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Appendix A Quick-View Guides Compiled by Jennifer S. Mills 310 APPENDIX A QUICK-VIEW GUIDES 311 312 APPENDIX A QUICK-VIEW GUIDES 313 314 APPENDIX A QUICK-VIEW GUIDES 315 316 APPENDIX A QUICK-VIEW GUIDES 317 Appendix B Reprinted Measures Measures for Anxiety and Related Constructs 322 APPENDIX B Anxiety Control Questionnaire (ACQ) Listed below are a number of statements describing a set of beliefs. Please read each statement carefully and, on the 0–5 scale below, indicate how much you think each statement is typical of you. 1. I am usually able to avoid threat quite easily. 2. How well I cope with difficult situations depends on whether I have outside help. 3. When I am put under stress, I am likely to lose control. 4. I can usually stop my anxiety from showing. 5. When I am frightened by something, there is generally nothing I can do. 6. My emotions seem to have a life of their own. 7. There is little I can do to influence people’s judgments of me. 8. Whether I can successfully escape a frightening situation is always a matter of chance with me. 9. I often shake uncontrollably. 10. I can usually put worrisome thoughts out of my mind easily. 11. When I am in a stressful situation, I am able to stop myself from breathing too hard. 12. I can usually influence the degree to which a situation is potentially threatening to me. 13. I am able to control my level of anxiety. 14. There is little I can do to change frightening events. 15. The extent to which a difficult situation resolves itself has nothing to do with my actions. 16. If something is going to hurt me, it will happen no matter what I do. 17. I can usually relax when I want. 18. When I am under stress, I am not always sure how I will react. 19. I can usually make sure people like me if I work at it. 20. Most events that make me anxious are outside my control. 21. I always know exactly how I will react to difficult situations. 22. I am unconcerned if I become anxious in a difficult situation, because I am confident in my ability to cope with my symptoms. 23. What people think of me is largely outside of my control. 24. I usually find it hard to deal with difficult problems. 25. When I hear someone has a serious illness, I worry that I am next. 26. When I am anxious, I find it hard to focus on anything other than my anxiety. 27. I am able to cope as effectively with unexpected anxiety as I am with anxiety that I expect to occur. REPRINTED MEASURES 323 28. I sometimes think, “Why even bother to try coping with my anxiety when nothing I do seems to affect how frequently or intensely I experience it?” 29. I often have the ability to get along with “difficult” people. 30. I will avoid conflict due to my inability to successfully resolve it. © 1996 Association for Advancement of Behavior Therapy. Reprinted from Rapee, R.M., Craske, M.G., Brown, T.A., & Barlow, D.H. (1996). Measurement of perceived control over anxiety-related events. Behavior Therapy, 27, 279– 293. Reprinted with permission from the Association for Advancement of Behavior Therapy and Ron Rapee, Ph.D. 324 APPENDIX B Clinical Anxiety Scale (CAS) Instructions: The Scale is an instrument for the assessment of the present state of anxiety; therefore the emphasis on eliciting information for the ratings should be on how the patient feels at the present time. However, the interview itself may raise, or lower, the severity of anxiety and the interviewer should inform the patient that he should describe how he has felt during the period of the past two days. Psychic tension (care should be taken to distinguish tension from muscular tension—see next item). Score 4: Very marked and distressing feeling of being ‘on edge’, ‘keyed up’, ‘wound up’ or ‘nervous’ which persists with little change throughout the waking hours. Score 3: As above, but with some fluctuation of severity during the course of the day. Score 2: A definite experience of being tense which is sufficient to cause some, although not severe, distress. Score 1: A slight feeling of being tense which does not cause distress. Score 0: No feeling of being tense apart from the normal degree of tension experienced in response to stress and which is acceptable as normal for the population. Ability to relax (muscular tension) Score 4: The experience of severe tension throughout much of the bodily musculature which may be accompanied by such symptoms as pain, stiffness, spasmodic contractions, and lack of control over movements. The experience is present throughout most of the waking day and there is no ability to produce relaxation at will. Score 3: As above, but the muscular tension may only be experienced in certain groups of muscles and may fluctuate in severity throughout the day. Score 2: A definite experience of muscular tension in some part of the musculature suffi- cient to cause some, but not severe, distress. Score 1: Slight recurrent muscular tension of which the patient is aware but which does not cause distress. Very mild degrees of tension headache or pain in other groups of muscles should be scored here. Score 0: No subjective muscular tension or of such degree which, when it occurs, can easily be controlled at will. Startle response (hyperarousability) Score 4: Unexpected noise causes severe distress so that the patient may complain in some such phrase as “I jump out of my skin”. Distress is experienced in psychic and somatic modalities so that, in addition to the experience of fright, there is muscular activity and autonomic symptoms such as sweating or palpitation. Score 3: Unexpected noise causes severe distress in psychic or somatic, but not in both modalities. Score 2: Unexpected noise causes definite but not severe distress. Score 1: Patient agrees that he is slightly ‘jumpy’ but is not distressed by this. Score 0: The degree of startle response is entirely acceptable as normal for the population. Worrying (The assessment must take into account the degree to which worry is out of proportion to actual stress). REPRINTED MEASURES 325 Score 4: The patient experiences almost continuous preoccupation with painful thoughts which cannot be stopped voluntarily and the distress is quite out of proportion to the subject matter of the thoughts. Score 3: As above, but there is some fluctuation in intensity throughout the waking hours and the distressing thoughts may cease for an hour or two, especially if the patient is distracted by activity requiring his attention. Score 2: Painful thoughts out of proportion to the patient’s situation keep intruding into consciousness but he is able to dispel or dismiss them. Score 1: The patient agrees that he tends to worry a little more than necessary about minor matters but this does not cause much distress. Score 0: The tendency to worry is accepted as being normal for the population; for instance even marked worrying over a severe financial crisis or unexpected illness in a relative should be scored as 0 if it is judged to be entirely in keeping with the degree of stress. Apprehension Score 4: The experience is that of being on the brink of some disaster which cannot be explained. The experience need not be continuous and may occur in short bursts several times a day. Score 3: As above, but the experience does not occur more than once a day. Score 2: The sensation of groundless apprehension of disaster which is not severe although it causes definite distress. The patient may not use strong terms such as “disaster” or “catastrophe” but may express his experience in some such phrase as “I feel as if something bad is about to happen.” Score 1: A slight degree of apprehensiveness of which the patient is aware but which does not cause distress. Score 0: No experience of groundless anticipation of disaster. Restlessness Score 4: The patient is unable to keep still for more than a few minutes and engages in restless pacing or other purposeless activity. Score 3: Same as above, but he is able to keep still for an hour or so at a time. Score 2: There is a feeling of “needing to be on the move” which causes some, but not severe, distress. Score 1: Slight experience of restlessness which causes no distress. Score 0: Absence of restlessness. The following item may be rated if required, but should not be added to the CAS Score Panic attacks Score 4: Episodes, occurring several times a day, of the sudden experience of groundless terror accompanied by marked autonomic symptoms, feelings of imminent col- lapse or loss of control over reason and self-integrity. Score 3: As above, but the episodes do not occur more than once a day. Score 2: The episodes may occur only once or twice a week; they are generally less severe than described above but still cause distress. 326 APPENDIX B Score 1: Episodic slight increases in the level of anxiety which are only precipitated by definite events or activities. For instance, the experience of a patient who is recovering from agoraphobia and who experiences a perceptible rise of anxiety on leaving the house would be scored here. Score 0: No episodic sudden increase in the level of anxiety. © 1982 Royal College of Psychiatrists. Reprinted from Snaith, R.P., Baugh, S.J., Clayden, A.D., Husain, A., & Sipple, M.A. (1982) The Clinical Anxiety Scale: An instrument derived from the Hamilton Anxiety Scale.