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**

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

© 2020 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 Exericse for (month)

Daily Record of Exercise* for

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

* Based on a maximum frequency of six days of exercise per week.

© 2020 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: Bodily Symptoms

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

© 2020 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: Catastrophic Thoughts*

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. 0 1 2 3 4 5
2. I’m going insane. 0 1 2 3 4 5
3. I’m losing control. 0 1 2 3 4 5
4. This will never end. 0 1 2 3 4 5
5. I’m really scared. 0 1 2 3 4 5
6. I’m having a heart attack. 0 1 2 3 4 5
7. I’m going to pass out. 0 1 2 3 4 5
8. I don’t know what people will think. 0 1 2 3 4 5
9. I won’t be able to get out of here. 0 1 2 3 4 5
10. I don’t understand what’s happening to me. 0 1 2 3 4 5
11. People will think I’m crazy. 0 1 2 3 4 5
12. I’ll always be this way. 0 1 2 3 4 5
13. I’m going to throw up. 0 1 2 3 4 5
14. I must have a brain tumor. 0 1 2 3 4 5
15. I’ll choke to death. 0 1 2 3 4 5
16. I’m going to act foolish. 0 1 2 3 4 5
17. I’m going blind. 0 1 2 3 4 5
18. I’ll hurt someone. 0 1 2 3 4 5
19. I’m going to have a stroke. 0 1 2 3 4 5
20. I’m going to scream. 0 1 2 3 4 5
21. I’m going to babble or talk funny. 0 1 2 3 4 5
22. I’ll be paralyzed by fear. 0 1 2 3 4 5
23. Something is really physically wrong with me. 0 1 2 3 4 5
24. I won’t be able to breathe. 0 1 2 3 4 5
25. Something terrible will happen. 0 1 2 3 4 5
26. I’m going to make a scene. 0 1 2 3 4 5

* 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 permission of the publisher.

© 2020 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:

© 2020 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 that follows):

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)

© 2020 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
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. For each phobia, make a separate hierarchy for the coping exposure phase and for the full
exposure phase. If you feel ready to proceed to full exposure without going through a coping exposure phase, then just
write a single hierarchy involving incremental steps of facing your fear without the assistance of anxiety management
techniques. Make a number of copies of the Hierarchy Worksheet from this page. Or you can download it from the website
and make copies. (See the last page of the book for more information about the website for downloading worksheets in
this book.) Use separate worksheets for the coping and full exposure phases for each of your phobias.

Step Date Completed

1.

2.

3.

4.\

5.

6.

7.

8.

9.

10.

11.

12.

13.

© 2020 Edmund J. Bourne / New Harbinger Publications.

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

Subpersonality Worksheet: 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
(Determine the Worrier’s self-talk for each of your
phobias—use a separate sheet if necessary.)

© 2020 Edmund J. Bourne / New Harbinger Publications.

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

Subpersonality Worksheet: 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

Phobias
(Identify critical self-talk for each of your phobias—use a
separate worksheet if needed.)

© 2020 Edmund J. Bourne / New Harbinger Publications.

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

Subpersonality Worksheet: 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
(Identify the Victim’s self-talk for each of your phobias on
a separate worksheet.)

© 2020 Edmund J. Bourne / New Harbinger Publications.

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

Subpersonality Worksheet: 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
(Identify the Perfectionist’s self-talk for each of your
phobias on a separate worksheet.)

© 2020 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Countering Self-Talk Worksheet

Countering Self-Talk 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.”

© 2020 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Exercise: Make a Plan to Deal with Your Worry

Exercise: Make a Plan to Deal with Your Worry

Think about what worries you the most. Is it money? A particular relationship? Your kids? Your health? Your problem
with anxiety itself? An upcoming public speaking situation? Among your worries, which one has highest priority for
you to take action on right now? If you are ready and willing to take action, follow the sequence of steps below, adapted
with permission from The Worry Control Workbook by Mary Ellen Copeland.
Write down the particular situation that is worrying you below:

1. Make a list of possible things you can do to deal with and improve the situation. Write them down, even if they
seem overwhelming or impossible to you right now. Ask family and friends for ideas as well. Don’t judge any
possible options at this point—simply write them down.

2. Consider each idea. Which ones are not possible? Which ones are doable but difficult to implement? Put a ques-
tion mark after these. Which ones could you do in the next week or perhaps the next month? Put a check after
these.

3. Make a contract with yourself to do all the things you checked off. Set specific dates by which you will complete
them. When you have completed the checked items, go on to the more difficult things. Make a similar contract
with yourself to do them and complete them by specific dates.

4. Are there any other items that originally looked impossible that you might be able to do now? If so, make a
contract with yourself to do these, too—again completing them by specific dates.

5. Once you’ve fulfilled all of your contracts, ask yourself how the situation has changed. Has your worry been
satisfactorily resolved? If the situation has not been resolved, go through this process again.

If you continue to have problems with a particular worry, perhaps you have some self-limiting thought patterns
or beliefs that are getting in your way. To understand and modify your personal thought patterns or belief system, see
chapter 8, Self-Talk, and chapter 9, Mistaken Beliefs.

© 2020 Edmund J. Bourne / New Harbinger Publications.

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

Checklist for Symptoms of Stress

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, † When nervous, use of alcohol, cigarettes,

even at rest or recreational drugs

© 2020 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 non-abusive 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.

© 2020 Edmund J. Bourne / New Harbinger Publications.

Permission is granted to the reader to reproduce this form for personal use.
The Anxiety & Phobia Workbook Exercise: Write Out Assertive Requests for Real-Life Situations

Exercise: Write Out Assertive Requests

for Real-Life Situations
Select two or three of the problem people or situations you previously described and write out your assertive request
following the guidelines in “Practice Assertive Requests That You Could Use in Real-Life Situations” above.

Once you’ve written out in detail your assertive request to one or more particular problem situations, you’ll find that
you feel more prepared and confident when you confront the situation in real life. This process of methodically writing
out a preview of your assertive request is especially helpful during the time when you’re learning to be assertive. Later
on, when you have a fair degree of mastery, you may not need to write out your request in advance every time. It’s never
a bad idea, though, to prepare your request, especially when a lot is at stake. Attorneys do so as a way of life because
they typically assert the rights of their clients in high-stakes situations.

© 2020 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—see the back of the book for information)
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, days 1 to 3, by 3 to get your daily average for the period. Compare your eating pattern to the ideal,
specified in the left column.

Week of: (dates) Day one Day two Day three Average Ideal
servings servings 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 1 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 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, 2 eggs, 1¼ cups cooked
beans, ¾ cup nuts (2 to 3 servings per day)

© 2020 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.)

© 2020 Edmund J. Bourne / New Harbinger Publications.

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