The Anxiety & Phobia Workbook

Weekly Practice Record

Weekly Practice Record

Goals for Week Date:
1.
2.
3.

Thurs
Mon

Wed
Tues

Sun
Sat
Fri
Used deep breathing technique (6–­7)
Used deep relaxation technique* (5–­7)
Did one-­half hour vigorous exercise (5–­7)
Used coping techniques to manage panic**
Practiced countering negative self-­talk (5–­7)
Used affirmations to counter mistaken beliefs (5–­7)
Practiced imagery exposure (3–­5)
Practiced real-­life exposure (3–­5)
Identified/expressed feelings**
Practiced assertive communication with significant other**
Practiced assertive communication to avoid manipulation**
Self-­esteem: worked on improving body image**
Self-­esteem: took steps toward achieving goals**
Self-­esteem: worked on countering inner critic**
Self-­esteem: worked on nurturing inner child**
Nutrition: eliminated caffeine/sugar/stimulants (7)
Nutrition: ate only whole, unprocessed foods (5–­7)
Nutrition: used antistress supplements (5–­7)
Medication: used appropriate medications as prescribed by doctor (7)
Meaning: worked on discovering/realizing life purpose**
Spirituality: utilized spiritual beliefs and practices to reduce anxiety**

Estimated percent recovery (0 percent to 100 percent):     * e.g., progressive muscle relaxation,
visualization, or meditation
** Recommended frequency varies
depending on focus

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Daily Record of Exercise

Daily Record of Exercise* for          

                (month)

Date Time Type of Exercise Duration Pulse Satisfaction Reason for Not
Rate Level Exercising

* Based on a maximum frequency of six days of exercise

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Panic Attack Worksheet 1

Panic Attack Worksheet 1: Bodily Symptoms

Any of the following bodily symptoms can occur during a panic attack. Please evaluate each one
according to its effect when you are having an attack and indicate your answers on the 0 to 5 scale
in the right-hand column.
0 = No effect 3 = Strong effect
1 = Mild effect 4 = Severe effect
2 = Medium effect 5 = Very severe effect

1. Sinking feeling in stomach 0  1  2  3  4  5

2. Sweaty palms 0  1  2  3  4  5
3. Warm all over 0  1  2  3  4  5
4. Rapid or heavy heartbeat 0  1  2  3  4  5
5. Tremor of the hands 0  1  2  3  4  5
6. Weak or rubbery knees or legs 0  1  2  3  4  5
7. Shaky inside and/or outside 0  1  2  3  4  5
8. Dry mouth 0  1  2  3  4  5
9. Lump in throat 0  1  2  3  4  5
10. Tightness in chest 0  1  2  3  4  5
11. Hyperventilation 0  1  2  3  4  5
12. Nausea or diarrhea 0  1  2  3  4  5
13. Dizzy or light-headed 0  1  2  3  4  5
14. A feeling of unreality—as if “in a dream” 0  1  2  3  4  5
15. Unable to think clearly 0  1  2  3  4  5
16. Blurred vision 0  1  2  3  4  5
17. A feeling of being partially paralyzed 0  1  2  3  4  5
18. A feeling of detachment or floating away 0  1  2  3  4  5
19. Palpitations or irregular heartbeat 0  1  2  3  4  5
20. Chest pain 0  1  2  3  4  5
21. Tingling in hands, feet, or face 0  1  2  3  4  5
22. Feeling faint 0  1  2  3  4  5
23. Fluttery stomach 0  1  2  3  4  5
24. Cold, clammy hands 0  1  2  3  4  5

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Panic Attack Worksheet 2

Panic Attack Worksheet 2: Catastrophic Thoughts*

Catastrophic thoughts play a major role in aggravating panic attacks. Using the scale below, rate
each of the following thoughts according to the degree to which you believe that each thought
contributes to your panic attacks.
1 = Not at all 3 = Quite a lot
2 = Somewhat 4 = Very much
1. I’m going to die. 1  2  3  4
2. I’m going insane. 1  2  3  4
3. I’m losing control. 1  2  3  4
4. This will never end. 1  2  3  4
5. I’m really scared. 1  2  3  4
6. I’m having a heart attack. 1  2  3  4
7. I’m going to pass out. 1  2  3  4
8. I don’t know what people will think. 1  2  3  4
9. I won’t be able to get out of here. 1  2  3  4
10. I don’t understand what’s happening to me. 1  2  3  4
11. People will think I’m crazy. 1  2  3  4
12. I’ll always be this way. 1  2  3  4
13. I’m going to throw up. 1  2  3  4
14. I must have a brain tumor. 1  2  3  4
15. I’ll choke to death. 1  2  3  4
16. I’m going to act foolish. 1  2  3  4
17. I’m going blind. 1  2  3  4
18. I’ll hurt someone. 1  2  3  4
19. I’m going to have a stroke. 1  2  3  4
20. I’m going to scream. 1  2  3  4
21. I’m going to babble or talk funny. 1  2  3  4
22. I’ll be paralyzed by fear. 1  2  3  4
23. Something is really physically wrong with me. 1  2  3  4
24. I won’t be able to breathe. 1  2  3  4
25. Something terrible will happen. 1  2  3  4
26. I’m going to make a scene. 1  2  3  4

* Adapted from “Panic Attack Cognitions Questionnaire” in Coping with Panic: A Drug-Free Approach
to Dealing with Anxiety Attacks by G. A. Clum. Copyright 1990 by Brooks/Cole Publishing Company,
a division of International Thomson Publishing Inc., Pacific Grove, CA 93950. Reprinted by permis-
sion of the publisher.

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Connecting Bodily Symptoms and Catastrophic Thoughts

Connecting Bodily Symptoms and Catastrophic Thoughts

In the left-hand column below, list bodily symptoms you rated 5 or 4 on the first Panic Attack
Worksheet. Describe your most troublesome bodily symptoms, one at a time. Then list catastrophic
self-statements from the second worksheet that you rated 4 or 3. List those catastrophic statements
you would be most likely to make in response to each particular bodily symptom. For example,
“rapid heartbeat” is a bodily symptom that might elicit such catastrophic self-statements as “I’m
having a heart attack” and “I’m going to die.”

Bodily symptom: Catastrophic thoughts:

Bodily symptom: Catastrophic thoughts:

Bodily symptom: Catastrophic thoughts:

Bodily symptom: Catastrophic thoughts:

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Panic Attack Record

Panic Attack Record

Fill out one form for each separate panic attack during a two-week period.

Date:       

Time:       

Duration (minutes):       

Intensity of panic (rate 5 to 10 using the Anxiety Scale in The Anxiety & Phobia Workbook):       

Antecedents

1. Stress level during preceding day (rate on a 1 to 10 scale where 1 is the lowest stress level and
10 is the highest):       

2. Alone or with someone?       

3. If with someone, was it a family member, friend, stranger?       

4. Your mood for three hours preceding panic attack. Anxious       

Depressed        Excited        Angry        Sad        

Other (specify)                                 

5. Were you facing a challenge        or taking it easy        ?

6. Were you engaging in negative or fearful thoughts before you panicked? Yes     No    
If so, what thoughts?        

7. Were you tired        or rested        ?

8. Were you experiencing some kind of emotional upset or loss? Yes     No   

9. Were you feeling hot        , cold        , neither        ?

10. Were you feeling restless and impatient? Yes     No   

11. Were you asleep before you panicked? Yes     No   

12. Did you consume caffeine or sugar within eight hours before you panicked?  
Yes     No    If yes, how much?        

13. Have you noticed any other circumstances that correlate with your panic reactions? (specify)

       

       

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Panic Attack Record

The Anxiety Scale featured in the print book is reprinted here for your convenience.

Anxiety Scale

7–10 Major Panic Attack All of the symptoms in level 6 exaggerated; terror; fear of going
crazy or dying; compulsion to escape

6 Moderate Panic Attack Palpitations; difficulty breathing; feeling disoriented or detached

(feeling of unreality); panic in response to perceived loss of control

5 Early Panic Heart pounding or beating irregularly; constricted breathing;

spaciness or dizziness; definite fear of losing control; compulsion
to escape

4 Marked Anxiety Feeling uncomfortable or “spacey”; heart beating fast; muscles

tight; beginning to wonder about maintaining control

3 Moderate Anxiety Feeling uncomfortable but still in control; heart starting to beat
faster; more rapid breathing; sweaty palms

2 Mild Anxiety Butterflies in stomach; muscle tension; definitely nervous

1 Slight Anxiety Passing twinge of anxiety; feeling slightly nervous

0 Relaxation Calm; a feeling of being undistracted and at peace

The Anxiety & Phobia Workbook Hierarchy Worksheet

Hierarchy Worksheet
Hierarchy for 
(specify phobia)

Instructions: Start with a relatively easy or mild instance of facing your phobia. Develop at least
seven or eight steps that involve progressively more challenging exposures. The final step should
be your goal or even a step beyond what you’ve designated as your goal. Write down the date on
which you complete each step as you work your way up in the hierarchy. For each phobia, make a
separate hierarchy for the coping exposure phase and for the full exposure phase.

Step Date Completed

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Note: Remember to have at least two copies of the Hierarchy Worksheet for each of your phobias (one for
coping exposure, and one for full exposure) in hand before beginning the work described in the book.

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Subpersonality: The Worrier

Subpersonality: The Worrier

Affects me: not at all                    very much
           1  2  3  4  5  6

Negative Self-­Talk Positive Counterstatements

Situation

Work/School

Relationships

Anxiety Symptoms

Phobias

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Subpersonality: The Critic

Subpersonality: The Critic

Affects me: not at all                    very much
           1  2  3  4  5  6

Negative Self-­Talk Positive Counterstatements

Situation

Work/School

Relationships

Anxiety Symptoms

Phobia

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Subpersonality: The Victim

Subpersonality: The Victim

Affects me: not at all                    very much
           1  2  3  4  5  6

Negative Self-­Talk Positive Counterstatements

Situation

Work/School

Relationships

Anxiety Symptoms

Phobias

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Subpersonality: The Perfectionist

Subpersonality: The Perfectionist

Affects me: not at all                    very much
           1  2  3  4  5  6

Negative Self-­Talk Positive Counterstatements

Situation

Work/School

Relationships

Anxiety Symptoms

Phobias

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook The Worry Worksheet

The Worry Worksheet

Specific Fear or Phobia 

Anxious Self-­Talk Counterstatements

Overestimating thoughts (or images)
“What if…?”

Catastrophic thoughts (or images)

“If the worst happened, then…”

Coping strategies: List the ways in which you would cope if a negative (but unlikely) outcome did
occur. Use the other side of the sheet if needed. Change “What if” to “What I would do if (one of
the negative predictions) actually did come about.”

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Cognitive Distortion Worksheet

Cognitive Distortion Worksheet

Type of Distorted Rational Counterstatements

Thinking:               

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Daily Record of Dysfunctional Thoughts

Daily Record of Dysfunctional Thoughts

Date Situation Emotion(s) Automatic Thought(s) Rational Response Outcome
Describe: 1. Specify sad, anxious/ 1. Write automatic 1. Write rational response 1. Rerate belief in
angry, etc. thought(s) that preceded to automatic thought(s). automatic thought(s),
1. Actual event leading to
emotion(s). 0 to 100.
unpleasant emotion, or 2. Rate degree of emotion, 2. Rate belief in rational
0 to 100. 2. Rate belief in automatic response, 0 to 100. 2. Specify and rate your
2. Stream of thoughts,
thought(s), subsequent emotions,
daydream, or recollection
0 to 100. 0 to 100.
leading to unpleasant
emotion

Instructions: When you experience an unpleasant emotion, note the situation that seemed to stimulate the emotion. If the emotion occurred
while you were thinking, daydreaming, et cetera, then note the automatic thought associated with the emotion. Record the degree to which
you believe this thought: 0 = not at all; 100 = completely. In rating degree of emotion, 0 = a trace; 100 = the most intense possible.

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Stress Symptom Checklist

Stress Symptom Checklist

Instructions: Check each item that describes a symptom you have experienced to any significant
degree during the last month, then total the number of items checked.

Physical Symptoms Psychological Symptoms

††Headaches (migraine or tension) ††Anxiety

††Backaches ††Depression
††Tight muscles ††Confusion or “spaciness”
††Neck and shoulder pain ††Irrational fears
††Jaw tension ††Compulsive behavior
††Muscle cramps, spasms ††Forgetfulness
††Nervous stomach ††Feeling “overloaded” or “overwhelmed”
††Other pain ††Hyperactivity—feeling you can’t slow down
††Nausea ††Mood swings
††Insomnia (sleeping poorly) ††Loneliness
††Fatigue, lack of energy ††Problems with relationships
††Cold hands and/or feet ††Dissatisfied/unhappy with work
††Tightness or pressure in the head ††Difficulty concentrating
††High blood pressure ††Frequent irritability
††Diarrhea ††Restlessness
††Skin condition (e.g., rash) ††Frequent boredom
††Allergies ††Frequent worrying or obsessing
††Teeth grinding ††Frequent guilt
††Digestive upsets (cramps, bloating) ††Temper flare-ups
††Stomach pain or ulcer ††Crying spells
††Constipation ††Nightmares
††Hypoglycemia ††Apathy
††Appetite change ††Sexual problems
††Colds ††Weight change
††Profuse perspiration ††Overeating
††Heart beats rapidly or pounds,
even at rest
††When nervous, use of alcohol, cigarettes,
or so-called recreational drugs

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Personal Bill of Rights

Personal Bill of Rights

1. I have the right to ask for what I want.

2. I have the right to say no to requests or demands I can’t meet.

3. I have the right to express all of my feelings, positive or negative.

4. I have the right to change my mind.

5. I have the right to make mistakes and not have to be perfect.

6. I have the right to follow my own values and standards.

7. I have the right to say no to anything when I feel I am not ready, it is unsafe, or it violates my
values.

8. I have the right to determine my own priorities.

9. I have the right not to be responsible for others’ behavior, actions, feelings, or problems.

10. I have the right to expect honesty from others.

11. I have the right to be angry at someone I love.

12. I have the right to be uniquely myself.

13. I have the right to feel scared and say “I feel afraid.”

14. I have the right to say “I don’t know.”

15. I have the right not to give excuses or reasons for my behavior.

16. I have the right to make decisions based on my feelings.

17. I have the right to my own needs for personal space and time.

18. I have the right to be playful and frivolous.

19. I have the right to be healthier than those around me.

20. I have the right to be in a nonabusive environment.

21. I have the right to make friends and be comfortable around people.

22. I have the right to change and grow.

23. I have the right to have my needs and wants respected by others.

24. I have the right to be treated with dignity and respect.

25. I have the right to be happy.

Post the above list in a conspicuous place. By taking time to carefully read through the list every
day, you will eventually learn to accept that you are entitled to each one of the rights enumerated.

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Exercise: Developing an Assertive Response

Exercise: Developing an Assertive Response

Select one of the problem situations you described in “Practicing Assertive Responses” and write
up an assertive response following the six steps outlined above. (If you need more room than the
worksheet provides, use a separate sheet of paper.)

1. Evaluate your rights.

2. Designate a time.

3. State the problem situation in terms of its consequences.

4. Express your feelings.

5. Make your request.

6. State the consequences of gaining (or not gaining) the other person’s cooperation.

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Food Diary

Food Diary
Instructions: Use the following chart to evaluate your eating habits for three days. The areas in
which your average daily consumption varies the most from the ideal are the areas in which you
can make the greatest improvement in what you eat. Make copies of this form (or download the
blank version available online) so that you can track your diet for two or three weeks.

For three days, keep track of how many servings you have of each of these food categories. For
each category, divide the total servings by 3 to get your daily average for the period. Compare
your eating pattern to the ideal, specified in the left column.

Week of:            Day one Day two Day Average Ideal

(dates) servings servings three servings servings
servings per day per day

Caffeine
serving = 1 cup coffee or black tea,
or regular tea (1 serving)

Sweets
serving = 1 candy bar, 1 piece of pie,
1 cup ice cream (1 serving)

Alcohol
serving = 1 beer, 1 glass of wine, or
cocktail (1 serving)

Vegetables and fruits

serving = 1 cup string beans, 1 apple,
medium potato (5 to 10 servings per
day)

Whole-grain breads and cereal

serving = 1 slice of bread, ¾ cup
cereal; ¾ cup rice, oats, or quinoa
(4 to 6 servings per day)

Milk, cheese, yogurt

serving = 1 cup milk, 1 medium slice
cheese, 1 carton of yogurt (2 to 3
servings per day)

Meat, poultry, fish, eggs, beans, and

nuts serving = 3 oz lean meat or fish,
two eggs, 1¼ cup cooked beans,
¾ cup nuts (2 to 3 servings per day)

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Plan of Action: Steps Toward Your Goal

Plan of Action: Steps Toward Your Goal

1. Your goal (be as specific as possible):

2. What small step can you take right now to make some progress toward achieving this goal?

3. What other steps will you need to take to achieve this goal? (Estimate the time required to
complete each step.)

© 2015 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.