CUXOS: Clinically Useful Anxiety Outcome Scale

What this assessment is

The CUXOS, or Clinically Useful Anxiety Outcome Scale, is a 20-item self-report measure for tracking general anxiety symptoms over the past week. Its responses produce a total from 0 to 80. The five proposed ranges describe reported symptom severity. The CUXOS does not diagnose an anxiety disorder.

Mark Zimmerman and colleagues developed it for routine outcome measurement. Its first validation was in adult psychiatric outpatients.

Who it was designed for

The original study included 963 adults completing an intake evaluation at a psychiatric outpatient practice. Participants had varied diagnoses.

It is a general measure. It was not built to identify one specific anxiety disorder.

The CUXOS can support repeated symptom measurement during care. Keep the version, language, timeframe, and scoring method consistent when comparing results.

The CUDOS is the companion depression outcome scale. Its score is separate and not interchangeable with a CUXOS total.

How it is administered

The CUXOS asks how well each statement describes the respondent during the past week, including the day of completion, with responses worth 0 to 4 points.

The VA measurement toolkit describes the same 20-item, past-week format.

What it measures

The original study grouped six items as psychological symptoms involving thoughts and feelings and 14 as physical symptoms. It reported results for those groups as well as the total.

The developers said that their routine clinical practice used the total because calculating the two groups separately took more time. The published severity ranges below apply to the total.

Physical symptoms need context. Illness, pain, medication, sleep loss, caffeine, and other factors can resemble or increase anxiety symptoms.

How scoring works

Add the 20 responses, each worth 0 to 4 points, to produce a total that runs from 0 to 80. No items are reverse scored.

Higher totals indicate more severe reported anxiety symptoms during the past week.

The published scoring method is a straight sum. The sources reviewed for this page do not establish one universal missing-response rule.

Do not silently score missing answers as zero. A service should state its completeness rule with the result.

How to interpret a CUXOS score

The developers proposed these approximate ranges:

• 0 to 10: nonanxious range
• 11 to 20: minimal range
• 21 to 30: mild range
• 31 to 44: moderate range
• 45 to 80: severe range

The original publication says these bands came from data and clinical experience, while noting that further comparison with a validated clinician measure was still needed.

Treat the labels as approximate descriptions. The word nonanxious does not rule out an anxiety disorder.

Repeated scores can show direction of change. A lower total suggests fewer reported symptoms, but it does not prove recovery or identify the reason for change.

What the score cannot tell you

The CUXOS cannot identify which anxiety disorder, if any, is present or distinguish anxiety from every medical or medication-related cause of physical symptoms.

It also cannot choose treatment or determine urgency by itself. A clinical assessment should consider triggers, avoidance, function, health, medication, substance use, and history.

Evidence and limitations

The original validation study found high reliability, stronger correlations with anxiety measures than with other symptom domains, and sensitivity to change in its psychiatric outpatient samples.

The later Korean study tested a translated form in 838 psychiatric outpatients and found support for its reliability and validity. It also found substantial overlap between anxiety and depression.

The original authors called for replication in populations with different demographic and clinical characteristics. Results still depend on population, language, setting, and purpose.