Agoraphobic Cognitions Questionnaire

The Agoraphobic Cognitions Questionnaire (ACQ) is a validated 14-item clinical tool designed to measure the frequency of catastrophic thoughts experienced…

Questions: 14
Duration: 5 min
Original title: Agoraphobic Cognitions Questionnaire
Adaptation: Agoraphobic Cognitions Questionnaire
Authors: Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R.
Created: 1984

The Agoraphobic Cognitions Questionnaire (ACQ) is a validated 14-item clinical tool designed to measure the frequency of catastrophic thoughts experienced during episodes of intense anxiety or panic. Developed by Chambless et al. in 1984, the instrument specifically targets the "fear of fear" mechanism, mapping the cognitive distortions that fuel panic attacks and agoraphobia.

By differentiating between fears of physical collapse and fears of losing behavioral control, the ACQ allows clinicians to precisely target cognitive restructuring interventions. As a repeatable baseline and monitoring measure, the ACQ provides objective data on how a patient's threat appraisals shift, making it an essential instrument for understanding the CBT maintaining processes in panic disorder.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

2.857/ 5

Self-report questionnaire assessing the frequency of catastrophic thoughts (“fear of fear”) typical of panic disorder with agoraphobia. It measures cognitions related to the feared consequences of anxiety/panic across two dimensions: physical concerns (death, feeling faint, heart attack…) and loss of control (going crazy, fainting publicly, losing self-control). Useful for cognitive screening, monitoring, and assessing the effects of CBT in panic disorder and agoraphobia.

généralemixed · community sample · France

2.857

M = 1.46 ± 0.44

généralemixed · general population · Germany · n = 1520 · 2025

2.857

M = 1.3 ± 0.24

cliniquemixed · pathology: agoraphobia · United States · n = 175

2.857

M = 2.32

cliniquemixed · pathology: agoraphobia · France

2.857

M = 2.15 ± 0.63

cliniquepathology: agoraphobia · Germany · Breuninger et al. (2017)

2.857

M = 1.97 ± 0.68

Scoring

Mean (total score and by subscale), total score from 1 to 5, each item is rated on a 5-point scale (from 1 to 5).

Loss of Control

2.571/ 5

Thoughts related to loss of control, acting foolishly, or emotional collapse.

items 6, 8, 9, 11, 12, 13, 14

2.571

Physical Concerns

3.143/ 5

Thoughts concerning physiological or physical catastrophes like heart attacks, stroke, or choking.

items 1, 2, 3, 4, 5, 7, 10

3.143

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What the test measures

The ACQ measures the frequency of catastrophic misinterpretations that occur when a patient feels nervous or frightened. It breaks these fearful cognitions down into two primary dimensions:

Physical Concerns: Thoughts centered on severe medical emergencies or physiological collapse resulting from somatic anxiety symptoms.
Loss of Control: Thoughts centered on mental incapacitation, social humiliation, or behaving dangerously.

The instrument is primarily intended for adults suffering from panic disorder, agoraphobia, or severe anxiety disorders characterized by heightened anxiety sensitivity. Integrating these insights into the cognitive case formulation helps the clinician structure targeted exposure.

When and why to use it

Clinicians utilize the ACQ to map and monitor the core beliefs driving a patient's panic cycle. It is particularly useful in the following clinical scenarios:

Intake baseline: To identify the specific catastrophic outcomes the patient anticipates, establishing a clear profile of their panic triggers.
Targeting cognitive restructuring: To pinpoint which somatic sensations or social fears need addressing when helping patients challenge automatic thoughts related to panic.
Monitoring treatment progress: To track the frequency of these maladaptive thoughts over the course of therapy, ensuring that comfort, stretch, and panic zones are appropriately calibrated during behavioral experiments.
Differentiating symptom drivers: To distinguish whether a patient's panic is predominantly driven by health anxiety or social apprehension, guiding the clinician to evaluate coping strategies specific to those domains.

Using a validated questionnaire provides a structured metric for anxiety sensitivity that goes beyond unstructured clinical interviewing, capturing shifts in specific cognitive patterns over time.

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The questions

Below are some thoughts or ideas that may pass through your mind when you are nervous or frightened. Please indicate how often each thought occurs when you are nervous.
1. I am going to vomit.
Assesses the fear of losing gastrointestinal control or experiencing intense nausea.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
2. I am going to faint.
Probes the catastrophic misinterpretation of dizziness or lightheadedness as impending syncope.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
3. I must have a brain tumor.
Evaluates the tendency to attribute neurological-like anxiety symptoms to a severe, terminal illness.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
4. I am going to have a heart attack.
Targets the misinterpretation of palpitations, chest pain, or tachycardia as a fatal cardiac event.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
5. I am going to suffocate.
Explores the fear of airway constriction or the globus sensation leading to asphyxiation.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
6. I am going to behave foolishly (ridiculously).
Examines the social anxiety component of panic where the patient fears public embarrassment.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
7. I am going to go blind.
Assesses the misinterpretation of visual disturbances such as tunnel vision or blurriness.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
8. I won't be able to control myself.
Probes the overarching fear of losing behavioral or emotional regulation.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
9. I am going to hurt someone.
Evaluates intrusive fears of acting out violently due to an inability to manage panic.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
10. I am going to have a stroke.
Targets the catastrophic attribution of numbness or weakness to a cerebrovascular event.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
11. I am going to go crazy.
Explores the fear of permanent mental illness or losing touch with reality.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
12. I am going to start screaming.
Examines the fear of exhibiting loud, uncontrollable verbal outbursts in response to panic.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
13. I am going to stammer or speak strangely.
Assesses the fear of cognitive impairment manifesting as an inability to communicate coherently.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous
14. I am going to be paralyzed by fear.
Probes the fear of motor freezing or an inability to escape a frightening situation.
- 1 — The thought never occurs
- 2 — The thought rarely occurs
- 3 — The thought occurs about half the time I am nervous
- 4 — The thought occurs most of the time I am nervous
- 5 — The thought always occurs when I am nervous