 10+), Cognitions Checklist—Anxiety subscale (M = 18.13, SD

= 10.06 for primary diagnosis of anxiety disorder),* Penn State Worry Questionnaire (cutoff score

45+), Anxiety Sensitivity Index (M = 19.1, SD = 9.11 for nonclinical; M = 36.4, SD = 10.3 for panic

disorder)+, bDI-II (cutoff score 14+), Daily Mood Rating (Appendix 6.1—Daily Anxiety Ratings and

Situation Record); optional measures (HRSA, DASS, STAI)

III. Immediate Fear activation Profile

1. Situational Analysis (assess environmental, interoceptive, and cognitive triggers; use Appendix
   5.2—Situational Analysis Form; detailed description, rate intensity and duration of anxiety, escape/
   avoidance responses, specific triggering cues; begin with in session and then assign as self-
   monitoring)


2. Assess First Apprehensive Thoughts (give illustrative explanation on page 142; probe— “What’s
   the worst that could happen?”, “What concerns you about the situation?”; use Appendix
   5.4—Apprehensive Thought Record to self-monitor; begin with in-session probing)


3. Perceived Autonomic Arousal (typical physiological responses and their interpretation; use Appendix
   5.3—Physical Sensation Self-Monitoring Form or Appendix 5.5—Expanded Physical Sensations
   Checklist for self-monitoring; in session and self-monitor)


4. Automatic Defensive Responses (probe for automatic cognitive avoidance, reassurance seeking,
   compulsions, immediate fight/flight, avoids eye contact, fainting, automatic safety seeking, freezing,
   etc.; complete in session and observation)


5. Cognitive Processing Errors (give client list of common errors—Appendix 5.6, and use Identifying
   Anxious Thinking Errors to discover client’s typical errors; complete in session)

IV. Secondary Elaborative Response Profile

1. Evaluate Coping Responses (assess behavioral and emotional coping responses when anxious; use
   Appendix 5.7—behavioral Responses to Anxiety Checklist in session)


2. Assess Safety-Seeking Function of Coping Responses (identify responses used to instill sense of
   safety and its effects on anxiety; complete in session)


3. Identify Constructive, Adaptive Approaches to Anxiety (any evidence that client has healthy ways of
   coping with anxiety in other situations; complete in session)


4. Assess Role of Worry (use Appendix 5.8—Worry Self-Monitoring Form A to assess worry content;
   determine its effects on anxiety; complete in session)


5. Identify Cognitive Coping Strategies (use Appendix 5.9—Cognitive Responses to Anxiety Checklist
   to identify reliance and perceived effectiveness of maladaptive cognitive responses like thought
   suppression, reassurance seeking, thought stopping, etc.; complete in session)


6. Obtain Description of Threat Reappraisal (use Appendix 5.10—Anxious Reappraisal Form to obtain
   anxious and nonanxious appraisals; latter becomes goal of treatment; complete in session)

V. Complete Case Formulation (use Appendix 5.11—Diagram of Cognitive Case Conceptualization of
Anxiety)
*Steer, R. A., beck, A. T., Clark, D. A., & beck, J. S. (1994). Psychometric properties of the Cognitions Checklist with
psychiatric outpatients and university students. Psychological Assessment, 6, 67–70.
+Antony, M. M. (2001). Measures for panic disorder and agoraphobia. In: M. M. Antony, S. M. orsillo, & L. Roemer (Eds.),
Practitioner’s guide to empirically based measures of anxiety (pp. 95–125). New York: Kluwer Academic/Plenum.