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Panic and Agoraphobia Questionnaires


The Agoraphobic Cognitions Questionnaire (ACQ)

This is a modified version of Dianne Chambless’ agoraphobic cognitions questionnaire. Many thanks to Dianne who kindly gave permission for us to modify it in the first place and to post the modified version here. On the lefthand side the frequency of each of the cognitions is totalled to provide a frequency score. On the right-hand side belief ratings are totalled in the same way.

Agoraphobic Cognitions Questionnaire (PDF) (145kb)

The Body Sensations Questionnaire

This is also from Dianne Chambless and is totalled.

Body Sensations Questionnaire (PDF) (121kb)

The Behaviours Questionnaire

The first section of the behaviour scale identifies safety-seeking behaviours frequently reported by panic patients. It is scored as a total with “never” scoring 0, “sometimes” 1, “often” 2, “always” 3. As a clinically used instrument the clinician may wish to look at individual items to identify those safety-seeking behaviours engaged in by a patient. It can be totalled across this section.

The second part of this scale incorporates parts of the Marks & Matthews scale but is scaled on a 0 – 3 basis. Blood injury subscale is obtained by totalling item 5, item 7, item 13, item 16 and item 19. The social phobia scale is obtained by totalling items 6, 10, 12, 14 and 17. The agoraphobia items are number 8, 9, 11, 15 and 18. Items 1, 2, 3, 4, 20 and 21 form a miscellaneous subscale.

Behaviours Questionnaire (PDF) (145kb)

The Mobility Inventory (MI)

This is a version of the Chambless Mobility Inventory and is scored on the basis of total ratings for being alone and being with other people.

Mobility Inventory Questionnaire (PDF) (128kb)

The Panic Rating Scales

These are simple ratings of panic frequency and intensity and other mood ratings. These are scored as individual items.

Panic Rating Scales Questionnaire (PDF) (135kb)

The Panic Diary

This is the diary that was used in treatment trials (Clark et al.1994Clark et al. 1999). There are three versions. The first version is a recording only version which identifies date, situation, frequency of panic attacks and the specific symptoms experienced in each panic attack. Panic severity is also rated as a 0 – 100 rating. This version is used simply to assess the frequency of panics and allow these to be validated against the DSM-IV criteria in terms of number of symptoms.

The second version asks patients to identify the main bodily sensation and how they interpreted that. The third version also includes a response to the catastrophic misinterpretation made. These later versions allow continued monitoring of panic together with the incorporation of work being carried out as part of cognitive therapy.

Panic Diary 1 (PDF) (483kb)

Panic Diary 2 (PDF) (770KB)

Blueprint for Panic Disorder (PDF) (29kb)

questionnaires for clinical use

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