Planning imaginal exposure to worry
Plan a short imagined worry scenario with your therapist and practise staying with uncertainty, then review what you notice over repeated attempts.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Planning imaginal exposure to worry
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One fear, one short scene
Stay with one agreed feared outcome rather than adding a chain of new worries.
Agree the practice
Decide the length, frequency and review together. Finish at the agreed point, not only when anxiety falls.
Brief notes after each practice
For each attempt, note the date, time spent, distress and willingness at the start and end, and any checking or reassuring. Distress: 0 = None, 10 = Extreme. Willingness to stay with uncertainty: 0 = Not willing, 10 = Fully willing. These are conversation aids, not scores.
What you learnt about uncertainty
If overwhelmed, pause, orient to the room and contact your therapist through the agreed route. If you need urgent help while they are unavailable, use your agreed urgent-care contact.
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
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When to use ‘Planning imaginal exposure to worry’
‘Planning imaginal exposure to worry’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for generalised anxiety (GAD).
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 25 minutes. It moves through four short steps:
- One fear, one short scene: Stay with one agreed feared outcome rather than adding a chain of new worries.
- Agree the practice: Decide the length, frequency and review together. Finish at the agreed point, not only when anxiety falls.
- Brief notes after each practice: For each attempt, note the date, time spent, distress and willingness at the start and end, and any checking or reassuring. Distress: 0 =…
- What you learnt about uncertainty: If overwhelmed, pause, orient to the room and contact your therapist through the agreed route. If you need urgent help while they are…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Planning imaginal exposure to worry’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Dugas, M. J., & Robichaud, M. (2007). Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. Routledge.
- Robichaud, M., & Dugas, M. J. (2015). The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear. New Harbinger Publications.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
More Generalised Anxiety (GAD) worksheets
View all Generalised Anxiety (GAD) worksheets →Generalised Anxiety (GAD)
GAD Metacognitive Formulation (Wells)
A formulation based on Wells' metacognitive model of GAD — mapping the role of positive and negative beliefs about worry in maintaining the worry cycle.
Generalised Anxiety (GAD)
Worry decision tree
Work through a worry tree, one question at a time, to decide whether a worry is practical, with something you can do now or later, or a "what if" worry to let go. Adapted from Butler, Grey and Hope (2018).
Generalised Anxiety (GAD)
Worry classification worksheet
Sort your worries into practical ones you can act on and hypothetical "what if" ones, then choose a response for each. Based on Dugas and Robichaud (2007): it adds a "now or later" test from the worry tree, a "both" option, and refocusing or a worry period for "what if" worries.
Generalised Anxiety (GAD)
Tolerating uncertainty practice
Practise noticing and living with everyday uncertainty, so it gets easier over time. Write down what you fear, practise without trying to resolve the uncertainty, then compare what happened. Based on Dugas and Robichaud (2007): it adds a written fear and belief rating before and after each practice.
Generalised Anxiety (GAD)
Worry diary with postponement record
Write down worries as they come, sort them into practical and "what if" worries, and put the "what if" ones off to a set worry period. Based on Borkovec, Wilkinson, Folensbee and Lerman (1983) and Dugas and Robichaud (2007): it adds a next step for practical worries and a second strength rating at the worry period.
Generalised Anxiety (GAD)
Positive meta-beliefs about worry
Spot the beliefs that keep you worrying because you think it helps, look at the evidence, and test one belief with an experiment. Based on Wells (2009): belief ratings, evidence and an experiment, with a prediction and a rating before the test added.
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