Situation
Fear
Avoidance
1. Using a telephone in public
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
2. Participating in a small group activity
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
3. Eating in public
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
4. Drinking with others
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
5. Talking to someone in authority
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
6. Acting, performing, or speaking in front of an
audience
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
7. Going to a party
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
8. Working while being observed
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
9. Writing while being observed
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
10. Calling someone you don't know very well
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
11. Talking face to face with someone you don't know
very well
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
12. Meeting strangers
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
Situation
Fear
Avoidance
13. Urinating in a public bathroom
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
14. Entering a room when others are already seated
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
15. Being the center of attention
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
16. Speaking up at a meeting
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
17. Taking a test of your ability, skill, or
knowledge
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
18. Expressing disagreement or disapproval to
someone you don't know very well
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
19. Looking someone who you don't know very well
straight in the eyes
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
20. Giving a prepared oral talk to a group
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
21. Trying to make someone's acquaintance for the
purpose of a romantic/sexual relationship
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
22. Returning goods to a store for a refund
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
23. Giving a party
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
24. Resisting a high pressure sales person
0 - None 1 - Mild 2 - Moderate 3 -
Severe 0 - Never 1 - Occasionally 2 - Often 3
- Usually
Result:
