Anxiety

Fear and its associated reactions (freeze, flight, fight) can be useful responses to a dangerous or threatening situation. However, clients suffering from anxiety disorders experience these reactions too strongly, too often, or in inappropriate situations - and they can be distressing and exhausting. Psychology Tools can help you with CBT for anxiety - our anxiety worksheets are designed to help clients with generalized anxiety disorder (GAD), health anxiety (hypochondriasis), panic disorder, phobias, and social anxiety. Read more

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Assessment

Brief Fear Of Negative Evaluation Scale | Leary | 1983
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Fear Questionnaire (FQ) (Phobia) | Marks, Matthews | 1979
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- Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17(3), 263-267.
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Generalized Anxiety Disorder 7-item (GAD-7) | Spitzer, Kroenke, Williams, Lowe | 2006
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- Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.
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Hamilton Rating Scale For Anxiety (HAM-A) | Hamilton | 1959
- Hamilton, M. (1959).The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50-55.
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Health Anxiety Inventory (HAI) | Salkovskis, Rimes, Warwick, Clark | 2002
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- Reference 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
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Mobility Inventory For Agoraphobia(MIA) | Chambless, Caputo, Jasin, Gracely, Williams | 1985
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- 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.
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Panic Disorder Severity Scale (PDSS) | Shear, Brown, Barlow, Money, Sholomskas, Woods, Gorman, Papp | 1997
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- 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.
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Penn State Worry Questionnaire | Meyer, Miller, Metzger, Borkovec | 1990
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- 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.
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Spence Children’s Anxiety Scale | Spence | 1998
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- Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36 (5), 545-566.
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Severity Measure For Agoraphobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebu | 2013
- Scale – Adult
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Severity Measure For Generalized Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
- Scale – Adult
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- Scale – Child Age 11-17
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Severity Measure For Panic Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
- Scale – Adult
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Severity Measure For Social Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
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- Scale – Adult
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- Scale – Child Age 11-17
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Severity Measure For Specific Phobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
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- Scale – Adult
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- Scale – Child Age 11-17
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Social Phobia Inventory (SPIN) | Connor, Davidson, Churchill, Sherwood, Weisler, Foa | 2000
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Social Phobia Scale | Mattick, Clarke | 1995
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Brief Fear of Negative Evaluation Scale | Leary | 1983
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Oxford - Agoraphobic Avoidance Scale (O-AS) | Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. | 2023
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- Reference Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. (2023). The Oxford agoraphobic avoidance scale. Psychological Medicine, 53(4), 1233-1243.

Guides

Anxiety And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Triningham | 2011
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Health Anxiety – A Self-Help Guide | Maunder, Cameron, Young, Leyland | 2015
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Phobia Self-Help Booklet | Anne Joice, Jim White | 2006
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Social Anxiety (An NHS Self-Help Guide) | Lesley Maunder, Lorna Cameron | 2020
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Working To Overcome Anxiety (Workbook) | Lucock, Noble, Pallister, Horsefield, Padgett, Westley, Atha, Khan | 2015
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Specific phobia: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD)
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Information Handouts

Panic

Progressive Muscle Relaxation
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Panic self-help booklet by | Charles Young, Alison Hunte, Jessica Newell, Pat Valian | 2011
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Panic attacks: what they are and how to stop the next one | Glasgow STEPS
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Social anxiety

What is social anxiety?
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What can be done about social anxiety?
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Calming technique: breathing
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Procrastination (Information Handouts) | Centre For Clinical Interventions
- What Is Procrastination?
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- Vicious Cycle of Procrastination
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- Dismissing Procrastination Excuses
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- Practical Strategies to Stop Procrastination
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- Procrastination: Unhelpful Rules and Assumptions
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- Tolerating Discomfort
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- Action Plan
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Anxiety - Information sheets | Centre For Clinical Interventions
- What is anxiety?
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- The vicious cycle of anxiety
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- Analysing your thinking
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- Unhelpful thinking styles
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- Behavioral experiments
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- Situational exposure
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- What are safety behaviours?
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- Breathing retraining
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- Progressive muscle relaxation
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- Stress and anxiety
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- Coping with stress
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- Anxiety and exercise
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- What is needle phobia?
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- Overcoming needle phobia
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- CBT for anxiety
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Information (Professional)

Assertive defense of the self (A more effective treatment focus for social phobia?) | Padesky | 1985
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Interoceptive Exposure Definition | White, Basden, Barlow
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Task Concentration Training Definition | Bögels
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Presentations

New developments in exposure therapy for anxiety and related disorders: the inhibitory learning approach | Blakey, Abramowitz | 2018
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Desirable difficulties: optimizing exposure therapy for anxiety through inhibitory learning | Abramowitz, Jacoby, Blakey | 2018
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GAD – a cognitive model and treatment
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Bringing Specificity to Generalized Anxiety Disorder: Conceptualization and Treatment of GAD using Intolerance of Uncertainty as the Theme of Threat | Robichaud | 2013
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Why worry? Key cognitive processes that maintain worry and Generalised Anxiety Disorder | Colette Hirsch
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Self-Help Programmes

When Panic Attacks (Workbook) | Centre For Clinical Interventions | 2023
- Module 1: Overview Of Panic
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- Module 2: What Keeps Panic Disorder Going
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- Module 3: Overcoming Thoughts About Panic
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- Module 4: Coping With Physical Alarms
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- Module 5: Facing Feared Situations
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- Module 6: Dropping Safety Behaviors
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- Module 7: Maintaining Your Gains
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Stepping Out Of Social Anxiety (Workbook) | Centre For Clinical Interventions | 2020
- Module 1: Understanding Social Anxiety
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- Module 2: Overcoming Negative Thinking
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- Module 3: Overcoming Avoidance
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- Module 4: Behavioral Experiment Stepladders
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- Module 5: Safety Behaviors
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- Module 6: The Role Of Attention
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- Module 7: How I Think I Appear To Others
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- Module 8: Challenging Core Beliefs
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- Module 9: Strengthening New Core Beliefs
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- Module 10: Maintaining Your Gains And Dealing With Setbacks
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What? Me Worry? (Workbook) | Centre For Clinical Interventions | 2015
- Module 1: Overview Of Generalized Anxiety
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- Module 2: Overview Of Worrying
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- Module 3: Challenging Uncontrollability Beliefs
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- Module 4: Attention Training
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- Module 5: Challenging Danger Beliefs
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- Module 6: Challenging Positive Beliefs
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- Module 7: Problem-Solving
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- Module 8: Helpful Thinking
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- Module 9: Accepting Uncertainty
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- Module 10: Self Management Plan
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Treatment Guide

NICE Guidelines For GAD And Panic | NICE | 2011
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NICE Guidelines For Social Anxiety Disorder | NICE | 2013
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Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Ledley, Foa, Huppert, Clark | 2006
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Panic disorder: Manual for Improving Access to Psychological Therapy (IAPT) High intensity CBT therapists. | David Clark, Paul Salkovskis | 2009
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A brief cognitive-behavioural treatment for social anxiety disorder | Eric P. Morris, David Mensink, and Sherry H. Stewart
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Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014
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Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Deborah Roth Ledley, Edna B. Foa, Jonathan D. Huppert (in consultation with David M. Clark) | 2005
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The CARS cognitive behavioral treatment for anxiety manual | Center for Adolescent Research in Schools | 2014
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Cognitive behavioral therapy for anxiety: an application of the F.E.A.R. model for adults | Stephen Lenz
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Worksheets

Generalized anxiety and mindfulness

Letting go with mindfulness
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Challenging intolerance of uncertainty
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Social anxiety

Monitoring your relaxation level
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Anxiety (Worksheets) | Centre For Clinical Interventions
- Anxiety Symptoms Record
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- Breathing Rate Record
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- Monitoring Relaxation
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- Situational Exposure Diary
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- Making The Connection
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- Thought Diary 1
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- Thought Diary 2
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- Thought Diary 3
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- Thought Diary (Tri-Fold)
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- Behavioral Experiment Worksheet
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Procrastination Cycle | Centre For Clinical Intervention
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Anxiety - Worksheets | Centre For Clinical Interventions
- Anxiety symptoms record
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- Breathing rate record
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- Monitoring relaxation
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- Situational exposure diary
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- Making the connection
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- Thought diary 1
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- Thought diary 2
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- Thought diary 3
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- Thought diary (tri-fold)
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- Behavioral experiment worksheet
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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.

Anxiety

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Resource type

Problem

Therapy tool

Links to external resources

Assessment

Guides

Information Handouts

Panic

Social anxiety

Information (Professional)

Presentations

Self-Help Programmes

Treatment Guide

Worksheets

Generalized anxiety and mindfulness

Social anxiety

Recommended Reading

General

Generalized Anxiety Disorder

Health anxiety

Panic disorder

Social Anxiety Disorder

What Is Anxiety?

Signs and Symptoms of Anxiety Disorders

Psychological Models and Theories of Anxiety

Evidence-Based Psychological Approaches for Working with Anxiety

Resources for Working with Anxiety

References