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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
Anxiety
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"Should" Statements

The “Should” Statements information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more e ... https://www.psychologytools.com/resource/should-statements

Information handouts

A Guide To Emotions (Psychology Tools For Living Well)

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ... https://www.psychologytools.com/resource/a-guide-to-emotions-psychology-tools-for-living-well

Books & Chapters

ABC Model

ABC is an acronym for Antecedents, Behavior, Consequences. It is used as a tool for the assessment and formulation of problem behaviors and is useful ... https://www.psychologytools.com/resource/abc-model

Worksheets

Am I Experiencing Death Anxiety?

Am I Experiencing Death Anxiety? is an indicative screening tool, designed to help clients self-assess whether their experiences might warrant further ... https://www.psychologytools.com/resource/am-i-experiencing-death-anxiety

Exercises

Am I Experiencing Generalized Anxiety Disorder (GAD)?

Generalized anxiety disorder (GAD) is a condition characterized by problematic worry. Am I Experiencing Generalized Anxiety Disorder? is an indicative ... https://www.psychologytools.com/resource/am-i-experiencing-generalized-anxiety-disorder-gad

Exercises

Am I Experiencing Health Anxiety?

Health anxiety (also referred to as illness anxiety disorder and hypochondriasis) is a condition characterized by a preoccupation with, or fear about, ... https://www.psychologytools.com/resource/am-i-experiencing-health-anxiety

Exercises

Am I Experiencing Social Anxiety?

Social anxiety disorder is characterized by persistent fear or anxiety concerning social or performance situations that is out of proportion to the ac ... https://www.psychologytools.com/resource/am-i-experiencing-social-anxiety

Exercises

Anxiety - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/anxiety-self-monitoring-record

Worksheets

Anxiety Self-Monitoring Record (Archived)

NOTE: An improved version of this resource is available here: Anxiety Self-Monitoring Record. Older versions of a resource may be archived in the even ... https://www.psychologytools.com/resource/anxiety-self-monitoring-record-archived

Archived

Approach Instead Of Avoiding (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses avoi ... https://www.psychologytools.com/resource/approach-instead-of-avoiding-psychology-tools-for-overcoming-panic

Books & Chapters

Arbitrary Inference

The Arbitrary Inference information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/arbitrary-inference

Information handouts

Assertive Communication

Communicating and acting assertively is an interpersonal skill that helps people to maintain healthy relationships, resolve interpersonal conflict, an ... https://www.psychologytools.com/resource/assertive-communication

Information handouts

Assertive Responses

Being able to communicate assertively is an essential skill for developing and maintaining healthy relationships and positive self-esteem. Individuals ... https://www.psychologytools.com/resource/assertive-responses

Exercises

Attention Training Experiment

Self-focused attention can make people less likely to see their social performance in a positive light, and contributes to the maintenance of social a ... https://www.psychologytools.com/resource/attention-training-experiment

Exercises

Attention Training Practice Record

When people struggle to control the focus of their attention, they find it much harder to interrupt cycles of worry, rumination, and other forms of se ... https://www.psychologytools.com/resource/attention-training-practice-record

Exercises

Audio Collection: Psychology Tools For Developing Self-Compassion

Psychology Tools For Developing Self-Compassion is an audio collection which guides clients through an empirically-supported programme of compassionat ... https://www.psychologytools.com/resource/psychology-tools-for-developing-self-compassion-audio-collection

Audio

Audio Collection: Psychology Tools For Mindfulness

The Psychology Tools For Mindfulness Audio Collection is the perfect way to introduce your clients to the practice of mindfulness. Developed by a clin ... https://www.psychologytools.com/resource/psychology-tools-for-mindfulness-audio-collection

Audio

Audio Collection: Psychology Tools For Relaxation

The Psychology Tools For Relaxation Audio Collection is designed to help anyone experiencing stress or heightened physiological arousal. The audio col ... https://www.psychologytools.com/resource/psychology-tools-for-relaxation-audio-collection

Audio

Autonomic Nervous System

The autonomic nervous system (ANS) automatically regulates the function of body systems outside of voluntary control. The Autonomic Nervous System han ... https://www.psychologytools.com/resource/autonomic-nervous-system

Information handouts

Avoidance Hierarchy (Archived)

NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are ava ... https://www.psychologytools.com/resource/avoidance-hierarchy

Archived

Balance

Our sense of balance is the result of a complex system which receives visual, vestibular, and proprioceptive inputs. This Balance client information h ... https://www.psychologytools.com/resource/balance

Information handouts

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment

Worksheets

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format

Worksheets

Behaviors In Panic (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses beha ... https://www.psychologytools.com/resource/behaviors-in-panic-psychology-tools-for-overcoming-panic

Books & Chapters

Being With Difficulty (Audio)

Being With Difficulty is a mindfulness exercise which gently brings present-moment awareness to bear upon thoughts and feelings that are more difficul ... https://www.psychologytools.com/resource/being-with-difficulty-audio

Audio

Body Scan (Audio)

The Body Scan is a mindfulness exercise encouraging present-moment awareness, with the sensations of the body being used as an anchor for mindful atte ... https://www.psychologytools.com/resource/body-scan-audio

Audio

Body Sensations In Panic (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses body ... https://www.psychologytools.com/resource/body-sensations-in-panic-psychology-tools-for-overcoming-panic

Books & Chapters

Boundaries - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/boundaries-self-monitoring-record

Worksheets

Breathing To Calm The Body Sensations Of Panic (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses the ... https://www.psychologytools.com/resource/breathing-to-calm-the-body-sensations-of-panic-psychology-tools-for-overcoming-panic

Books & Chapters

Catching Your Thoughts (CYP)

Before thoughts can be examined or challenged they must be ‘caught’ – they must be noticed and distinguished from events and feelings. The Catch ... https://www.psychologytools.com/resource/catching-your-thoughts-cyp

Worksheets

CBT Appraisal Model

The CBT Appraisal Model worksheet is a transdiagnostic formulation tool. The centrality of appraisals underpins all of the disorder-specific cognitive ... https://www.psychologytools.com/resource/cbt-appraisal-model

Worksheets

CFT Compassion Formulation

Within CFT, two methods are commonly used for understanding a client’s difficulties. The threat-focused formulation takes a longitudinal approa ... https://www.psychologytools.com/resource/cft-compassion-formulation

Worksheets

Challenging Your Negative Thinking (Archived)

NOTE: An improved version of this resource is available here: Evaluating Unhelpful Automatic Thoughts. Older versions of a resource may be archived in ... https://www.psychologytools.com/resource/challenging-your-negative-thinking

Archived

Classical Conditioning

Classical conditioning is a process by which stimuli become associated with responses. This information handout describes key principles of Classical ... https://www.psychologytools.com/resource/classical-conditioning

Information handouts

Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)

Depersonalization is an experience where an individual feels a sense of detachment from themselves, or estrangement from their perceptions, actions, a ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-depersonalization-hunter-phillips-chalder-sierra-david-2003

Information handouts

Cognitive Behavioral Model Of Fear Of Body Sensations

Fear of bodily sensations is present in a number of conditions, most notably panic disorder. The Cognitive Behavioral Model Of Fear Of Bodily Sensatio ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-fear-of-body-sensations

Information handouts

Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)

Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Numer ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-generalized-anxiety-disorder-gad-dugas-gagnon-ladouceur-freeston-1998

Information handouts

Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)

Health anxiety is characterized by a preoccupation with having or acquiring a serious illness, and a high level of anxiety about health. People with h ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-health-anxiety-salkovskis-warwick-deale-2003

Information handouts

Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)

Intolerance of uncertainty (IU) has been defined as “an underlying fear of the unknown”. Intolerance of uncertainty is a risk factor for the deve ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-intolerance-of-uncertainty-hebert-dugas-2019

Information handouts

Cognitive Behavioral Model Of Panic (Clark, 1986)

The Cognitive Behavioral Model Of Panic identifies catastrophic misinterpretation of body sensations as a criticial maintenance factor which serves to ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-panic-clark-1986

Information handouts

Cognitive Behavioral Model of Perfectionism (Shafran, Egan, Wade, 2010)

People with perfectionism pursue high standards in one or more areas of their life, and base their self-worth on their ability to achieve these standa ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-perfectionism-shafran-egan-wade-2010

Information handouts

Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)

Persistent postural-perceptual dizziness (PPPD) is a form of dizziness which is thought to be maintained by psychological factors. ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-persistent-postural-perceptual-dizziness-pppd-whalley-cane-2017

Information handouts

Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)

People suffering from social anxiety disorder (previously known as social phobia) experience persistent fear or anxiety concerning social or performan ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-social-phobia-clark-wells-1995

Information handouts

Combined Relaxation Exercise (Audio)

The Combined Relaxation Exercise is an audio track from the Psychology Tools For Relaxation Audio Collection. It is designed to help anyone experienci ... https://www.psychologytools.com/resource/combined-relaxation-exercise-audio

Audio

Compassionate Thought Challenging Record

Thought challenging records are commonly used in CBT to help people to evaluate their negative automatic thoughts for accuracy and bias. This Compassi ... https://www.psychologytools.com/resource/compassionate-thought-challenging-record

Worksheets

Coping With Body Sensations (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses inte ... https://www.psychologytools.com/resource/coping-with-body-sensations-psychology-tools-for-overcoming-panic

Books & Chapters

Core Belief Magnet Metaphor

Core beliefs (schemas) are self-sustaining. They act to 'attract' confirmatory evidence and 'repel' (or distort) disconfirmatory evidence. This inform ... https://www.psychologytools.com/resource/core-belief-magnet-metaphor

Information handouts

Court Trial Thought Challenging Record (Archived)

NOTE: An improved version of this resource is available here: Thought Record - Courtroom Trial. Older versions of a resource may be archived in the ev ... https://www.psychologytools.com/resource/court-trial-thought-challenging-record

Archived

Critical Care And PTSD

The Critical Care And PTSD information handout is designed to help clients to learn about the properties of critical care that can increase the likeli ... https://www.psychologytools.com/resource/critical-care-and-ptsd

Information handouts

Decatastrophizing

Catastrophic thinking (magnification) is characteristic of many anxiety problems. This CBT worksheet for decatastrophizing is a tool for cognitive res ... https://www.psychologytools.com/resource/decatastrophizing

Exercises

Developing Psychological Flexibility

Developing Psychological Flexibility is a client information handout which can be used to familiarize clients with the ACT model. ... https://www.psychologytools.com/resource/developing-psychological-flexibility

Information handouts

Disqualifying The Positive

This Disqualifying the Positive information handout forms part of the cognitive distortions series, designed to help clients and therapists work more ... https://www.psychologytools.com/resource/disqualifying-the-positive

Information handouts

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty

Exercises

Emotional Reasoning

The Emotional Reasoning information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/emotional-reasoning

Information handouts

Emotions In Panic (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses the ... https://www.psychologytools.com/resource/emotions-in-panic-psychology-tools-for-overcoming-panic

Books & Chapters

Emotions Motivate Actions

Many clients find it helpful to recognize the range of actions that are motivated by different emotional states. This worksheet encourages clients to ... https://www.psychologytools.com/resource/emotions-motivate-actions

Information handouts

Evaluating Unhelpful Automatic Thoughts

The Evaluating Unhelpful Automatic Thoughts guide is written for clients who struggle with negative automatic thoughts. It provides a comprehensive in ... https://www.psychologytools.com/resource/evaluating-unhelpful-automatic-thoughts

Guides

Exercise For Mental Health

Exercise is an evidence-based treatment for depression and anxiety and research suggests that, in the treatment of depression, exercise interventions ... https://www.psychologytools.com/resource/exercise-for-mental-health

Information handouts

Exposure Practice Form

Exposure is an effective treatment for many forms of anxiety. The Exposure Practice Form is a CBT worksheet which guides therapists and clients throug ... https://www.psychologytools.com/resource/exposure-practice-form

Exercises

Exposure Session Record

The Exposure Session Record is a tool for recording clients’ use of exposure. The worksheet guides clients to identify a specific fear they are will ... https://www.psychologytools.com/resource/exposure-session-record

Worksheets

Exposures For Fear Of Appearing Anxious

Concerns about appearing anxious in front of others plays a central role in social anxiety. Exposure is an effective treatment for tackling these fear ... https://www.psychologytools.com/resource/exposures-for-fear-of-appearing-anxious

Information handouts

Exposures For Fear Of Body Sensations

Fearful responses to physical sensations are common in several disorders. Interoceptive exposure (or ‘symptom induction’) is an effective treatmen ... https://www.psychologytools.com/resource/exposures-for-fear-of-body-sensations

Information handouts

Exposures For Fear Of Breathlessness

Fearful responses to benign physical sensations such as breathlessness are common in several disorders, most notably panic disorder (with and without ... https://www.psychologytools.com/resource/exposures-for-fear-of-breathlessness

Information handouts

Exposures For Fear Of Causing Harm To Others

Many individuals with obsessive compulsive disorder (OCD) struggle with thoughts relating to harming other people (such as their own children or stran ... https://www.psychologytools.com/resource/exposures-for-fear-of-causing-harm-to-others

Information handouts

Exposures For Fear Of Causing Harm To Yourself

Many individuals with obsessive compulsive disorder (OCD) struggle with thoughts about harming themselves. Exposure is an effective treatment for thes ... https://www.psychologytools.com/resource/exposures-for-fear-of-causing-harm-to-yourself

Information handouts

Exposures For Fear Of Death

Fear of death is common, and is associated with a variety of psychological disorders including generalized anxiety disorder, depression, panic disorde ... https://www.psychologytools.com/resource/exposures-for-fear-of-death

Information handouts

Exposures For Fear Of Flying

Fear of flying is a very common fear, affecting up to 18% of individuals, and is characterized by intense and persistent fear during, or in anticipati ... https://www.psychologytools.com/resource/exposures-for-fear-of-flying

Information handouts

Exposures For Fear Of Heights

Fear of heights is a very common fear, characterized by an avoidance of high places including staircases, tall buildings, and bridges. Exposure is an ... https://www.psychologytools.com/resource/exposures-for-fear-of-heights

Information handouts

Exposures For Fear Of Illness

Fear of illness is a common and persistent fear that can result in significant functional impairment. Exposure is an effective treatment for health-re ... https://www.psychologytools.com/resource/exposures-for-fear-of-illness

Information handouts

Exposures For Fear Of Losing Control Of Your Mind

Fearful responses to benign physical sensations are common in several disorders, and interoceptive exposure (or ‘symptom induction’) is an effecti ... https://www.psychologytools.com/resource/exposures-for-fear-of-losing-control-of-your-mind

Information handouts

Exposures For Fear Of Uncertainty

Fear of uncertainty is commonly associated with many psychological difficulties, including generalized anxiety disorder (GAD), obsessive compulsive di ... https://www.psychologytools.com/resource/exposures-for-fear-of-uncertainty

Information handouts

Exposures For Fear Of Vomiting

Fear of vomiting is a chronic and distressing difficulty that is associated with significant impairment. Exposure is an effective treatment for addres ... https://www.psychologytools.com/resource/exposures-for-fear-of-vomiting

Information handouts

Exposures For Fear Of Weight Gain

Fears related to weight gain are common in eating disorders including anorexia nervosa and bulimia nervosa. Exposure is an effective treatment for fea ... https://www.psychologytools.com/resource/exposures-for-fear-of-weight-gain

Information handouts

Exposures For Trauma

Avoidance is a common feature of post-traumatic stress disorder (PTSD), for which exposure is an effective treatment. Clients sometimes find it diffic ... https://www.psychologytools.com/resource/exposures-for-trauma

Information handouts

Facing Your Fears (CYP)

Graded or graduated exposure is a traditional way of overcoming fears and phobias. The therapist helps the client to draw up a list of feared situatio ... https://www.psychologytools.com/resource/facing-your-fears-cyp

Exercises

Facing Your Fears And Phobias

The Facing Your Fears And Phobias guide is written for clients who struggle with fears or phobias. It provides comprehensive information about what fe ... https://www.psychologytools.com/resource/facing-your-fears-and-phobias

Guides

Fear Ladder

The Fear Ladder is a tool for exploring and ranking the contexts or situations in which a client experiences fear. It is designed to help the client a ... https://www.psychologytools.com/resource/fear-ladder

Worksheets

Fight or Flight (CYP)

The Fight Or Flight (CYP) information handout has been specifically designed for younger children and includes carefully simplified language. The full ... https://www.psychologytools.com/resource/fight-or-flight-cyp

Information handouts

Fight Or Flight Response

The fight or flight response is an automatic physiological reaction to an event that is perceived as stressful or frightening. The perception of threa ... https://www.psychologytools.com/resource/fight-or-flight-response

Information handouts

Grounding Statements (Audio)

Grounding techniques are used to help people to reorient themselves to the present moment and to safety. Grounding Statements are a form of cognitive ... https://www.psychologytools.com/resource/grounding-statements-audio

Audio

Grounding Techniques

Individuals who have experienced trama often find it difficult to stay within the 'window of tolerance'. Grounding techniques (which can be sensory/pe ... https://www.psychologytools.com/resource/grounding-techniques

Exercises

Grounding Techniques Menu

Dissociation can be described as a shift of a person’s attention away from the present moment. When working with traumatized clients, this shift oft ... https://www.psychologytools.com/resource/grounding-techniques-menu

Information handouts

Habituation

The Habituation information sheets are designed to help clinicians to explain the concept of habituation and its role in exposure therapy. The handout ... https://www.psychologytools.com/resource/habituation

Information handouts

Health Anxiety - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/health-anxiety-self-monitoring-record

Worksheets

Health Anxiety Formulation

Health anxiety is characterized by a preoccupation with having or acquiring a serious illness, and a high level of anxiety about health. People with h ... https://www.psychologytools.com/resource/health-anxiety-formulation

Information handouts

Health Anxiety Self-Monitoring Record (Archived)

NOTE: An improved version of this resource is available here: Health Anxiety Self-Monitoring Record. Older versions of a resource may be archived in t ... https://www.psychologytools.com/resource/health-anxiety-self-monitoring-record-edition-1

Archived

Health Anxiety Thought Record

Individuals with health anxiety experience clinically significant distress associated with health concerns. This thought-challenging record enables cl ... https://www.psychologytools.com/resource/health-anxiety-thought-record

Worksheets

How Breathing Affects Feelings

Normal, anxious, and exercise breathing have significant effects upon our physiology and our emotions. This information handout explains the physiolog ... https://www.psychologytools.com/resource/how-breathing-affects-feelings

Information handouts

How Does This All Add Up To A Panic Attack? (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter discusses the ... https://www.psychologytools.com/resource/how-does-this-all-add-up-to-a-panic-attack-psychology-tools-for-overcoming-panic

Books & Chapters

How Is Panic Disorder Different From A Panic Attack? (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter disambiguates ... https://www.psychologytools.com/resource/how-is-panic-disorder-different-from-a-panic-attack-psychology-tools-for-overcoming-panic

Books & Chapters

How Much Do You Know About Panic? (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter includes a qui ... https://www.psychologytools.com/resource/how-much-do-you-know-about-panic-psychology-tools-for-overcoming-panic

Books & Chapters

How Your Body Responds To Stress

Many clients identify with the concept of ‘stress’ more readily than ‘threat’ and the The How Your Body Responds To Stress information handou ... https://www.psychologytools.com/resource/how-your-body-responds-to-stress

Information handouts

Identifying The Meaning Of Body Sensations

Some anxiety disorders (including panic and health anxiety), are concerned with body sensations and symptoms. The Identifying The Meaning Of Body Sens ... https://www.psychologytools.com/resource/identifying-the-meaning-of-body-sensations

Worksheets

Interoceptive Exposure

Misappraisals of body sensations trigger emotional and physiological reactions of fear and heightened arousal. These feelings motivate behavioral resp ... https://www.psychologytools.com/resource/interoceptive-exposure

Exercises

Interpersonal Beliefs And Styles

Interpersonal issues and relationship problems form an important part of what clients bring to therapy: they might present as clients’ current conce ... https://www.psychologytools.com/resource/interpersonal-beliefs-and-styles

Worksheets

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty

Information handouts

Introduction To CBT (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter includes a bri ... https://www.psychologytools.com/resource/introduction-to-cbt-psychology-tools-for-overcoming-panic

Books & Chapters

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record

Worksheets

Jumping To Conclusions

The Jumping to Conclusions information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more ef ... https://www.psychologytools.com/resource/jumping-to-conclusions

Information handouts

Learning To Relax (CYP)

Stress and tension are prevalent complaints amongst children and young people. Teaching relaxation exercises can engender a beneficial sense of contro ... https://www.psychologytools.com/resource/learning-to-relax-cyp

Exercises

Assessment

  • Brief Fear Of Negative Evaluation Scale | Leary | 1983
  • 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 Therapy17(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
  • Mobility Inventory For Agoraphobia (MIA) | Chambless, Caputo, Jasin, Gracely, Williams | 1985
    • Scale download  archived copy
    • Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour research and therapy23(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 Psychiatry154(11), 1571-1575.
  • Penn State Worry Questionnaire | Meyer, Miller, Metzger, Borkovec | 1990
    • Scale download 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 Therapy28(6), 487-495.
  • Spence Children’s Anxiety Scale | Spence | 1998
  • Severity Measure For Agoraphobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebu | 2013
  • Severity Measure For Generalized Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Severity Measure For Panic Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Severity Measure For Social Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Severity Measure For Specific Phobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Social Phobia Inventory (SPIN) | Connor, Davidson, Churchill, Sherwood, Weisler, Foa | 2000
  • Social Phobia Scale | Mattick, Clarke | 1995

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 download archived copy
  • A brief cognitive-behavioural treatment for social anxiety disorder | Morris, Mensink, Stewart  download  archived copy

Useful resources

  • Assertive defense of the self | Padesky | 1985 download archived copy
  • Interoceptive exposure definition | White, Basden, Barlow download archived copy
  • Task concentration training definition | Bögels download archived copy
  • Task concentration training and fear of blushing | Bögels, Mulkens, De Jong | 1997 download archived copy

Information Handouts

Generalized anxiety and mindfulness

Health anxiety

Panic

Panic

  • Panic self-help booklet by | Charles Young, Alison Hunte, Jessica Newell, Pat Valian | 2011 download archived copy
  • Panic self-help booklet from Glasgow STEPS including information about panic and self-help interventions download archived copy

Phobia

  • Phobia self-help booklet from Glasgow STEPS including information about phobia and self-help interventions download archived copy

Social anxiety

Social anxiety

  • ‘Shyness and social anxiety – a self help guide’ download archived copy

Worksheets

Generalized anxiety and mindfulness

Panic

Social anxiety

Self-Help Programmes

Self-help programme for anxiety

Self-help programme for generalized anxiety and mindfulness

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

Self-help programme for social anxiety

 

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 psychology7, 1723 download  archived copy
  • Hirsch, C. R., Beale, S., Grey, N., & Liness, S. (2019). Approaching cognitive behavior therapy for generalized anxiety disorder from a cognitive process perspective. Frontiers in psychiatry, 10, 796. 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 therapy36(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 practice2004.
  • 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 Practice20(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 Practice20(3), 301-313.
  • Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy23(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 Practice20(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 Practice9(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 Practice9(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 Research29(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.org archived 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. 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 Practice10(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
  • Warnock-Parkes, E., Wild, J., Thew, G., Kerr, A., Grey, N., & Clark, D. (2022). ‘I’m unlikeable, boring, weird, foolish, inferior, inadequate’: How to address the persistent negative self-evaluations that are central to social anxiety disorder with cognitive therapy. The Cognitive Behaviour Therapist, 15, E56. doi:10.1017/S1754470X22000496 view archived copy

What Is Anxiety?

Signs and Symptoms of Anxiety Disorders

Different anxiety disorders are characterized by various foci of concern.

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:

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.