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People think angels fly because they have wings.  Angels fly because they take themselves lightly.

- Anonymous

Here are many of the handouts and questionnaires I use currently (autumn '09) when working with people suffering from panic disorder, agoraphobia, OCD or depersonalization/derealization disorder. 

Panic disorder severity scale - self report (PDSS-SR) - this is the main scale I use to assess initial panic severity and track progress.  It's the self-report form of the PDSS, which has been shown to be comparable to the interview version.  The PDSS is copyrighted to Dr Katherine Shear who has given permission for the scale to be used by clinicians in their practice and researchers in non-industry settings.  For other uses of the scale Katherine Shear should be contacted.   Scores for the PDSS are interpreted somewhat differently depending on whether there is also agoraphobia present or not.  See Scoring the PDSS

Diagnosing panic attacks, etc - I will sometimes sit down beside the person I'm working with, show them these diagnostic criteria and clarify which symptoms they suffer from and which they don't ... and then come to a diagnosis.

Vicious circle & maintaining factors - I often print this Powerpoint handout out (2 slides to a page) to use as a handout and also to clarify why and what we're doing in therapy.

Interoceptive symptom induction tests - again, I use this to remind myself of standard 'interoceptive' challenges.  Can be helpful when fear of catastrophized internal sensations (e.g. feeling faint/might have stroke; heart palpitations/might have heart attack, etc) seems an important part of the symptom picture.  These tests can then be used to clarify anxiety pathways and also as desensitization/exposure/behavioural experiments. 

Panic attack diary page 1 - this diary format (both pages) can be useful for gathering lots of relevant information about symptoms, triggers, avoidance and so on. 

Panic attack diary page 2 

Paired word exercise - a classic test.  If reading through these paired words induces anxiety/panic in a sufferer it can be very useful in helping them see how their catastrophic interpretations are a key part of the problem.

Catastrophic beliefs questionnaire - again can be useful in assessment and monitoring when using a CBT approach for panic disorder.

Panic rating scale (PRS) - I tend to use this scale particularly to clarify safety seeking behaviours and catastrophic thoughts. 

Agoraphobia assessment and scoring, Ost - a scale I use a lot as an initial assessment, to guide desensitization/exposure/behavioural experiments and monitor progress.

See too the Centre for Anxiety Disorders and Trauma website for other freely downloadable panic-relevant questionnaires. 

Normal intrusions - a list of 52 "normal intrusive thoughts" with the percentage of 293 students (none of whom had been diagnosed with a mental health problem) who reported that they had experienced this thought.  I often hand out this leaflet to help people realize that experiencing occasional disturbing intrusive thoughts is totally normal.

OCD diagnosis & prevalence - leaflet giving DSM-IV diagnostic criteria for obsessive-compulsive disorder and some details of prevalence rates.

Obsessive-compulsive inventory (OCI) - this is designed as a questionnaire to be completed by people suffering from OCD.  It is recommended for use by the NHS Increasing Access to Psychological Therapies (IAPT) initiative.  Here is a Word version with each question 'tagged' to indicate which subscale it refers to (the hoarding subscale is probably the least helpful).  The UK Institute of Psychiatry website provides a PDF version of the scale and see too pages 22-23 of their booklet for more details on OCI scoring, including typical scores for OCD sufferers and a 'normal' control group.  It is suggested too that a total score of 40 or more suggests probable "caseness".  Note both versions of the OCI given above just assess distress, not frequency, of symptoms.  Note that the excellent Centre for Anxiety Disorders and Trauma website provides a series of other helpful OCD questionnaires. OCD flow chart (Menzies) - an interesting & informative flow chart developed by Menzies and colleagues in Australia.

More recently still, I have moved to using the shortened 18-item OCI-R - for more details see the blog post A better way to assess & monitor progress with OCD.

OCD flow chart & explanation (Wells) - this flow chart developed by Adrian Wells is particularly helpful in guiding cognitive behavioural therapy for OCD.  The behavioural exposure & response prevention approach is at the heart of treatment, but other cognitive targets can usefully be included in therapy.  The explanatory background sheet gives helpful instructions on using the flow chart that are relevant for both sufferer and therapist.

Dysfunctional thoughts record - a classic cognitive therapy thought record sheet adapted for use in OCD.

Assessing rituals - simple listing, general diary & timed diary - forms for assessing what rituals are being used.

Assessing obsessions - simple listing of obsessions, often used with the rituals diaries (see above)

Target symptoms list (long term goals) - this sheet & the one below are used in conjunction with Lee Baer's fine self-help OCD book "Getting control" - often useful to use with therapist help.

Rating progress (practice goals) - used with Lee Baer's book on OCD (see above).

Exposure practice record - a simple exposure & response prevention exercise record sheet for OCD exposure (real life) practice.

Imagery practice record - a simple exposure & response prevention exercise record sheet for OCD exposure (in imagery) practice.

Depersonalization scale, scoring and background - good for assessment and monitoring progress. 

 

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