Checklist for Signs of Social Anxiety

Instructions: Please take a moment to think about whether any of the following statements apply
to you. If you answer "yes" to some of these statements, you may benefit from treatment for
social anxiety.

Has there ever been a period of time when you were not your usual self and…

1. I feel anxious or nervous when making presentations for work or school (or
almost always avoid these situations). Y  N
   
2. I feel anxious or nervous when interacting with others (or almost always avoid
these situations). Y  N
   
3. I feel anxious or nervous eating or drinking in front of others. Y  N
   
4. I have trouble being assertive with family, friends, or strangers. Y  N
   
5. I have difficulty interacting with authority figures (i.e., boss or teacher). Y  N
   
6. I have used alcohol or tranquilizers to calm my nerves before interacting with
others. Y  N
   
7. I am afraid I will do something to humiliate or embarrass myself in a social
situation. Y  N
   
8. I fear being judged as inadequate or incompetent by others. Y  N
   
 

 
Checklist for signs of Social Anxiety Reference:
Stanford University Clinically Applied Affective Neuroscience website:
www.psych-stanford.edu/~caan/current_research_cbt.html