Please indicate how much the following problems have bothered you during the past week. Mark only one box for each problem, and be sure to answer all items.

In the past month, how much were you bothered by: Not at All A Little Bit Somewhat Very Much Extremely
1. I am afraid of people in authority
2. I am bothered by blushing in front of people
3. Parties and social events scare me
4. I avoid talking to people I don’t know
5. Being criticized scares me a lot
6. Fear of embarrassment causes me to avoid doing things or speaking to people
7. Sweating in front of people causes me distress
8. I avoid going to parties
9. I avoid activities in which I am the center of attention
10. Talking to strangers scares me
11. I avoid having to give speeches
12. I would do anything to avoid being criticized
13. Heart palpitations bother me when I am around people
14. I am afraid of doing things when people might be watching
15. Being embarrassed or looking stupid is among my worst fears
16. I avoid speaking to anyone in authority
17. Trembling or shaking in front of others is distressing to me