a) Please circle a number from the scale below that best describes how severe your social anxiety has been in the last week:
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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not at all disturbing and/or disabling |
slightly disturbing and/or disabling |
definitely disturbing and/or disabling |
markedly disturbing and/or disabling |
severely disturbing and/or disabling |
b) Please circle a number from the scale below to show how often in the last week you have avoided difficult social situations or aspects of those situations.
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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not at all |
rarely |
sometimes |
often |
always |
c) For social situations in general‚ please choose a number from the scale below to show the extent to which your attention was focused on yourself or on the external situation in the last week.
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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Entirely externally focused |
both equally |
entirely self-focused |
d) For social situations that you found difficult‚ please choose a number from the scale below to show the extent to which your attention was focused on yourself or on the external situation in the last week.
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
|
Entirely externally focused |
both equally |
entirely self-focused |
e) Over the past week how often have you gone over in your mind things that you think might go wrong in a social situation before entering the situation.
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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not at all |
rarely |
sometimes |
often |
always |
f) Over the past week how often have you gone over social interactions in your mind after they have finished.
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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not at all |
rarely |
sometimes |
often |
always |
Social Phobia Weekly Summary Scale (PDF file and Word doc): this 6 item questionnaire uses 0 to 8 numerical rating scales to assess disturbance/disablement‚ avoidance‚ other-focused/self-focused attention in general & in difficult social situations‚ pre-event anticipatory worry‚ and post-event subsequent rumination.