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Appendix A - Reproducible Client Worksheets
Assessment Sheet # 1
Client Anxiety Assessment
Symptoms in Anxiety Disorders
According to Physiological Symptoms
(P) Represents parasympathetic symptoms that facilitate the strategy of collapse
Client Worksheet # 2
Six Stages in the Creation of Anxiety
you need additional space use the back of this paper or add sheets.
I know about my anxiety, the more confident I feel to cope with it. I choose to
explore my anxiety to reduce it.
One: Facing an Unknown
A. What was the situation that caused me to feel
B. Is there a mismatch between my perception of reality and my
expectation of what happened?
C. What did I expect to have happen?
D. What do I feel actually happened?
E. Is there a difference
between my expectation and my perception of what actually happened?
Two: Activating Emotional Memories
A. What is a past similar situation
this brings to mind?
B. What are similar memories I have of vulnerability?
Related to my self-esteem or self-respect concerning... Approval? Competence?
C. Did I feel an initial panic if I could not think
of any circumstances I had faced that were similar?
D. Did my mood
and the specifics of the current situation affect the way I recalled situations
from the past?
E. What successful experiences can I recall?
Three: Creating Images
A. Is my image an exaggeration of the current situation?
B. Am I "what if-ing"? What if I go crazy?" for "What
if I die?"?
C. Am I using "availability logic?" Whatever
springs to mind most easily I judge to be most
probable and most believable?
D. Are you creating pseudoproblems by pretending or imagining the worst? Are your
fantasies worse than what really happens?
E. The Trance: A state of
anxiety has a hypnotic trance-like quality:
___I restrict my awareness and
get tunnel vision.
___My "what if" thinking makes me act "as
if" something will happen.
___I act as I did in a past similar situation.
___What I imagine will happen, I start to believe will happen.
Four: Activating Belief Systems
A. Did I use reactive thinking? I labeled
___1) In an unacceptable way "This should not be"?
___2) By exaggerating the situation, "It's awful."?
___3) By direct
self-instruction, "I have to get out of here."?
___4) By minimizing
my ability to deal with the new information, "I can't handle it." "I
can't stand it."?
B. Reactive thinking serves to stop
the intrusion of frightening images, however it escalates the flow of these images.
Note, the Reactive thinking above in A. is based on the premise that others are
responsible for my thoughts, feelings, and actions.
I use rationalization (excuse making) and use selective attention to see what
I believed to be true based upon a past memory?
D. What can
I say to myself to help me substitute my need for control for one of making emotional
E. Most clients can learn to move into the choice
system relatively easily. However, clients can just as easily move out of it and
back into the reactive system. As you know, the more your client practices, the
easier and more automatic this flexibility becomes. Clients who appear to have
changed may in fact have simply reinforced a new deep-structural belief system.
F. Affirmation: I move from reactive thinking to "choice
Five: Blocking of Acceptance... Creating Subjective Feelings
A. The image
and thoughts clash. This clash causes a stopping of the accepting or processing
of incoming information. This creates a psychological response that your client
experiences subjectively as a feeling.
B. The clash between
my images and my reactive thinking stops me from processing information. This
creates the experience of feeling what? how?
C. Working It
Through... being "in the flow."
___When I accept reality, I feel
"in the flow."
___When I reject my thoughts and images of reality,
I feel "stuck," "blocked," or "conflicted" like
"I'm taking it poorly" or "I can't take it."
accept information about the world, I feel I am "taking it easy" or
"taking it in stride" when the process is blocked.
of big and small setbacks can block my acceptance of a situation.
I am in a state of resistance I have trouble accepting anything.
I accept information I have been fighting I experience a physical change, feeling
clearer, lighter and more energetic.
The feeling is a kinetic self-signal for your client to
take action. Once he or she takes this action, the self-signal stops. Because
the feeling often is experienced as an unknown, this sets the stage for spiraling
My feelings motivate me to take some action; for example
with anger, to attack; with depression, to shut down; with happiness, to approach;
and with anxiety, to flee or protect myself. Once I take action, the motivating
emotion starts to disappear. However, the beliefs that helped create the emotions
are strengthened. Avoidance, for example, decreases anxiety and fear.
Do I procrastinate and use the anxiety of being late to motivate myself?
I choose to switch from a motivation based on feelings of anxiety to motivation
based upon choice by using ACT:
A = Accept current reality.
Choose the experience I want to have and act as if I already have this experience.
For example, if I am socially anxious, I can accept my feelings and lack of social
skills. I then have a feeling of confidence for upcoming events.
T = Task is done directly without anxiety as a motivator. I act as if I am confident
when I am in the social situation. Complete the following: A = Accept reality;
C = Choose feelings; T = Task is acted upon based on chosen feeling.
The goal of the AWARE is to help you to accept and know your
anxiety by remaining present in the context of the situation.
is welcomed; deciding to be with the experience.
as an observer, separate from the experience.
Acting as if one
is not anxious.
Repeating acceptance; create affirmation "I can
handle this." "I am okay."
Expecting the best and accepting
future anxiety by giving up the hope that the anxiety will never recur and connecting
that with trust in one's ability to handle anxiety.
Experiences or feels the anxiety for 45 to 60 seconds. However, during this time,
do not try to fight or change it, and without feeding the anxiety any frightening
thoughts or images. Just feel.
Client Worksheet # 3
Questions About My Anxiety
1. What is the evidence for or against this idea? Make a list of pros and cons.
2. What is the logic behind my thoughts? Are you jumping to conclusions?
3. Am I oversimplifying the result of your actions? Does one failure mean all is
this thought coming from reality or is it coming from my habit of thinking a certain
way? (I am used to thinking I will fail and worthy of success, therefore I am
5. Is my interpretations of the situation too far removed from reality to be accurate?
If so, what did I see or hear?
6. Am I confusing my opinion of the facts with the facts as they are? I really
do not know what another person is thinking.
7. Am I thinking in all-or-nothing terms? (For example, everyone will hate me
or everyone will like me. What is the middle ground?)
8. Am I using words or phrases that are extreme or exaggerated? (like, always,
9. Am I taking selected examples out of context? One year from now, how do I think
I will view this situation?
10. Am I using cognitive defense mechanisms? (For example, denial: "I'm
not afraid, I just don't want to go out"; projections: "The other people
expect me to be perfect"; or rationalizations: "I don't want to make
the call because I don't have the time."
11. Is my source of information reliable? What is the other person's vested
interest, level of experience, or prejudice in this matter?
12. Am I trying to be 100 certain instead of accepting life is made up of probabilities?
13. Am I confusing a low probability with a high probability? Is it
probability or a possibility? Am I confusing probability with possibility?
14. Are my judgments based on feelings rather than on facts? Am I in the habit of
feeling anxious, therefore I am telling myself there is something to be anxious
about... rather than reviewing the fact?
15. Am I over focusing on irrelevant factors? What are the key factors?
Reproducible Client Worksheet # 4
Client Diagrams: The Vicious Cycle
in the boxes to the right with ideas regarding your Anxiety. If you need added
space, use the back of this sheet or additional paper. Briefly describe the situation
that caused you to be anxious.
of Appraisal to Components of Your Fear
Appraisal: Degree of Danger <->
Anxiety <-->Behavioral Mobilization
Vicious Cycle, Incorporating Unpleasant Emotional Feedback (Anxiety),
Performance Feedback, and Unpleasant Feedback
2. Inadequate performing skills <--> Anxiety <-->
in performance <--> Negative reaction of others
Client Assessment Sheet # 5
1) Motor aspects: What does the child do when he or she is afraid?
2) Cognitive components: What does the child think or say to himself or herself when
3) Physiological components: How does the body react when
the child is afraid? Which part(s) of the body are involved?
4) Under which conditions does he or she become fearful?
Child's awareness of their phobia or anxiety
Can the child identify the
various aspects of his or her fear ?
1) Motor aspects: What does
the child do when he or she is afraid?
2) Cognitive components:
What does the child think or say to himself or herself when afraid?
3) Physiological components: How does the child's body react when afraid and which
part(s) of the body is involved?
4) Conditional components:
---Under which conditions is he or she becoming fearful?
---Does the child
have the verbal capacity to generate, with the therapist, a series of self-statements
---Can these self-statements and rules be incorporated by the child,
at least temporarily, into his or her verbal repertoire?
---Is the child
able to apply these self-statements and rules under those conditions in which
he or she experiences anxiety?
1. Preoperative information: What preoperative
information could you provide the child? Is a puppet appropriate for presentation
of the information?
2. Coping procedures: What coping procedures
could you teach the child?
---Cue-controlled muscle relaxation, such as using
the cue "calm."
---Distracting mental imagery training; an example
is imagining a scene that was "quiet and made them feel happy."
---Comforting self-talk; the children, for example, were encouraged to think of
the phrase "I will be all better."
3. Media: Video modeling
children receiving preoperative information.
4. Tour and refreshments:
a 15-minute hospital tour and 15 to 20 minutes eating ice cream and cookies following
Client Worksheet # 6
The Five R's of Anxiety
First R: Realize Anxiety is part of my thoughts.
The first step in overcoming
a distorted view of myself is to realize that my negative and irrational thoughts
are a part of our consciousness. Once I admit the possibility that I am not thinking
clearly, I can choose a new lens with which to look at myself so that I can see
my real potential.
What are some anxious thoughts I have?
R: Recognize 10 ways Anxiety may be effecting my life.
causes me to set unreasonably high standards for myself and others.
2. Rejectionitis is the practice of exaggerating a single rejection until it affects
everything else in my life.
3. Negative focus is the habit of letting
one negative situation in my life obliterate all the positives.
4. Refusing the positives goes a step farther than negative focus. I tell myself
that even the good things in my life are negatives!
5. The white-is-black
phenomenon occurs when I use neutral or even positive facts to make negative conclusions.
I interpret someone else's actions as being hostile to me when they actually indicate
that person's own discomfort.
6. Stretch-or-Shrink thinking is the
habit of either stretching the truth into an anxiety-producing fiction when I've
done something that I'm less than proud of, or shrinking it until it's invisible,
if I did something positive.
7. Creating "excuses" means
letting emotions substitute for the truth about what is happening. Counter excuses
by realizing that your distorted thoughts bring on negative feelings. Affirm that
you are already feeling calm, happy and at peace. Use affirmations to change your
8. "Should" and "ought" statements cause
me to act in ways I would prefer not to, simply because I believe some imaginary
person is telling me that I will be less than perfect if I don't.
identity means telling myself I am all bad because I made a mistake.
10. Saying "My fault" assumes responsibility for a negative event even
when the responsibility is not mine.
The Third R: Refuse to let
Anxiety control my life.
It is one thing to recognize cognitive distortions
after I have suffered the consequences. It is still another to be able to spot
them while I am in the process of distorting so that I can immediately replace
them with a positive thought.
The Fourth R: Replace negative
and irrational thoughts with reality.
Reprograming my unconscious. It involves
planning ahead. I monitor my cognitive distortions and plan how I will confront
them with reality. I can record them in in three columns: 1. Problem Thinking,
2. Cognitive Distortion, and 3. Positive Replacement.
The Fifth R:
Relax and reprogram my unconscious mind.
With the Fifth R, I can learn
to reprogram my unconscious so that my anxiety is decreased in the future. I do
this by relaxing, using visualizations and affirmations.