Daily Social Anxiety Self-Monitoring Sheet

Name: Date (from-to):

Instructions: Use the following form to record your daily experiences with anxious or distressing social situations that may involve some performance on your part, an
evaluation by others, and/or interpersonal interactions. It is important to complete this form as soon after the social event as possible in order to maintain its
accuracy.

Postevent
Describe difficult or anxious social situation (what Anticipation of event Actual event exposure Long-term outcome
remembering
Date happened, who was involved, where, what was your (duration and average (duration and peak (rate embarrassment
(duration and average
role?) anxiety level; 0–100) anxiety level; 0–100) 0–100)
anxiety level; 0–100)

Note: Duration refers to the length of time (i.e., minutes, hours, or days) spent anticipating a social event, being exposed to it, or thinking back on it. Estimate the average (or peak where
applicable) level of anxiety on 0 (“no anxiety”), 50 (“moderately intense”) to 100 (“extreme, panic level”). Whenever a panic attack is experienced in the anticipation, exposure, or postevent
period, record with initials PA. In last column, rate level of embarrassment that remains associated with the situation from 0 (“none”) to 100 “the most embarrassing, humiliating experience in my
life”).
Note: Duration refers to the length of time (i.e., minutes, hours, or days) spent anticipating a social event, being exposed to it, or thinking back on it. Estimate the average (or peak where
applicable) level of anxiety on 0 (“no anxiety”), 50 (“moderately intense”) to 100 (“extreme, panic level”). Whenever a panic attack is experienced in the anticipation, exposure, or postevent
period, record with initials PA. In last column, rate level of embarrassment that remains associated with the situation from 0 (“none”) to 100 “the most embarrassing, humiliating experience in my
life”).

Daily Social Anxiety Self-Monitoring Sheet

Name: Date (from-to):

Postevent
Describe difficult or anxious social situation (what Anticipation of event Actual event exposure Long-term outcome
remembering
Date happened, who was involved, where, what was your (duration and average (duration and peak (rate embarrassment
(duration and average
role?) anxiety level; 0–100) anxiety level; 0–100) 0–100)
anxiety level; 0–100)