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Centre for Clinical Interventions (CCI): Self-help workbooks and modules

The  Centre for Clinical Interventions  (CCI) has produced resources for consumers and healthcare professionals to assist in providing interventions for mental health problems such as depression, bipolar, social anxiety, panic, self-esteem, procrastination, perfectionism, and eating disorders. Some of these resources have been developed so that they can be worked through by people dealing with particular problems, while others have been produced as part of CCI’s  treatment  and  training  services. The resources provided on this website aim to provide general information about various mental health problems, as well as, techniques that focus on a  cognitive behavioural approach  to managing difficulties.

Looking After Yourself

If you experience a condition that is affecting your mental health and are looking for specific information about different types of problems, then please visit the  self help resources  section to see if there are any information packages relevant to you. 

Information packages are available for conditions such as depression, panic, generalised anxiety, social anxiety, and disordered eating.

View the self-help resources here .

Looking After Others

Nearly half the adult population will experience anxiety or depression or some other psychological problem at some time during their life. This means that it is highly likely that someone you care about will need your support; it could be your partner, child, parents, sibling, other family member friend, or colleague. Looking after someone can be very rewarding, but can also be challenging. It is important that you take care of yourself and we would recommend accessing appropriate services to support you as you look after others. In  Looking After Others  section of our website you will find a range of information sheets about psychological disorders, along with the schedule of information sessions that we provide at CCI.

View the Looking after Others resources here .

For Clinicians

If you are a Mental Health Practitioner or a Doctor and you are interested in cognitive behavioural approaches to psychological interventions, then the resources provided in  For Clinicians  section may be useful in the delivery of mental health services to consumers. It is beneficial to have some background knowledge of cognitive behavioural therapy before using the manuals or information sheets/worksheets so that you are best able to use them in practice.

View the Resources for Clinicians here .

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10 Best Problem-Solving Therapy Worksheets & Activities

Cognitive science tells us that we regularly face not only well-defined problems but, importantly, many that are ill defined (Eysenck & Keane, 2015).

Sometimes, we find ourselves unable to overcome our daily problems or the inevitable (though hopefully infrequent) life traumas we face.

Problem-Solving Therapy aims to reduce the incidence and impact of mental health disorders and improve wellbeing by helping clients face life’s difficulties (Dobson, 2011).

This article introduces Problem-Solving Therapy and offers techniques, activities, and worksheets that mental health professionals can use with clients.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What is problem-solving therapy, 14 steps for problem-solving therapy, 3 best interventions and techniques, 7 activities and worksheets for your session, fascinating books on the topic, resources from positivepsychology.com, a take-home message.

Problem-Solving Therapy assumes that mental disorders arise in response to ineffective or maladaptive coping. By adopting a more realistic and optimistic view of coping, individuals can understand the role of emotions and develop actions to reduce distress and maintain mental wellbeing (Nezu & Nezu, 2009).

“Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella” (Nezu, Nezu, & D’Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.

Clinical research, counseling, and health psychology have shown PST to be highly effective in clients of all ages, ranging from children to the elderly, across multiple clinical settings, including schizophrenia, stress, and anxiety disorders (Dobson, 2011).

Can it help with depression?

PST appears particularly helpful in treating clients with depression. A recent analysis of 30 studies found that PST was an effective treatment with a similar degree of success as other successful therapies targeting depression (Cuijpers, Wit, Kleiboer, Karyotaki, & Ebert, 2020).

Other studies confirm the value of PST and its effectiveness at treating depression in multiple age groups and its capacity to combine with other therapies, including drug treatments (Dobson, 2011).

The major concepts

Effective coping varies depending on the situation, and treatment typically focuses on improving the environment and reducing emotional distress (Dobson, 2011).

PST is based on two overlapping models:

Social problem-solving model

This model focuses on solving the problem “as it occurs in the natural social environment,” combined with a general coping strategy and a method of self-control (Dobson, 2011, p. 198).

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

The model is a “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (Dobson, 2011, p. 199).

Relational problem-solving model

The theory of PST is underpinned by a relational problem-solving model, whereby stress is viewed in terms of the relationships between three factors:

• Stressful life events
• Emotional distress and wellbeing
• Problem-solving coping

Therefore, when a significant adverse life event occurs, it may require “sweeping readjustments in a person’s life” (Dobson, 2011, p. 202).

• Enhance positive problem orientation
• Decrease negative orientation
• Foster ability to apply rational problem-solving skills
• Reduce the tendency to avoid problem-solving
• Minimize the tendency to be careless and impulsive

D’Zurilla’s and Nezu’s model includes (modified from Dobson, 2011):

• Initial structuring Establish a positive therapeutic relationship that encourages optimism and explains the PST approach.
• Assessment Formally and informally assess areas of stress in the client’s life and their problem-solving strengths and weaknesses.
• Obstacles to effective problem-solving Explore typically human challenges to problem-solving, such as multitasking and the negative impact of stress. Introduce tools that can help, such as making lists, visualization, and breaking complex problems down.
• Problem orientation – fostering self-efficacy Introduce the importance of a positive problem orientation, adopting tools, such as visualization, to promote self-efficacy.
• Problem orientation – recognizing problems Help clients recognize issues as they occur and use problem checklists to ‘normalize’ the experience.
• Problem orientation – seeing problems as challenges Encourage clients to break free of harmful and restricted ways of thinking while learning how to argue from another point of view.
• Problem orientation – use and control emotions Help clients understand the role of emotions in problem-solving, including using feelings to inform the process and managing disruptive emotions (such as cognitive reframing and relaxation exercises).
• Problem orientation – stop and think Teach clients how to reduce impulsive and avoidance tendencies (visualizing a stop sign or traffic light).
• Problem definition and formulation Encourage an understanding of the nature of problems and set realistic goals and objectives.
• Generation of alternatives Work with clients to help them recognize the wide range of potential solutions to each problem (for example, brainstorming).
• Decision-making Encourage better decision-making through an improved understanding of the consequences of decisions and the value and likelihood of different outcomes.
• Solution implementation and verification Foster the client’s ability to carry out a solution plan, monitor its outcome, evaluate its effectiveness, and use self-reinforcement to increase the chance of success.
• Guided practice Encourage the application of problem-solving skills across multiple domains and future stressful problems.
• Rapid problem-solving Teach clients how to apply problem-solving questions and guidelines quickly in any given situation.

Success in PST depends on the effectiveness of its implementation; using the right approach is crucial (Dobson, 2011).

Problem-solving therapy – Baycrest

The following interventions and techniques are helpful when implementing more effective problem-solving approaches in client’s lives.

First, it is essential to consider if PST is the best approach for the client, based on the problems they present.

Is PPT appropriate?

It is vital to consider whether PST is appropriate for the client’s situation. Therapists new to the approach may require additional guidance (Nezu et al., 2013).

Therapists should consider the following questions before beginning PST with a client (modified from Nezu et al., 2013):

• Has PST proven effective in the past for the problem? For example, research has shown success with depression, generalized anxiety, back pain, Alzheimer’s disease, cancer, and supporting caregivers (Nezu et al., 2013).
• Is PST acceptable to the client?
• Is the individual experiencing a significant mental or physical health problem?

All affirmative answers suggest that PST would be a helpful technique to apply in this instance.

Five problem-solving steps

The following five steps are valuable when working with clients to help them cope with and manage their environment (modified from Dobson, 2011).

Ask the client to consider the following points (forming the acronym ADAPT) when confronted by a problem:

• Attitude Aim to adopt a positive, optimistic attitude to the problem and problem-solving process.
• Define Obtain all required facts and details of potential obstacles to define the problem.
• Alternatives Identify various alternative solutions and actions to overcome the obstacle and achieve the problem-solving goal.
• Predict Predict each alternative’s positive and negative outcomes and choose the one most likely to achieve the goal and maximize the benefits.
• Try out Once selected, try out the solution and monitor its effectiveness while engaging in self-reinforcement.

If the client is not satisfied with their solution, they can return to step ‘A’ and find a more appropriate solution.

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Positive self-statements

When dealing with clients facing negative self-beliefs, it can be helpful for them to use positive self-statements.

Use the following (or add new) self-statements to replace harmful, negative thinking (modified from Dobson, 2011):

• I can solve this problem; I’ve tackled similar ones before.
• I can cope with this.
• I just need to take a breath and relax.
• Once I start, it will be easier.
• It’s okay to look out for myself.
• I can get help if needed.
• Other people feel the same way I do.
• I’ll take one piece of the problem at a time.
• I can keep my fears in check.
• I don’t need to please everyone.

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PST practitioners have many different techniques available to support clients as they learn to tackle day-to-day or one-off trauma.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Ask the client to complete the following:

• Describe the problem you are facing.
• What is your goal?
• What have you tried so far to solve the problem?
• What was the outcome?

Reactions to Stress

It can be helpful for the client to recognize their own experiences of stress. Do they react angrily, withdraw, or give up (Dobson, 2011)?

The Reactions to Stress worksheet can be given to the client as homework to capture stressful events and their reactions. By recording how they felt, behaved, and thought, they can recognize repeating patterns.

What Are Your Unique Triggers?

Helping clients capture triggers for their stressful reactions can encourage emotional regulation.

When clients can identify triggers that may lead to a negative response, they can stop the experience or slow down their emotional reaction (Dobson, 2011).

The What Are Your Unique Triggers ? worksheet helps the client identify their triggers (e.g., conflict, relationships, physical environment, etc.).

Problem-Solving worksheet

Imagining an existing or potential problem and working through how to resolve it can be a powerful exercise for the client.

Use the Problem-Solving worksheet to state a problem and goal and consider the obstacles in the way. Then explore options for achieving the goal, along with their pros and cons, to assess the best action plan.

Getting the Facts

Clients can become better equipped to tackle problems and choose the right course of action by recognizing facts versus assumptions and gathering all the necessary information (Dobson, 2011).

Use the Getting the Facts worksheet to answer the following questions clearly and unambiguously:

• Who is involved?
• What did or did not happen, and how did it bother you?
• Where did it happen?
• When did it happen?
• Why did it happen?
• How did you respond?

2 Helpful Group Activities

While therapists can use the worksheets above in group situations, the following two interventions work particularly well with more than one person.

Generating Alternative Solutions and Better Decision-Making

A group setting can provide an ideal opportunity to share a problem and identify potential solutions arising from multiple perspectives.

Use the Generating Alternative Solutions and Better Decision-Making worksheet and ask the client to explain the situation or problem to the group and the obstacles in the way.

Once the approaches are captured and reviewed, the individual can share their decision-making process with the group if they want further feedback.

Visualization

Visualization can be performed with individuals or in a group setting to help clients solve problems in multiple ways, including (Dobson, 2011):

• Clarifying the problem by looking at it from multiple perspectives
• Rehearsing a solution in the mind to improve and get more practice
• Visualizing a ‘safe place’ for relaxation, slowing down, and stress management

Guided imagery is particularly valuable for encouraging the group to take a ‘mental vacation’ and let go of stress.

Ask the group to begin with slow, deep breathing that fills the entire diaphragm. Then ask them to visualize a favorite scene (real or imagined) that makes them feel relaxed, perhaps beside a gently flowing river, a summer meadow, or at the beach.

The more the senses are engaged, the more real the experience. Ask the group to think about what they can hear, see, touch, smell, and even taste.

Encourage them to experience the situation as fully as possible, immersing themselves and enjoying their place of safety.

Such feelings of relaxation may be able to help clients fall asleep, relieve stress, and become more ready to solve problems.

We have included three of our favorite books on the subject of Problem-Solving Therapy below.

1. Problem-Solving Therapy: A Treatment Manual – Arthur Nezu, Christine Maguth Nezu, and Thomas D’Zurilla

This is an incredibly valuable book for anyone wishing to understand the principles and practice behind PST.

Written by the co-developers of PST, the manual provides powerful toolkits to overcome cognitive overload, emotional dysregulation, and the barriers to practical problem-solving.

Find the book on Amazon .

2. Emotion-Centered Problem-Solving Therapy: Treatment Guidelines – Arthur Nezu and Christine Maguth Nezu

Another, more recent, book from the creators of PST, this text includes important advances in neuroscience underpinning the role of emotion in behavioral treatment.

Along with clinical examples, the book also includes crucial toolkits that form part of a stepped model for the application of PST.

3. Handbook of Cognitive-Behavioral Therapies – Keith Dobson and David Dozois

This is the fourth edition of a hugely popular guide to Cognitive-Behavioral Therapies and includes a valuable and insightful section on Problem-Solving Therapy.

This is an important book for students and more experienced therapists wishing to form a high-level and in-depth understanding of the tools and techniques available to Cognitive-Behavioral Therapists.

For even more tools to help strengthen your clients’ problem-solving skills, check out the following free worksheets from our blog.

• Case Formulation Worksheet This worksheet presents a four-step framework to help therapists and their clients come to a shared understanding of the client’s presenting problem.
• Understanding Your Default Problem-Solving Approach This worksheet poses a series of questions helping clients reflect on their typical cognitive, emotional, and behavioral responses to problems.
• Social Problem Solving: Step by Step This worksheet presents a streamlined template to help clients define a problem, generate possible courses of action, and evaluate the effectiveness of an implemented solution.

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While we are born problem-solvers, facing an incredibly diverse set of challenges daily, we sometimes need support.

Problem-Solving Therapy aims to reduce stress and associated mental health disorders and improve wellbeing by improving our ability to cope. PST is valuable in diverse clinical settings, ranging from depression to schizophrenia, with research suggesting it as a highly effective treatment for teaching coping strategies and reducing emotional distress.

Many PST techniques are available to help improve clients’ positive outlook on obstacles while reducing avoidance of problem situations and the tendency to be careless and impulsive.

The PST model typically assesses the client’s strengths, weaknesses, and coping strategies when facing problems before encouraging a healthy experience of and relationship with problem-solving.

Why not use this article to explore the theory behind PST and try out some of our powerful tools and interventions with your clients to help them with their decision-making, coping, and problem-solving?

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Cuijpers, P., Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. (2020). Problem-solving therapy for adult depression: An updated meta-analysis. European P sychiatry ,  48 (1), 27–37.
• Dobson, K. S. (2011). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Dobson, K. S., & Dozois, D. J. A. (2021). Handbook of cognitive-behavioral therapies  (4th ed.). Guilford Press.
• Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: A student’s handbook . Psychology Press.
• Nezu, A. M., & Nezu, C. M. (2009). Problem-solving therapy DVD . Retrieved September 13, 2021, from https://www.apa.org/pubs/videos/4310852
• Nezu, A. M., & Nezu, C. M. (2018). Emotion-centered problem-solving therapy: Treatment guidelines. Springer.
• Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual . Springer.

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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.
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• Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36 (5), 545-566.
• Scale website link Download Primary Link Archived Link
• 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.
• Scale archive.org Download Primary Link
• 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.
• Scale Download Archived Link
• 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.
• 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.
• Hamilton, M. (1959).The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50-55.
• Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.
• Scale Download Primary Link
• Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17(3), 263-267.
• Brief Fear Of Negative Evaluation Scale | Leary | 1983 Download Primary Link Archived Link

Guides and workbooks

• Anxiety And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Triningham | 2011 Download Primary Link Archived Link
• Specific phobia: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD) Download Primary Link Archived Link
• Working To Overcome Anxiety (Workbook) | Lucock, Noble, Pallister, Horsefield, Padgett, Westley, Atha, Khan | 2015 Download Primary Link Archived Link
• Social Anxiety (An NHS Self-Help Guide) | Lesley Maunder, Lorna Cameron | 2020 Download Primary Link Archived Link
• Phobia Self-Help Booklet | Anne Joice, Jim White | 2006 Download Archived Link
• Panic attacks: what they are and how to stop the next one | Glasgow STEPS Download Archived Link
• Coping with panic | Charles Young, Alison Hunte, Jessica Newell, Pat Valian | 2011 Download Archived Link
• Health Anxiety – A Self-Help Guide | Maunder, Cameron, Young, Leyland | 2015 Download Archived Link

Information Handouts

• What Is Panic? Download Primary Link Archived Link
• Biology and Psychology of Panic Download Primary Link Archived Link
• The Vicious Cycle of Anxiety Download Primary Link Archived Link
• Breathing Retraining Download Primary Link Archived Link
• Behavioural Experiments (Negative Predictions) Download Primary Link Archived Link
• Situational Exposure Download Primary Link Archived Link
• Physical Sensations and Panic Download Primary Link Archived Link
• What Are Safety Behaviours? Download Primary Link Archived Link
• What is health anxiety? Download Primary Link
• What are safety behaviors? Download Primary Link
• Dealing with health information Download Primary Link
• What is social anxiety? Download Primary Link
• What can be done about social anxiety? Download Primary Link
• Breathing retraining Download Primary Link
• Progressive muscle relaxation Download Primary Link
• Improving how you feel Download Primary Link
• Thinking and feeling Download Primary Link
• Analysing your thinking Download Primary Link
• Changing your thinking Download Primary Link
• Unhelpful thinking styles Download Primary Link
• What are core beliefs? Download Primary Link
• Situational exposure Download Primary Link
• Staying healthy Download Primary Link
• What is anxiety? Download Primary Link
• The vicious cycle of anxiety Download Primary Link
• Behavioral experiments Download Primary Link
• What are safety behaviours? Download Primary Link
• Stress and anxiety Download Primary Link
• Coping with stress Download Primary Link
• Anxiety and exercise Download Primary Link
• What is needle phobia? Download Primary Link
• Overcoming needle phobia Download Primary Link
• CBT for anxiety Download Primary Link

Information (Professional)

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

Presentations

• Cognitive-Behavioral Therapies for Social Anxiety Disorder: Integrating the 3 Waves of Evidence-Based Therapy | Larry Cohen | 2022 Download Primary Link Archived Link
• Why worry? Key cognitive processes that maintain worry and Generalised Anxiety Disorder | Colette Hirsch Download Primary Link Archived Link
• New developments in exposure therapy for anxiety and related disorders: the inhibitory learning approach | Blakey, Abramowitz | 2018 Download Primary Link Archived Link
• Bringing Specificity to Generalized Anxiety Disorder: Conceptualization and Treatment of GAD using Intolerance of Uncertainty as the Theme of Threat | Robichaud | 2013 Download Primary Link Archived Link
• GAD – a cognitive model and treatment Download Primary Link Archived Link
• Desirable difficulties: optimizing exposure therapy for anxiety through inhibitory learning | Abramowitz, Jacoby, Blakey | 2018 Download Primary Link Archived Link

Self-Help Programmes

• Module 1: Overview Of Generalized Anxiety Download Primary Link
• Module 2: Overview Of Worrying Download Primary Link
• Module 3: Challenging Uncontrollability Beliefs Download Primary Link
• Module 4: Attention Training Download Primary Link
• Module 5: Challenging Danger Beliefs Download Primary Link
• Module 6: Challenging Positive Beliefs Download Primary Link
• Module 7: Problem-Solving Download Primary Link
• Module 8: Helpful Thinking Download Primary Link
• Module 9: Accepting Uncertainty Download Primary Link
• Module 10: Self Management Plan Download Primary Link
• Module 1: Understanding Social Anxiety Download Primary Link Archived Link
• Module 2: Overcoming Negative Thinking Download Primary Link Archived Link
• Module 3: Overcoming Avoidance Download Primary Link Archived Link
• Module 4: Behavioral Experiment Stepladders Download Primary Link Archived Link
• Module 5: Safety Behaviors Download Primary Link
• Module 6: The Role Of Attention Download Primary Link Archived Link
• Module 7: How I Think I Appear To Others Download Primary Link Archived Link
• Module 8: Challenging Core Beliefs Download Primary Link
• Module 9: Strengthening New Core Beliefs Download Primary Link
• Module 10: Maintaining Your Gains And Dealing With Setbacks Download Primary Link
• Module 1: Overview Of Panic Download Primary Link
• Module 2: What Keeps Panic Disorder Going Download Primary Link
• Module 3: Overcoming Thoughts About Panic Download Primary Link
• Module 4: Coping With Physical Alarms Download Primary Link
• Module 5: Facing Feared Situations Download Primary Link
• Module 6: Dropping Safety Behaviors Download Primary Link
• Module 7: Maintaining Your Gains Download Primary Link

Treatment Guide

• 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 Download Primary Link Archived Link
• Cognitive behavioral therapy for anxiety: an application of the F.E.A.R. model for adults | Stephen Lenz Download Primary Link Archived Link
• The CARS cognitive behavioral treatment for anxiety manual | Center for Adolescent Research in Schools | 2014 Download Primary Link Archived Link
• Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014 Download Primary Link Archived Link
• Panic disorder: Manual for Improving Access to Psychological Therapy (IAPT) High intensity CBT therapists. | David Clark, Paul Salkovskis | 2009 Download Primary Link Archived Link
• Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Ledley, Foa, Huppert, Clark | 2006 Download Primary Link
• NICE Guidelines For Social Anxiety Disorder | NICE | 2013 Download Primary Link
• NICE Guidelines For GAD And Panic | NICE | 2011 Download Primary Link
• A brief cognitive-behavioural treatment for social anxiety disorder | Eric P. Morris, David Mensink, and Sherry H. Stewart Download Archived Link
• Breathing Rate Record Download Primary Link Archived Link
• Anxiety Symptoms Download Primary Link Archived Link
• Monitoring Relaxation Download Primary Link Archived Link
• Situational Exposure Diary Download Primary Link Archived Link
• Internal Exposure Record Download Primary Link Archived Link
• Anxiety symptoms record Download Primary Link
• Breathing rate record Download Primary Link
• Monitoring your relaxation level Download Primary Link
• Weekly activity schedule Download Primary Link
• Weekly goals record Download Primary Link
• Making the connection Download Primary Link
• Thought diary 1 Download Primary Link
• Thought diary 2 Download Primary Link
• Thought diary 3 Download Primary Link
• Thought diary (tri-fold) Download Primary Link
• Core beliefs worksheet Download Primary Link
• Situational exposure: building steps Download Primary Link
• Healthy me Download Primary Link
• Goal setting: end of therapy Download Primary Link
• Anxiety Symptoms Record Download Primary Link
• Breathing Rate Record Download Primary Link
• Monitoring Relaxation Download Primary Link
• Situational Exposure Diary Download Primary Link
• Making The Connection Download Primary Link
• Thought Diary 1 Download Primary Link
• Thought Diary 2 Download Primary Link
• Thought Diary 3 Download Primary Link
• Thought Diary (Tri-Fold) Download Primary Link
• Behavioral Experiment Worksheet Download Primary Link

Recommended Reading

Health anxiety.

• 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 Primary Link

Social Anxiety Disorder

• 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 Download Primary Link Archived Link
• 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 Download Primary Link Archived Link
• Veale, D. (2003). Treatment of social phobia. Advances in Psychiatric Treatment, 9, 258-264 Download Primary Link Archived Link
• Wild, Hackmann, Clark (2008). Rescripting early memories linked to negative images in social phobia: a pilot study. Behaviour Therapy, 39(1), 47-56. Download Primary Link
• 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 Link
• Clark, D. M. (2001). A cognitive perspective on social phobia Download Archived Link

Panic disorder

• Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Chichester: Wiley.
• 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 Link
• 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.
• Clark, D. A. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 Download Primary Link Archived Link
• 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 Download Archived Link
• Furer, P., Walker, J. R. (2008). Death anxiety: A cognitive behavioural approach. Journal of Cognitive Psychotherapy, 22(2), 167-182 Download Primary Link
• 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 Primary Link Archived Link

Generalized Anxiety Disorder

• 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.
• 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 Primary Link Archived Link
• 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 Primary Link Archived Link
• 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 Download Primary Link
• Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder.Behavioural and cognitive psychotherapy,23(3), 301-320 Download Archived Link
• 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.
• 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 Primary Link Archived Link
• 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.
• 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.
• 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 Primary Link
• 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 Primary Link Archived Link
• 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 Primary Link Archived Link
• 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 Primary Link Archived Link
• Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 Download Primary Link Archived Link
• Task concentration training and fear of blushing | Bögels, Mulkens, De Jong | 1997 Download Archived Link

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
• trembling or shaking
• difficulty breathing
• a feeling of choking
• nausea or abdominal discomfort
• derealization or depersonalization
• fear of losing control or passing out
• fear of dying
• hot flushes or cold chills
• numbness or tingling
• 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
• 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.
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LAST REVIEWED 17 August 2021

Centre for Clinical Interventions - Anxiety workbook

What is Centre for Clinical Interventions - Anxiety workbook ?

Generalised Anxiety Workbook

• Overview of Generalised Anxiety
• Overview of Worry
• Negative Beliefs About Worry (Uncontrollability)
• Attention Training
• Negative Beliefs About Worry (Danger)
• Positive Beliefs About Worrying
• Problem Solving
• Helpful Thinking
• Accepting Uncertainty
• Self-Management

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