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In my work as a school psychologist, I love incorporating worksheets into my daily practice with the students. Recently, I had a counseling session with an 11-year-old-student with a history of school refusal and somatic complaints. I immediately reached for the anxiety section of the CBT Toolbox for Children and Adolescents and selected the and the worksheets to help guide my session. I knew I needed to learn more about three key factors:

• What kind of worries was the student feeling
• How does this student display his worry
• What coping skills will reduce his somatic symptoms.

To help me uncover more about these critical questions, I began by using the worksheet to gain an understanding of where the student felt most comfortable and what causes him the most stress within the school setting. While completing this worksheet, I offered to scribe for the student so we could engage in more natural conversation. For the base of the pyramid, the student was able to describe times during the school day where he feels most comfortable, working up to times of the day that are very stressful. 

Next, I used the worksheet to gain perceptive of what “worry” feels like to the student. The student pointed to different areas of the body and described how his hands “get puffy” and his stomach hurts when he is among a large group of students. I then extended the activity to address coping strategies to help him calm his body when he feels these symptoms.

These two activities took approximately 20 minutes to complete and gave me a wealth of information about his worries and responses to worry. The student revealed that less structured activities with large groups of students are often very overwhelming for him; and often keep him from entering the school in the morning. With this information, I was able to help the school counselor create an alternative meeting site for him in the morning to help reduce the stress and make walking into school less stressful. 

Download the worksheets, FREE! for Anxiety Hierarchy. for Responses, Reactions, and Feelings.

I encourage you to try the worksheet with a client. I used the activity within the context of school; however it can be tailored to understand the anxiety in the context of different environments. Try drawing a line or folding the paper in half. On the left side, list triggers of anxiety at home and on the right side complete the same for school or another location (i.e., community, work, etc.). The hierarchy can be used again later in the therapeutic process to determine  growth with anxiety.

You can get over 200 worksheets in my new book, CBT Toolbox for Children and Adolescents. This quick access workbook was designed for therapists who are seeking tools and strategies to supplement their sessions with skill building activities, and it features worksheets appropriate for the needs of elementary to high school aged students.

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Lisa Weed Phifer, DEd, NCSP, is a Nationally Certified School Psychologist who has extensive experience providing school based mental health services to children and adolescents. Lisa has co-authored CBT Toolbox for Children and Adolescents: Over 200 Worksheets & Exercises for Trauma, ADHD, Autism, Anxiety, Depression & Conduct Disorders.

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