Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert and Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold).
Describe situations, thoughts, feelings, and actions associated with anxieties and worries, their impact on functioning, and attempts to resolve them. (3)
Ask the client to describe his/her/their past experiences of anxiety and their impact on functioning; assess the focus, excessiveness, and uncontrollability of the worry and the type, frequency, intensity, and duration of his/her/their anxiety symptoms (consider using a structured interview such as the Anxiety and Related Disorders Interview Schedule for the DSM-5).
Complete psychological tests designed to assess worry and anxiety symptoms. (4)
Administer psychological tests or objective measures to help assess the nature and degree of the client's worry and anxiety and their impact on functioning (e.g. The Penn State Worry Questionnaire; OQ-45.2; the Symptom Checklist-90-R).
Cooperate with and complete a medical evaluation. (5)
Arrange for a medical evaluation to rule out nonpsychiatric medical and substance-induced etiologies (e.g. hyperthyroidism, stimulant use).
Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (6, 7, 8, 9)
Assess the client's level of insight (syntonic versus dystonic) toward the presenting problems (e.g. demonstrates good insight into the problematic nature of the described behavior, agrees with others' concern, and is motivated to work on change; demonstrates ambivalence regarding the problem described and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the problem described, is not concerned, and has no motivation to change).
Assess the client for evidence of research-based correlated disorders (e.g. oppositional defiant behavior with ADHD, depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g. increased suicide risk when comorbid depression is evident).
Assess for any issues of age, gender, or culture that could help explain the client's currently defined “problem behavior” and factors that could offer a better understanding of the client's behavior.
Assess for the severity of the level of impairment to the client's functioning to determine appropriate level of care (e.g. the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g. the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment).
Cooperate with a medication evaluation by a prescriber. (10, 11)
Refer the client to a prescriber for a medication evaluation.
Monitor the client's medication adherence, side effects, and effectiveness; consult with the prescriber, as needed.
Discuss ambivalence about changing current worry patterns toward deciding on whether to make changes. (12)
Use Motivational Interviewing techniques to assess the client's current stage of change and willingness to take action steps toward change (see Motivational Interviewing by Miller & Rollnick).
Acknowledge the powerlessness and unmanageability caused by excessive anxiety and addiction. (13, 14)
Help the client understand how anxiety and powerlessness over addiction have made his/her/their life unmanageable.
Teach the client about the relationship between anxiety and addiction (e.g. how the substance was used to treat the anxious symptoms, why more substance use became necessary; or supplement with “Coping with Stress” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Verbalize an understanding of the cognitive, physiological, and behavioral components of anxiety and its treatment. (15, 16, 17)
Discuss how anxiety typically involves excessive worry about unrealistically appraised threats, various bodily expressions of overarousal, hypervigilance, and avoidance of what is threatening that interact to maintain the problem (see Mastery of Your Anxiety and Worry: Therapist Guide by Zinbarg, Craske, & Barlow; Treating Generalized Anxiety Disorder by Rygh & Sanderson).
Discuss how treatment targets worry, anxiety symptoms, and avoidance to help the client manage worry effectively, reduce overarousal, eliminate unnecessary avoidance, and reengage in rewarding activities.
Assign the client to read psychoeducational materials as a bibliotherapy adjunct to in-session work (e.g. Mastery of Your Anxiety and Worry: Workbook by Craske & Barlow; The Anxiety and Worry Workbook by Clark & Beck).
Learn and implement calming skills to reduce overall anxiety and manage anxiety. (18, 19)
Teach the client calming/relaxation/mindfulness skills such as applied relaxation, progressive muscle relaxation, cue controlled relaxation, mindful breathing, and biofeedback as well as how to discriminate better
Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert and Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold). 
