01732 808 626 info@thinkcbt.com

01732 808 626 info@thinkcbt.com

01732 808 626 info@thinkcbt.com

Social Anxiety Disorder / Social Phobia (DSM-5 Assessment)
You can respond anonymously, and no data will be retained from this assessment. If you choose to include your initials and an email address, your results will be automatically sent to the email address provided. Please check that the email address has been entered correctly before submitting this form. All client information is managed on a strictly confidential basis. Please Note: Whilst every effort is made to ensure that our system is securely encrypted, email is not a completely secure means of communication. Think CBT does not accept liability for loss or theft of personal data where any individual chooses to transmit or receive information via email.
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This questionnaire is not designed to provide a definitive psychological diagnosis or to take the place of a professional consultation. Please answer all questions as accurately and honestly as possible.


The following questions ask about thoughts, feelings, and behaviors that you may have had about social situations. Usual social situations include: public speaking, speaking in meetings, attending social events or parties, introducing yourself to others, having conversations, giving and receiving compliments, making requests of others, and eating and writing in public. Please respond to each item by marking one box per row.

During the PAST 7 DAYS I have...
1. felt moments of sudden terror, fear, or fright in social situations.

2. felt anxious, worried, or nervous about social situations

3. had thoughts of being rejected, humiliated, embarrassed, ridiculed, or offending others

4. felt a racing heart, sweaty, trouble breathing, faint, or shaky in social situations

5. felt tense muscles, felt on edge or restless, or had trouble relaxing in social situations

6. avoided, or did not approach or enter, social situations

7. left social situations early or participated only minimally (e.g., said little, avoided eye contact)

8. spent a lot of time preparing what to say or how to act in social situations

9. distracted myself to avoid thinking about social situations

10. needed help to cope with social situations (e.g., alcohol or medications, superstitious objects)