Tell us about your shyness by completing the following information
andreturning it to: Bernardo J. Carducci, Department of Psychology,
Indiana University Southeast, New Albany, IN 47:150 or by FAX:
812-941-2591. Written comments can also be sent by E-mail to:
bcarducc@lUS.lndiana.edu
Responses will be kept confidential.
Your age:
Your occupation:
Date of birth:
Ethnic identification:
Indicate: male or female
Education:
Please answer the following questions as honestly as
possible:
1) Do you consider yourself to be a shy person?
1) yes 2) no
2) If yes, have you always been shy' (were shy previously
and
still are)?
1) yes 2) no
3) If no to question 1, was there ever a prior time in your life
when you were shy?
1) yes 2) no
If no to all three, then you are finished with this survey. Thanks.
If yes to any of the above, please continue.
4) How often do you experience (or have you experienced) these
feelings of shyness?
1) every day
2) almost every day
3) often, nearly every other day
4) once or twice a week
5) occasionally, less than once a week
6) rarely, once a month or less
5) Compared to your peers (of similar age, sex, and background),
how shy are you?
1) much more shy
2) more shy
3) about as shy
4) less shy
5) much less shy
6) How desirable is it for you to be shy?
1) very undesirable
2) undesirable
3) neither
4) desirable
5) very desirable
7) Is (or was) your shyness ever a personal problem for you?
1) yes, often
2) yes, sometimes
3) yes, occasionally
4) rarely
5) never
8) Types of people who make me feel shy:
o my parents
o my siblings (brothers and/or sisters)
o other relatives
o friends
o strangers
o foreigners
o authorities by virtue of their knowledge (intellectual superiors,
experts)
o elderly people (much older than you)
o children (much younger than you)
o persons of the opposite sex, in a group
o persons of the opposite sex, one-to-one
o a person of the same sex, in a group
o a person of the same sex, one-to-one
o authorities by virtue of their role (police, teacher, superior at
work)
9) Do you think your shyness can be overcome?
1) yes 2) no 3) uncertain
10) Are you willing to seriously work at overcoming it?
1) yes, definitely
2) not sure yet
3) yes, perhaps
4) no
Feel free to use additional sheets to answer these questions:
Describe factors you believe have contributed to your shyness.
Describe how your shyness is expressed.
Describe what problems your shyness has created for you in your
personal, social. and/or professional life.
Describe what you have tried to do to overcome your shyness. What
else would you like to say about your shyness?
What else would you like to say about your shyness?
Tags:
age sex,
date of birth,
department of psychology,
e mail,
foreigners,
indiana university southeast,
new albany,
occupation,
personal problem,
shy person,
shyness
