Anxiety
Living With Worry And Anxiety Amidst Global Uncertainty
Free Guide
Understanding Generalized Anxiety And Worry
Guide
Understanding Panic
Guide
Understanding Social Anxiety
Guide
A Guide To Emotions (Psychology Tools For Living Well)
Chapter
Anxiety Self-Monitoring Record
Worksheet
Approach Instead Of Avoiding (Psychology Tools For Overcoming Panic)
Chapter
Assertive Communication
Information Handout
Assertive Responses
Exercise
Autonomic Nervous System
Information Handout
Avoidance Hierarchy
Exercise
Behavioral Experiment
Worksheet
Behavioral Experiment (Portrait Format)
Worksheet
Behaviors In Panic (Psychology Tools For Overcoming Panic)
Chapter
Body Sensations In Panic (Psychology Tools For Overcoming Panic)
Chapter
Breathing To Calm The Body Sensations Of Panic (Psychology Tools For Overcoming Panic)
Chapter
CBT Appraisal Model
Worksheet
CBT Thought Record
Worksheet
Challenging Your Negative Thinking
Guide
Classical Conditioning
Information Handout
Cognitive Behavioral Model Of Fear Of Body Sensations
Information Handout
Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)
Information Handout
Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)
Information Handout
Cognitive Behavioral Model Of Intolerance Of Uncertainty (Herbert, Dugas, 2019)
Information Handout
Cognitive Behavioral Model Of Panic (Clark, 1986)
Information Handout
Combined Relaxation Exercise (Audio)
Audio
Coping With Body Sensations (Psychology Tools For Overcoming Panic)
Chapter
Decatastrophizing
Exercise
Developing Psychological Flexibility
Information Handout
Dissociation Record
Worksheet
Embracing Uncertainty
Exercise
Emotions In Panic (Psychology Tools For Overcoming Panic)
Chapter
Emotions Motivate Actions
Information Handout
Exercise For Mental Health
Information Handout
Exposure Practice Form
Exercise
Facing Your Fears (CYP)
Exercise
Fight or Flight (CYP)
Information Handout
Fight Or Flight Response
Information Handout
Grounding Statements (Audio)
Audio
Grounding Techniques
Exercise
Habituation
Information Handout
Health Anxiety Formulation
Information Handout
Health Anxiety Thought Monitoring Record
Worksheet
Health Anxiety Thought Record
Worksheet
How Breathing Affects Feelings
Exercise
How Does This All Add Up To A Panic Attack? (Psychology Tools For Overcoming Panic)
Chapter
How Is Panic Disorder Different From A Panic Attack? (Psychology Tools For Overcoming Panic)
Chapter
How Much Do You Know About Panic? (Psychology Tools For Overcoming Panic)
Chapter
How Your Body Responds To Stress
Information Handout
Identifying The Meaning Of Body Sensations
Worksheet
Interoceptive Exposure
Exercise
Interpersonal Beliefs And Styles
Worksheet
Intolerance Of Uncertainty
Information Handout
Introduction To CBT (Psychology Tools For Overcoming Panic)
Chapter
Intrusive Memory Record
Worksheet
Intrusive Thoughts Brain Metaphor
Information Handout
Learning To Relax (CYP)
Exercise
Making Sense Of Your Panic (Psychology Tools For Overcoming Panic)
Chapter
Maximizing The Effectiveness Of Exposure Therapy
Information Handout
Mindful Attention (Audio)
Audio
Monitoring Your Panic (Psychology Tools For Overcoming Panic)
Chapter
Motivational Systems (Emotional Regulation Systems)
Information Handout
Panic Attack Progress Record
Worksheet
Panic Attack Record Form
Worksheet
Panic Diary
Worksheet
Panic Symptom Tracker
Worksheet
Peaceful Place (Audio)
Audio
Problem Solving (CYP)
Exercise
Progressive Muscle Relaxation
Exercise
Progressive Muscle Relaxation (Audio)
Audio
Progressive Muscle Relaxation (Edition 1)
Exercise
Psychology Tools For Living Well
eBook
Psychology Tools For Mindfulness Audio Collection
Audio Collection
Psychology Tools For Overcoming Panic
eBook
Psychology Tools For Relaxation Audio Collection
Audio Collection
Reciprocal CBT Formulation
Worksheet
Recognizing Agoraphobia
Information Handout
Recognizing Generalized Anxiety Disorder (GAD)
Information Handout
Recognizing Panic Attacks And Panic Disorder
Information Handout
Recognizing Social Anxiety Disorder
Information Handout
Assessment
- Brief Fear Of Negative Evaluation Scale | Leary | 1983
- Scale download archived copy
- Fear Questionnaire (FQ) (Phobia) | Marks, Matthews | 1979
- Scale download archived copy
- Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17(3), 263-267.
- Generalized Anxiety Disorder 7-item (GAD-7) | Spitzer, Kroenke, Williams, Lowe | 2006
- Scale download
- Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.
- Hamilton Rating Scale For Anxiety (HAM-A) | Hamilton | 1959
- Scale download archived copy
- Hamilton, M. (1959).The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50-55.
- Health Anxiety Inventory (HAI) | Salkovskis, Rimes, Warwick, Clark | 2002
- Scale download
- Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(05), 843-853.
- Liebowitz Social Anxiety Scale (LSAS-SR) | Liebowitz | 1987
- Scale download archived copy
- Mobility Inventory For Agoraphobia (MIA) | Chambless, Caputo, Jasin, Gracely, Williams | 1985
- Scale outcometracker.org archive.org
- Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour research and therapy, 23(1), 35-44.
- Panic Disorder Severity Scale (PDSS) | Shear, Brown, Barlow, Money, Sholomskas, Woods, Gorman, Papp | 1997
- Scale download archived copy
- Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … & Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154(11), 1571-1575.
- Penn State Worry Questionnaire | Meyer, Miller, Metzger, Borkovec | 1990
- Scale outcometracker.org archive.org
- Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487-495.
- Spence Children’s Anxiety Scale | Spence | 1998
- Scale download archived copy
- Scale website link archived copy
- Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36 (5), 545-566.
- Severity Measure For Agoraphobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebu | 2013
- Scale – Adult download archived copy
- Severity Measure For Generalized Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
- Scale – Adult download archived copy
- Scale – Child Age 11-17 download archived copy
- Severity Measure For Panic Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
- Scale – Adult download archived copy
- Severity Measure For Social Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
- Scale – Adult download archived copy
- Scale – Child Age 11-17 download archived copy
- Severity Measure For Specific Phobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
- Scale – Adult download archived copy
- Scale – Child Age 11-17 download archived copy
- Social Phobia Inventory (SPIN) | Connor, Davidson, Churchill, Sherwood, Weisler, Foa | 2000
- Scale download archived copy
- Social Phobia Scale | Mattick, Clarke | 1995
- Scale download archived copy
Intervention
Treatment guidelines
- NICE guidelines for GAD and panic | 2011 download
- NICE guidelines for social anxiety disorder | 2013 download
Treatment manuals
- Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Ledley, Foa, Huppert, Clark | 2006 download
- Treatment manual for panic disorder (IAPT treatment manual for high intensity CBT therapists) | Clark, Salkovskis | 2009
downloadarchived copy - A brief cognitive-behavioural treatment for social anxiety disorder | Morris, Mensink, Stewart
downloadarchived copy
Useful resources
- Assertive defense of the self | Padesky | 1985
downloadarchived copy - Interoceptive exposure definition | White, Basden, Barlow
downloadarchived copy - Task concentration training definition | Bögels download archived copy
- Task concentration training and fear of blushing | Bögels, Mulkens, De Jong | 1997
downloadarchived copy
Information Handouts
Generalized anxiety and mindfulness
- What is generalised anxiety disorder? download archived copy
- What is mindfulness? download archived copy
- Mindfulness and letting go download archived copy
- How worry works download archived copy
- Accepting uncertainty download archived copy
- Postpone your worry download archived copy
- Coping with stress download archived copy
Health anxiety
- Health anxiety – a self-help guide
downloadarchived copy
Panic
- What is panic? download
- Biology & Psychology of Panic download
- Vicious Cycle of Anxiety download
- Calming Technique download
- Progressive Muscle Relaxation download
- Behavioural Experiments download
- Situational Exposure download
- Physical Sensations and Panic download
Panic
- Panic self-help booklet by Dr Charles Young download archived copy
- Panic self-help booklet from Glasgow STEPS including information about panic and self-help interventions
downloadarchived copy
Phobia
- Phobia self-help booklet from Glasgow STEPS including information about phobia and self-help interventions
downloadarchived copy
Social anxiety
- What is social anxiety? download
- What can be done about social anxiety? download
- Calming technique: breathing download
- Progressive muscle relaxation download
- Improving how you feel download
- Thinking and feeling download
- Analysing your thinking download
- Changing your thinking download
- Unhelpful thinking styles download
- What are core beliefs? download
- Situational exposure download
- Staying healthy download
Social anxiety
- ‘Shyness and social anxiety – a self help guide’ is an excellent resource
downloadarchived copy
Worksheets
Generalized anxiety and mindfulness
- Postpone your worry download
- Letting go with mindfulness download
- Accepting uncertainty download
- Challenging intolerance of uncertainty download
Panic
- Breathing Rate Record download
- Anxiety Symptoms Record download
- Monitoring Relaxation download
- Sitational Exposure Diary download
- Internal Exposure Record download
Social anxiety
- Anxiety symptoms record download
- Breathing rate record download
- Monitoring your relaxation level download
- Weekly activity schedule download
- Weekly goals record download
- Making the connection download
- Thought diary 1 download
- Thought diary 2 download
- Thought diary 3 download
- Thought diaries (Tri-fold) download
- Core beliefs worksheet download
- Situational exposure download
- Situational exposure diary download
- Healthy me download
- Goal setting download
Self-Help Programmes
Self-help programme for anxiety
- Introduction to the pack
downloadarchived copy - Introduction to anxiety
downloadarchived copy - Physical effects of anxiety
downloaddownload - Recognizing anxious thinking
downloadarchived copy - Dealing with our anxious thinking
downloadarchived copy - Effects of anxiety on mood and behavior
downloadarchived copy - Dealing with setbacks and final thoughts
downloadarchived copy
Self-help programme for generalized anxiety and mindfulness
- Overview of generalised anxiety download
- Overview of worrying download
- Challenging uncontrollability beliefs download
- Attention training download
- Challenging danger beliefs download
- Challenging positive beliefs download
- Problem solving download
- Helpful thinking download
- Accepting uncertainty download
- Self-management plan download
Self-help programme for health anxiety
- Understanding health anxiety download
- How health anxiety develops download
- What keeps health anxiety going? download
- Reducing your focus on health anxiety symptoms and worries download
- Re-evaluating unhelpful health-related thinking download
- Reducing checking and reassurance seeking download
- Challenging avoidance and safety behaviors download
- Adjusting health rules and assumptions download
- Healthy living and self-management planning download
Self-help programme for panic
- Overview of panic download
- More about panic download
- The thinking-feeling connection download
- The ABC’s of thinking and feeling download
- Unhelpful thinking styles download
- Detective work and disputation download
- Evaluation and balanced thinking download
- Core beliefs download
- Coping with physical alarms – Exposure part 1 download
- Coping with physical alarms – Exposure part 2 download
- The calming technique download
- Self management download
Self-help programme for social anxiety
- Overview of social anxiety download
- The calming technique: breathing download
- Progressive muscle relaxation download
- The thinking-feeling connection download
- The ABCs of thinking and feeling download
- Unhelpful thinking styles download
- Detective work and disputation download
- The end result download
- Core beliefs download
- Graded exposure 1 download
- Graded exposure 2 download
- Self management download
Presentations
- New developments in exposure therapy for anxiety and related disorders: the inhibitory learning approach | Blakey, Abramowitz | 2018 download archived copy
- Desirable difficulties: optimizing exposure therapy for anxiety through inhibitory learning | Abramowitz, Jacoby, Blakey | 2018 download archived copy
- GAD – a cognitive model and treatment download archived copy
- Bringing Specificity to Generalized Anxiety Disorder: Conceptualization and Treatment of GAD using Intolerance of Uncertainty as the Theme of Threat | Robichaud | 2013 download archived copy
Recommended Reading
General
- Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 download archived copy
Generalized Anxiety Disorder
- Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011-1023 download archived copy
- Bottesi, G., Ghisi, M., Carraro, E., Barclay, N., Payne, R., & Freeston, M. H. (2016). Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples. Frontiers in psychology, 7, 1723 download archived copy
- Milne, S., Lomax, C., & Freeston, M. H. (2019). A review of the relationship between intolerance of uncertainty and threat appraisal in anxiety. the Cognitive Behaviour Therapist, 12. download
A number of treatment packages have demonstrated efficacy in the treatment of GAD:
Laval model
- Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour research and therapy, 36(2), 215-226.
Avoidance model of worry and GAD
- Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. Generalized anxiety disorder: Advances in research and practice, 2004.
- Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2013). Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration. Cognitive and Behavioral Practice, 20(3), 301-313 download archived copy
Metacognitive model
- Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2013). Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration. Cognitive and Behavioral Practice, 20(3), 301-313.
- Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 23(3), 301-320 download archived copy
Emotional dysregulation model
- Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. (2013). Emotion regulation therapy for generalized anxiety disorder. Cognitive and Behavioral Practice, 20(3), 282-300 nih.gov
- Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 85-90 download archived copy
Acceptance-based model of GAD
- Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance‐based approaches with existing cognitive‐behavioral models. Clinical Psychology: Science and Practice, 9(1), 54-68 download archived copy
- Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29(1), 71-88.
Health Anxiety
- Asmundson, G. J. G., Abramowitz, J. S., Richter, A. A., Whedon, M. (2010). Health anxiety: current perspectives and future directions. Current Psychiatry Reports, 12, 306-312 download
- Furer, P., Walker, J. R. (2008). Death anxiety: A cognitive behavioural approach. Journal of Cognitive Psychotherapy, 22(2), 167-182 download
- Salkovskis, P. M., Warwick, H. M. C., Deale, A. C. (2003). Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353-367
btci.edina.clockss.orgarchived copy - Walker, J. R., Furer, P. (2008). Interoceptive exposure in the treatment of health anxiety and hypochondirasis. Journal of Cognitive Psychotherapy, 22(4), 366-378 download
Panic disorder
- Clark D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24:461–470. download archived copy
- Clark, D. A. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 download archived copy
- Huppert, J. D., & Baker-Morissette, S. L. (2003). Beyond the manual: The insider’s guide to panic control treatment. Cognitive and Behavioral Practice, 10(1), 2-13.
- Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J. et al. (2000). Dismantling cognitive-behavioural treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417-424 download archived copy
- Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Chichester: Wiley.
Social Anxiety Disorder
- Clark, D. M. (2001). A cognitive perspective on social phobia download archived copy
- Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioural Practice, 16. 123-134 download archived copy
- Wild, Hackmann, Clark (2008). Rescripting early memories linked to negative images in social phobia: a pilot study. Behaviour Therapy, 39(1), 47-56. download
- Veale, D. (2003). Treatment of social phobia. Advances in Psychiatric Treatment, 9, 258-264 download archived copy
- Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A., & Clark, D. M. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and behavioral practice, 24(2), 245-255. view archived copy
What Is Anxiety?
Signs and Symptoms of Anxiety Disorders
Different anxiety disorders are characterized by various foci of concern.
- Generalized anxiety disorder (GAD) is characterized by excessive worry about hypothetical future events.
- Health anxiety is characterized by concern about one’s health or illness.
- Panic attacks are characterized by an abrupt surge or intense fear.
- Specific phobia is characterized by the ability for a specific object or situation to provoke marked fear or anxiety.
- Social anxiety disorder is characterized by a fear of social situations in which the individual may be exposed to possible scrutiny.
In addition to disorder-specific cognitive content, individuals experiencing anxiety disorders are likely to experience physical symptoms of anxiety including:
- palpitations or accelerated heart rate
- sweating
- trembling or shaking
- dry mouth
- difficulty breathing
- a feeling of choking
- nausea or abdominal discomfort
- dizziness
- derealization or depersonalization
- fear of losing control or passing out
- fear of dying
- hot flushes or cold chills
- numbness or tingling
- blushing
- fear of vomiting
- urgency or fear of urination or defecation
Psychological Models and Theories of Anxiety
One broad conceptualization of anxiety can be summarized by an ‘anxiety equation’ (Beck, Emery, & Greenberg, 1985; Salkovskis, Forrester, & Richards, 1998):
Anxiety = (perceived probability of therapy × perceived cost or awfulness of danger)
÷ (perceived ability to cope + perceived ‘rescue factors’)
Disorder-specific ‘CBT for anxiety’ cognitive models have been developed for all of the anxiety disorders. These are helpful in that they direct the therapist’s attention toward key interpretations and behaviors that act to perpetuate the anxiety disorders. For example, the critical mechanism that Clark identified in the cognitive model of panic (1986) is that body sensations are misinterpreted catastrophically as signs of danger, with concomitant effects upon emotions, behavior, and secondary cognitions.
Evidence-Based Psychological Approaches for Working with Anxiety
Cognitive behavior therapy has a strong evidence base for treating all of the anxiety disorders. Key components of CBT for anxiety interventions include exposure to the feared situations or stimulus, and an experimental approach to test the accuracy of beliefs.
Resources for Working with Anxiety
Psychology Tools resources available for working therapeutically with anxiety may include:
- psychological models of anxiety
- information handouts for anxious patients
- exercises for anxiety
- CBT worksheets for anxiety
- self-help programs for anxiety including a guide to overcoming panic attacks and panic disorder
References
- Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
- Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53–63.