Survey: The Henderson/Zimbardo Shyness Questionnaire (form only) Background Information Age: Year in school: Not in school Grade school (year) 1 2 3 4 5 6 7 8 High school (year) 1 2 3 4 College undergraduate (year) 1 2 3 4 College graduate school Gender: Female Male Questions Please indicate, for each of the statements below, how characteristic the statement is of you, that is, how much it reflects what you typically think, feel, and do: Not at all characteristic Somewhat characteristic Often characteristic Very characteristic Extremely characteristic 1 2 3 4 5 1 : I am afraid of looking foolish in social situations. 1 2 3 4 5 2 : I often feel insecure in social situations. 1 2 3 4 5 3 : Other people appear to have more fun in social situations than I do. 1 2 3 4 5 4 : If someone rejects me I assume that I have done something wrong. 1 2 3 4 5 5 : It is hard for me to approach people who are having a conversation. 1 2 3 4 5 6 : I feel lonely a good deal of the time. 1 2 3 4 5 7 : I tend to be more critical of other people than I appear to be. 1 2 3 4 5 8 : It is hard for me to say “no” to unreasonable requests. 1 2 3 4 5 9 : I do more than my share on projects because I can’t say no. 1 2 3 4 5 10 : I find it easy to ask for what I want from other people.. 1 2 3 4 5 11 : I do not let others know I am frustrated or angry. 1 2 3 4 5 12 : I find it hard to ask someone for a date. 1 2 3 4 5 13 : It is hard for me to express my real feelings to others. 1 2 3 4 5 14 : I tend to be suspicious of other people’s intentions toward me. 1 2 3 4 5 15 : I am bothered when others make demands on me. 1 2 3 4 5 16 : It is easy for me to sit back in a group discussion and observe rather than participate. 1 2 3 4 5 17 : I find myself unable to enter new social situations without fearing rejection or not being noticed. 1 2 3 4 5 18 : I worry about being a burden on others. 1 2 3 4 5 19 : Personal questions from others make me feel anxious. 1 2 3 4 5 20 : I let others take advantage of me.. 1 2 3 4 5 21 : I judge myself negatively when I think others have negative reactions to me. 1 2 3 4 5 22 : I try to figure out what is expected in a given situation and then act that way. 1 2 3 4 5 23 : I feel embarrassed when I look or seem different from other people. 1 2 3 4 5 24 : I am disappointed in myself. 1 2 3 4 5 25 : I blame myself when things do not go the way I want them to. 1 2 3 4 5 26 : I sometimes feel ashamed after social situations. 1 2 3 4 5 27 : I am usually aware of my feelings, even if I do not know what prompted them. 1 2 3 4 5 28 : I am frequently concerned about others approval.. 1 2 3 4 5 29 : I like taking risks in social situations. 1 2 3 4 5 30 : If someone is critical of me I am likely to assume that they are having a bad day. 1 2 3 4 5 31 : If I let people know too much about me they will gossip about me. 1 2 3 4 5 32 : I think it is important to please others. 1 2 3 4 5 33 : People feel superior when someone is socially anxious. 1 2 3 4 5 34 : I spend a lot of time thinking about my social performance after I spend time with people. 1 2 3 4 5 35 : I am satisfied with my level of social support.. 1 2 3 4 5 I understand that no identifying information is included in this data. In submitting this data, I give permission for its unlimited use in research. © 2008 Lynne Henderson, Ph.D., All rights reserved.
