Rarely

Sometimes

Frequently

A lot

Effects on thinking

Worrying about what others think of you

0

1

2

3

Finding it difficult to concentrate, or remember what people say

0

1

2

3

Focusing attention on yourself; being painfully aware of what you do and say

0

1

2

3

Thinking about what might go wrong, ahead of time

0

1

2

3

Dwelling on things you think you did wrong, after the event

0

1

2

3

Mind going blank; being unable to think what to say

0

1

2

3

Effects on behavior

Speaking quickly or quietly, mumbling, getting words mixed up

0

1

2

3

Avoiding catching someone’s eye

0

1

2

3

Doing things to make sure that you do not attract attention

0

1

2

3

Keeping safe: in ‘safe’ places, or talking to ‘, ‘safe’ people, about ‘safe’ topics

0

1

2

3

Avoiding difficult social occasions or situations

0

1

2

3

Effects on the body

Signs of anxiety that others can see, such as blushing, sweating or trembling

0

1

2

3

Feeling tense; the aches and pains that go with being unable to relax

0

1

2

3

Panicky feelings: heart pounding, dizziness or nausea, breathlessness

0

1

2

3

Effects on emotions or feelings

Nervousness, anxiety, fear, apprehension, self-consciousness

0

1

2

3

Frustration and anger, with oneself and/or with others

0

1

2

3

Feeling unconfident; feelings of inferiority

0

1

2

3

Feeling sad, or depressed, or hopeless about being able to change

0

1

2

3

Sub total

0

Total