385
From
Cognitive Therapy of Anxiety Disorders: Scienc
e and Practice
by David A. Clark and Aaron T. Beck. Copy
right 2010 by The Guilford Press. Permission to photocopy
this appendix is granted to purchasers of this book fo
r personal use only (see copyright page for details).
aPPENDIX 9.1
Daily Social Anxiety Self-Monitoring Sheet
Name:
Date:
from
to:
Instructions:
Use the following form to record your daily experiences with anx
ious or distressing social situations that may involve some
performance on your part, an evaluation by others, and/or interpersonal i
nteractions. It is important to complete this form as soon after the social
event as possible in order to maintain its accuracy.Date
Describe Difficult or a
nxious
Social Situation (what
happened, who was involved, where, what was your role?)
anticipation of Event
(duration
and average anxiety level;
0 –100)
actual Event
Exposure
(duration and peak anxiety level; 0–100)
Postevent
Remembering
(duration and average anxiety level; 0–100)
Long-Term
Outcome (rate embarrassment
0 –100)
Note:
Duration refers to the length of time (i.e., minutes
, hours, or days) spent anticipating a social event, being expos
ed to it, or thinking back on it. Estimate the average (or
peak where applicable) level of anxiety on 0 (“no anxiety
”), 50 (“moderately intense”) to 100 (“extreme, panic level”). W
henever a panic attack is experienced in the anticipation,
exposure, or postevent period, record with initials PA. In l
ast column, rate level of embarrassment that remains assoc
iated with the situation from 0 (“none”) to 100 (“the most
embarrassing, humiliating experience in my life”).