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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 identified as contributing to the client's currently defined “problem behavior” and these were taken into account in regard to their treatment.Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.

      9 Assess Severity of Impairment (9)The severity of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to their impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that their impairment appears to create severe to very severe effects on the client's functioning.The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.

      10 Refer to a Physician (10)The client was referred to a prescribing clinician for an evaluation for a prescription of psychotropic medications.The client was reinforced for following through on a referral to a prescribing clinician for an assessment for a prescription of psychotropic medications, but none were prescribed.The client has been prescribed psychotropic medications.The client declined evaluation by a physician for a prescription of psychotropic medications and was redirected to cooperate with this referral.

      11 Monitor Medications (11)The client was monitored for compliance with the psychotropic medication regimen.The client was provided with positive feedback about regular use of psychotropic medications.The client was monitored for the effectiveness and side effects of the prescribed medications.Concerns about the client's medication effectiveness and side effects were communicated to the prescribing clinician.Although the client was monitored for medication side effects, they reported no concerns in this area.

      12 Use Motivational Interviewing (12)Motivational interviewing techniques were used to help the client clarify their stage of motivation to change.Motivational interviewing techniques were used to help move the client to the action stage in which they agree to learn new ways to conceptualize and manage anxiety.The client was assisted in identifying dissatisfaction with the status quo and the benefits of making changes.The client was assisted in identifying level of optimism for making changes.

      13 Explore Anxiety/Addiction Making Life Unmanageable (13)The client was presented with the concept that powerlessness over anxiety and addiction makes their life unmanageable.The client was assisted in identifying specific instances wherein they have been powerless over addiction and have experienced anxiety, causing life to be unmanageable.As the client's anxiety has decreased, their life has been noted to be somewhat more manageable.The client denied any concerns in regard to anxiety/addiction making life unmanageable and was provided with feedback about how the clinician sees this occurring.

      14 Teach Anxiety/Addiction Relationship (14)The client was taught the relationship between anxiety and addiction, including how substances can be used to treat the anxious symptoms.The client was taught about how more substance abuse becomes necessary to cope with the ongoing anxiety symptoms.The client was assigned “Coping With Stress” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client accepted the relationship between anxiety and addiction and was assisted in identifying specific examples from experience that support this pattern.The client reported decreased substance use during anxious situations, and this success was celebrated.It was noted that despite learning about the connection between anxiety and addiction, the client has not decreased substance use during anxious situations.The client has not completed the “Coping With Stress” homework and was redirected to do so.

      15 Discuss Anxiety Components (15)The client was taught 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.The client was taught how treatment breaks the anxiety cycle by encouraging positive, corrective experiences.The client was taught information from Mastery of Your Anxiety and Worry: Therapist Guide (Zinbarg, Craske, & Barlow) or Treating Generalized Anxiety Disorder (Rygh & Sanderson) regarding the anxiety pattern.The client was reinforced as they displayed a better understanding of the anxiety cycle of unwarranted fear and avoidance and how treatment breaks the cycle.The client displayed a poor understanding of the anxiety and was provided with remedial feedback in this area.

      16 Discuss Target of Treatment (16)A discussion was held about how treatment targets worry, anxiety symptoms, and avoidance to help the client manage worry effectively.The reduction of overarousal and unnecessary avoidance and a reengagement in rewarding activities were emphasized as treatment targets.The client displayed a clear understanding of the target of treatment and was provided with positive feedback in this area.The client struggled to understand the target of treatment and was provided with specific examples in this area.

      17 Assign Reading on Anxiety (17)The client was assigned to read psychoeducational chapters of books or treatment manuals on anxiety.The client was assigned information from Mastery of Your Anxiety and Worry: Workbook (Barlow & Craske) or The Anxiety and Worry Workbook (Clark & Beck).The client has read the assigned information on anxiety, and key points were reviewed.The client has not read the assigned information on anxiety and was redirected to do so.

      18 Teach Relaxation Skills (18)The client was taught calming/relaxation/mindfulness skills.The client was taught skills such as applied relaxation, progressive muscle relaxation, cue-controlled relaxation, mindful breathing, and biofeedback.The client was taught

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