a) Please circle a number from the scale below that best describes how severe your social anxiety has been in the last week:
|
0
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
|
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
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1
|
2
|
3
|
4
|
5
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6
|
7
|
8
|
|
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
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1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
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Entirely externally focused
|
both equally
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entirely self-focused
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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.
|
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
|
|
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
|
|
not at all
|
rarely
|
sometimes
|
often
|
always
|
http://www.goodmedicine.org.uk/stressedtozest/2013/09/assessment-monitoring-questionnaires-cbt-treatment-social-anxiety-disorder
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.