longer than 6 months.The client has worry symptoms more days than not.The client described that they worry excessively about two or more events or activities.The client reported that worry about events or activities has diminished and they are living with more of a sense of peace and confidence.2 Excessive Worry About Recent Stressor (2)The client described symptoms of unrealistic preoccupations with worry in response to a recent stressor.The client showed some recognition that excessive worry is beyond the scope of rationality but feels unable to control it.The worry symptoms have continued for longer than 6 months.The client has worry symptoms more days than not.The client described that they worry about recent stressors.The client reported that worry about recent stressors has diminished, and they are living with more of a sense of peace and confidence.
3 Excessive Worry (3)The client described symptoms of excessive and/or unrealistic worry.The client's symptoms of excessive and/or unrealistic worry have not decreased.The client's symptoms of excessive and/or unrealistic worry have decreased through therapeutic techniques.
4 Motor Tension (4)The client described a history of restlessness, tiredness, muscle tension, and shaking.The client moved about in their chair frequently and sat stiffly.The client said that they are unable to relax and are always restless and stressed.The client reported that they have been successful in reducing levels of tension and in increasing levels of relaxation.
5 Autonomic Hyperactivity (5)The client reported symptoms of autonomic hyperactivity (e.g., heart palpitations, dry mouth, tightness in the throat, shortness of breath).The client reported periods of nausea and diarrhea when anxiety levels escalate.The client stated that tension headaches are also occurring, along with other anxiety- related problems.Anxiety-related symptoms have diminished as the client has learned new coping mechanisms.
6 Hypervigilance (6)The client related that they constantly feel on edge, that sleep is interrupted, and that concentration is difficult.The client reported being irritable in interactions with others, as their patience is thin and they are worrying about everything.The client's family members report that the client is difficult to get along with, as their irritability level is high.The client's level of tension has decreased, sleep has improved, and irritability has diminished as new anxiety-coping skills have been implemented.
7 Excessive Worry Based on Cognitive Biases (7)The client described symptoms of preoccupation with worry that something dire will happen that is driven largely by cognitive biases.The client showed some recognition that their uncontrolled worry is irrational.The client described worries about issues related to family, personal safety, health, employment, and many other things but cannot identify any rational reason for these worries.The client reported that worries regarding life's circumstances have diminished, and they are living with more of a sense of peace and confidence.
8 Substance Abuse Response (8)The client identified a pattern of substance abuse in response to excessive anxiety.The client has not decreased substance abuse in response to excessive anxiety.The client identified a decrease in the pattern of substance abuse in response to excessive anxiety.The client has stopped abusing substances in response to excessive anxiety.
9 Substance Abuse to Control Anxiety Symptoms (9)The client described a history of substance abuse as an attempt to control anxiety symptoms.The client identified substance abuse as a self-medication tool regarding anxiety symptoms.The client identified a decrease in the abuse of substances related to controlling anxiety symptoms.The client has maintained total abstinence despite ongoing anxiety symptoms.
INTERVENTIONS IMPLEMENTED
1 Build Trust and Establish Rapport (1)*Caring was conveyed to the client through support, warmth, and empathy.The client was provided with nonjudgmental support and a level of trust was developed.The client was urged to feel safe in expressing anxiety symptoms.The client began to express feelings more freely as rapport and trust level have increased.The client has continued to experience difficulty being open and direct about the expression of painful feelings; the client was encouraged to use the safe haven of therapy to express these difficult issues.
2 Focus on Strengthening Therapeutic Relationship (2)The relationship with the client was strengthened using empirically supported factors.The relationship with client was strengthened through the implementation of a collaborative approach, agreement on goals, demonstration of empathy, verbalization of positive regard, and collection of client feedback.The client reacted positively to the relationship-strengthening measures taken.The client verbalized feeling supported and understood during therapy sessions.Despite attempts to strengthen the therapeutic relationship, the client reports feeling distant and misunderstood.The client has indicated that sessions are not helpful and will be terminating therapy.
3 Assess Nature of Anxiety Symptoms (3)The client was asked to describe past experiences of anxiety and their impact on functioning, including the focus, excessiveness, uncontrollability, type, frequency intensity, and duration of symptoms.The Anxiety and Related Disorders Interview Schedule for the DSM-5 was used to assess the client's anxiety symptoms.The assessment of the client's anxiety symptoms indicated that their symptoms are extreme and severely interfere with their life.The assessment of the client's anxiety symptoms indicated that these symptoms are moderate and occasionally interfere with daily functioning.The assessment of the client's anxiety symptoms indicated that these symptoms are mild and rarely interfere with daily functioning.The results of the assessment of the client's anxiety symptoms were reviewed with the client.
4 Administer Assessments for Anxiety Symptoms (4)The client was administered psychological instruments designed to objectively assess their level of anxiety.The client was administered the Penn State Worry Questionnaire.The client was administered the Outcome Questionnaire 45.2 (OQ-45.2).The client was administered the Symptom Checklist-90-R.The client was provided with feedback regarding the results of the assessment of their level of anxiety.The client declined to participate in the objective assessment of their level of anxiety, and this resistance was processed.
5 Refer for Assessment Regarding Etiology (5)The client was referred for an assessment to rule out nonpsychiatric medical etiologies for their anxiety.The client was referred for an assessment to rule out substance-induced etiologies for their level of anxiety.The client has complied with the referral and the results of this evaluation were reviewed.The client has not complied with the referral for a medical evaluation and was redirected to do so.
6 Assess Level of Insight (6)The client's level of insight toward the presenting problems was assessed.The client was assessed in regard to the syntonic versus dystonic nature of their insight about the presenting problems.The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.The client was noted to be in agreement with others’ concerns and is motivated to work on change.The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
7 Assess for Correlated Disorders (7)The client was assessed for evidence of research-based correlated disorders.The client was assessed in regard to the level of vulnerability to suicide.The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.The client has been assessed for any correlated disorders, but none were found.
8 Assess for Culturally Based Confounding Issues (8)The client was assessed for age-related issues that could help to better understand their clinical presentation.The client was assessed for gender-related issues that could help to better understand their clinical presentation.The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand their clinical presentation.Alternative factors have been
