Considerations for Assessment

  • Colleen E. CarneyEmail author
  • Jack D. Edinger
Part of the Series in Anxiety and Related Disorders book series (SARD)


Before we consider complex issues such as the relation between sleep and anxiety, the sleep-related features of anxiety disorders, and the way sleep problems with co-existing anxiety are treated, it is imperative to consider diagnostic and assessment issues. Thus, this chapter provides an overview of assessment and measurement. While a comprehensive review of assessment techniques across all sleep and anxiety disorders is beyond the scope of this book, we focus on commonly used and supported measures and techniques for assessment, including physiologic, clinical, and structured interviews, and self-reported measures of sleep and anxiety.


Anxiety Disorder Fatigue Severity Scale Beck Anxiety Inventory Insomnia Symptom Sleep Diary 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abramowitz, J. S., ‖ Deacon, B. J. (2006). Psychometric properties and construct validity of the obsessive-compulsive inventory-revised: Replication and extension with a clinical sample. Journal of Anxiety Disorders, 20(8), 1016–1035.CrossRefPubMedGoogle Scholar
  2. American Sleep Disorders Association. (1995). Practice parameters for the use of polysomnography in the evaluation of insomnia. Sleep, 18(1), 55–57.Google Scholar
  3. Bastien, C. H., Vallières, A., ‖ Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.CrossRefPubMedGoogle Scholar
  4. Beck, A. T., Epstein, N., Brown, G., ‖ Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefPubMedGoogle Scholar
  5. Beck, A. T., Steer, R. A., ‖ Brown, G. K. (1996). Manual for the Beck depression inventory, 2nd edition (BDI-II). San Antonio, TX: The Psychological Association.Google Scholar
  6. Behar, E., Alcaine, O., Zuellig, A. R., ‖ Borkovec, T. D. (2003). Screening for generalized anxiety disorder using the Penn State Worry Questionnaire: A receiver operating characteristic analysis. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 25–43.CrossRefPubMedGoogle Scholar
  7. Blake, D. D., Weathers, F., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., et al. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. The Behavior Therapist, 13, 187–188.Google Scholar
  8. Broomfield, N. M., ‖ Espie, C. A. (2005). Towards a valid, reliable measure of sleep effort. Journal of Sleep Research, 14(4), 401–407.CrossRefPubMedGoogle Scholar
  9. Brown, T., Black, B., ‖ Uhde, T. (1994). The sleep architecture of social phobia. Biological Psychiatry, 35(6), 420–421.CrossRefPubMedGoogle Scholar
  10. Brown, T. A., Di Nardo, P. A., Lehman, C. L., ‖ Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for classification of emotional disorders. Journal of Abnormal Psychology, 110, 49–58.CrossRefPubMedGoogle Scholar
  11. Buckner, J. D., Bernert, R. A., Cromer, K. R., Joiner, T. E. J., ‖ Schmidt, N. B. (2008). Social anxiety and insomnia: The mediating role of depressive symptoms. Depression and Anxiety, 25, 124–130.CrossRefPubMedGoogle Scholar
  12. Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., ‖ Morin, C. M. (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29(9), 1155–1173.PubMedGoogle Scholar
  13. Buysse, D. J., Germain, A., Hall, M. L., Moul, D. E., Nofzinger, E. A., Begley, A., et al. (2008). EEG spectral analysis in primary insomnia: NREM period effects and sex differences. Sleep, 31(12), 1673–1682.PubMedGoogle Scholar
  14. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., ‖ Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefPubMedGoogle Scholar
  15. Carney, C. E., Edinger, J. D., Krystal, A. D., Stepanski, E. J., ‖Kirby, A. (2006). The contribution of general anxiety to sleep quality ratings in insomnia subtypes. Sleep, 29(Suppl.), A233.Google Scholar
  16. Chambless, D. L., Caputo, G. C., Bright, P., ‖ Gallagher, P. (1984). Assessment of “fear of fear” in agoraphobics: The body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.CrossRefPubMedGoogle Scholar
  17. Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., ‖ Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 35–44.CrossRefPubMedGoogle Scholar
  18. Chambless, D. L., ‖ Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research, 13, 9–20.CrossRefGoogle Scholar
  19. Clum, G. A., Broyles, S., Borden, J., ‖ Watkins, P. L. (1990). Validity and reliability of the panic attack symptoms and cognitions questionnaires. Journal of Psychopathology and Behavioral Assessment, 12, 233–245.CrossRefGoogle Scholar
  20. Coates, T. J., ‖ Thoresen, C. E. (1979). Treating arousals during sleep using behavioural self-management. Journal of Consulting and Clinical Psychology, 47, 603–605.CrossRefPubMedGoogle Scholar
  21. Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Foa, E. B., ‖ Weisler, R. H. (2000). Psychometric properties of the social phobia inventory (SPIN): A new self-rating scale. British Journal of Psychiatry, 176, 379–386.CrossRefPubMedGoogle Scholar
  22. Cox, B. J., Cohen, E., Direnfeld, D. M., ‖ Swinson, R. P. (1996). Does the beck anxiety inventory measure anything beyond panic attack symptoms? Behaviour Research and Therapy, 34, 949–954.CrossRefPubMedGoogle Scholar
  23. Craske, M. G., Lang, A. J., Tsao, J. C. I., Mystkowski, J. L., ‖ Rowe, M. K. (2001). Reactivity to interoceptive cues in nocturnal panic, Journal of Behavior Therapy and Experimental Psychiatry, 32, 173–190CrossRefPubMedGoogle Scholar
  24. Derogatis, L. (1992). Symptom checklist-90-revised: Administration, scoring, and procedures manual II. Towson, MD: Clinical Psychometrics Research.Google Scholar
  25. Derogatis, L. R., ‖ Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595–605.CrossRefPubMedGoogle Scholar
  26. Di Nardo, P. A., Brown, T. A., ‖ Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (lifetime version). San Antonio, TX: Psychological Corporation.Google Scholar
  27. Edinger, J. D., ‖ Carney, C. E. (2008). Overcoming insomnia: A cognitive-behavioral therapy approach-therapist guide. New York: Oxford University Press, Inc.Google Scholar
  28. Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. K., Kirby, A., et al. (2009). Cognitive behavioral therapy with primary and comorbid insomnia: A randomized clinical trial. Sleep, 32(4), 499–510.PubMedGoogle Scholar
  29. Espie, C. A. (2000). Assessment and differential diagnosis. In K. L. Lichstein ‖ C. M. Morin (Eds.), Treatment of late-life insomnia (pp. 81–108). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  30. Espie, C., Broomfield, N., MacMahon, K., Macphee, L., ‖ Taylor, L. M. (2006). The attention-intention-effort pathway in the development of psychophysiologic insomnia: A theoretical review. Sleep Medicine Reviews, 10(4), 215–245.CrossRefPubMedGoogle Scholar
  31. First, M., Gibbon, M., Spitzer, R., Williams, J. B. W., ‖ Benjamin, L. S. (1997). Users Guide for the structured clinical interview for DSM IV personality disorders (SCID-II). Washington, DC: American Psychiatric Press.Google Scholar
  32. Foa, E. B., Cashman, L., Jaycox, L., ‖ Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451.CrossRefGoogle Scholar
  33. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., ‖ Hajcak, G. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485–496.CrossRefPubMedGoogle Scholar
  34. Freedman, R. R. (1986). EEG power spectra in sleep-onset insomnia. Electroencephalography and Clinical Neurophysiology, 63(5), 408–413.CrossRefPubMedGoogle Scholar
  35. Fresco, D. M., Mennin, D. S., Heimberg, R. G., ‖ Turk, C. L. (2003). Using the Penn State Worry Questionnaire to identify individuals with generalized anxiety disorder: A receiver operating characteristic analysis. Journal of Behavior Therapy and Experimental Psychiatry, 34(3–4), 283–291.CrossRefPubMedGoogle Scholar
  36. Germain, A., Hall, M., Krakow, B., Shear, M. K., ‖ Buysse, D. J. (2005). A brief sleep scale for posttraumatic stress disorder: Pittsburgh sleep quality index addendum for PTSD. Journal of Anxiety Disorders, 19, 233–244.CrossRefPubMedGoogle Scholar
  37. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown obsessive compulsive scale. I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.PubMedGoogle Scholar
  38. Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40, 869–893.CrossRefPubMedGoogle Scholar
  39. Harvey, A. G., ‖ Greenall, E. (2003). Catastrophic worry in primary insomnia. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 11–23.CrossRefPubMedGoogle Scholar
  40. Horowitz, M., Wilner, N., ‖ Alvarez, W. (1979). Impact of events scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.PubMedGoogle Scholar
  41. Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540–545.PubMedGoogle Scholar
  42. Kluge, M., Schussler, P., Dresler, M., Yassouridis, A., ‖ Steiger, A. (2007). Sleep onset REM periods in obsessive compulsive disorder. Psychiatry Research, 152(1), 29–35.CrossRefPubMedGoogle Scholar
  43. Krupp, L. B., Jandorf, L., Coyle, P. K., ‖ Mendelson, W. (1993). Sleep disturbance in chronic fatigue syndrome. Journal of Psychosomatic Research, 37, 325–331.CrossRefPubMedGoogle Scholar
  44. Krupp, L. B., LaRocca, N. G., Muir-Nash, J., ‖ Sternberg, A. D. (1989). The Fatigue Severity Scale: Application to patients with multiple sclerosis and systemic lupus erythemasis. Archives of Neurology, 46, 1121–1123.PubMedGoogle Scholar
  45. Lacks, P. (1987). Behavioral treatment for persistent insomnia. New York: Pergamon Press.Google Scholar
  46. Lamarche, C. H., ‖ Ogilvie, R. D. (1997). Electrophysiological changes during the sleep onset period of psychophysiological insomniacs, psychiatric insomniacs and normal sleepers. Sleep, 20, 724–733.PubMedGoogle Scholar
  47. Lichstein, K. L., Means, M. K., Noeb, S. L., ‖ Aguillard, R. N. (1997). Fatigue and sleep disorders. Behaviour Research and Therapy, 35(8), 733–740.CrossRefPubMedGoogle Scholar
  48. Mastin, D. F., Bryson, J., ‖ Corwyn, R. (2006). Assessment of sleep hygiene using the sleep hygiene index. Journal of Behavioral Medicine, 29(3), 223–227.CrossRefPubMedGoogle Scholar
  49. Mattick, R. P., ‖ Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefPubMedGoogle Scholar
  50. McNair, D. M., Lorr, M., ‖ Droppleman, L. F. (1971). Manual for the profile of mood states. San Diego, CA: EDITS.Google Scholar
  51. Means, M. K., Edinger, J. D., Glenn, D. M., ‖ Fins, A. I. (2003). Accuracy of sleep perceptions among insomnia sufferers and normal sleepers. Sleep Medicine, 4, 285–296.CrossRefPubMedGoogle Scholar
  52. Meyer, T. J., Miller, M. L., Metzger, R. L., ‖ Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495.CrossRefPubMedGoogle Scholar
  53. Monk, T. H., Reynolds, C. F. R., Kupfer, D. J., Buysse, D. J., Coble, P. A., Hayes, A. J., et al. (1994). The Pittsburgh sleep diary. Journal of Sleep Research, 3, 111–120.CrossRefGoogle Scholar
  54. Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press.Google Scholar
  55. Morin, C. M., Vallières, A., ‖ Ivers, H. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30(11), 1547–1554.PubMedGoogle Scholar
  56. Nofzinger, E. A., Nowell, P. D., Buysse, D. J., Vasco, M. E., Thase, F. E., Kupfer, D. J., et al. (1999). Towards a neurobiology of sleep disturbance in primary insomnia and depression: A comparison of subjective, visually scored, period amplitude and power spectral density sleep measures. Sleep, 22(Suppl 1), S99.Google Scholar
  57. O’Mahony, J. F., ‖ Ward, B. G. (2003). Differences between those who panic by day and those who also panic by night. Journal of Behavior Therapy and Experimental Psychiatry, 34, 239–249.CrossRefPubMedGoogle Scholar
  58. Perlis, M. L., Smith, M. T., Andrew, P. J., Orff, H., ‖ Giles, D. E. (2001). Beta/gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep, 24, 110–117.PubMedGoogle Scholar
  59. Peters, L. (2000). Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). Behaviour Research and Therapy, 38(9), 943–950.CrossRefPubMedGoogle Scholar
  60. Peterson, R. A., ‖ Reiss, S. (1993). Anxiety sensitivity index revised test manual. Worthington, OH: IDS Publishing Corporation.Google Scholar
  61. Rechtshaffen, A., ‖ Kales, A. (1968). A manual of standardized terminology, techniques, and scoring systems of sleep stages of human subjects. Los Angeles: UCLA Brain Information Service/Brain Research Institute.Google Scholar
  62. Ree, M. J., ‖ Harvey, A. G. (2004). Insomnia: The development of the sleep-related behaviours questionnaire (SRBQ). Behaviour Change, 21(1), 26–36.CrossRefGoogle Scholar
  63. Sanford, S. D., Bush, A. J., Stone, K. C., Lichstein, K. L., ‖ Aguillard, N. (2008). Psychometric evaluation of the beck anxiety inventory: A sample with sleep-disordered breathing. Behavioral Sleep Medicine, 6(3), 193–205.CrossRefPubMedGoogle Scholar
  64. Sateia, M. J. (2002). Epidemiology, consequences, and evaluation of insomnia. In T. L. Lee-Chiong, M. J. Sateia, ‖ M. A. Carskadon (Eds.), Sleep medicine (pp. 151–160). Philadelphia: Hanley and Belfus.Google Scholar
  65. Savard, J., ‖ Morin, C. M. (2002). Insomnia. In M. Antony ‖ D. B. Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (pp. 523–555). New York: Guilford.Google Scholar
  66. Schmidt, N. B., Zvolensky, M. J., ‖ Maner, J. K. (2006). Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. Journal of Psychiatric Research, 40, 691–699.CrossRefPubMedGoogle Scholar
  67. Sharafkhaneh, A., Giray, N., Richardson, P., Young, T., ‖ Hirshkowitz, M. (2005). Association of psychiatric disorders and sleep apnea in a large cohort. Sleep, 28, 1405–1411.PubMedGoogle Scholar
  68. Shear, M. K., Brown, T. A., Sholomskas, D. E., Barlow, D. H., Gorman, J. M., Woods, S. W., et al. (1992). Panic disorder severity scale (PDSS). Pittsburgh, PA: University of Pittsburgh School of Medicine.Google Scholar
  69. Silverman, W. K., ‖ Albano, A. M. (1996). Manual for the anxiety disorders schedule for DSM-IV: Child version. Albany, NY: Graywind Publications.Google Scholar
  70. Spielberger, C. D., Gorsuch, R. L., ‖ Lushene, R. E. (1970). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  71. Spielman, A., ‖ Anderson, M. (1999). The clinical interview and treatment planning as a guide to understanding the nature of insomnia: The CCNY insomnia interview. In S. Chokroverty (Ed.), Sleep disorders medicine: Basic science, technical considerations, and clinical aspects (2nd ed., pp. 385–416). Boston: Butterworth-Heinemann.Google Scholar
  72. Spitzer, R. L., Williams, J. B. W., Gibbons, M., ‖ First, M. B. (1996). Instruction manual for the structured clinical interview for DSM-IV (SCID-IV). (SCID 1996 Revision). New York: Biometrics Research Department, New York Psychiatric Institute.Google Scholar
  73. Turner, J., Drummond, L. M., Mukhopadhyay, S., Ghodse, H., White, S., Pillay, A., et al. (2007). A prospective study of delayed sleep phase syndrome in patients with severe resistant obsessive-compulsive disorder. World Psychiatry, 6(2), 108–111.PubMedGoogle Scholar
  74. Turner, S. M., Beidel, D. C., Dancu, C. V., ‖ Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: The social phobia and anxiety inventory. Psychological Assessment, 1, 35–40.CrossRefGoogle Scholar
  75. Vincent, N., ‖ Walker, J. (2001). Anxiety sensitivity: Predictor of sleep-related impairment and medication use in chronic insomnia. Depression and Anxiety, 14, 238–243.CrossRefPubMedGoogle Scholar
  76. Wohlgemuth, W. K., ‖ Edinger, J. D. (2000). Sleep restriction therapy. In K. L. Lichstein ‖ C. M. Morin (Eds.), Treatment of late-life insomnia (pp. 147–184). Thousand Oaks, CA: Sage.Google Scholar
  77. Zayfert, C., ‖ DeViva, J. C. (2004). Residual insomnia following cognitive behavioral therapy for PTSD. Journal of Traumatic Stress, 17(1), 69–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of PsychologyRyerson UniversityTorontoCanada
  2. 2.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA

Personalised recommendations