1. Surveys
  2. 2014
  3. September
  4. S
  5. Social Anxiety and Assertiveness
0%
Exit Survey
 
 
Please type your participant number:
   
 
 
 
Dear Student:
We, Jordan Bierbrauer, Je Ryan Butler, Mikala Hora, Natalia Ramirez, Molly Wermers, are conducting a research project entitled “Questionnaire 25 and Questionnaire 20” as part of a class project at South Dakota State University.
The purpose of the study is to analyze the correlation of the questionnaires.
You as a student are invited to participate in the study by completing the following survey. We realize that your time is valuable and have attempted to keep the requested information as brief and concise as possible. It will take approximately 15 minutes of your time. Your participation in this project is voluntary. You may withdraw from the study at any time without consequence. There are no known risks to you for participating in this study; however some of these questions could be of a sensitive nature. If you feel anxiety you can contact the SDSU Counseling Services 605-688-6146. Their office hours are Monday-Friday 8:00 AM-5:00 PM.

The benefits to you by participating are learning about how psychology research is conducted, in addition for receiving either course credit or extra credit. Following the survey, you will be provided with a debriefing form discussing the purpose and expected results of this study. Your responses are strictly confidential. When the data and analysis are presented, you will not be linked to the data by your name, title or any other identifying item.
Please assist us in our research by completing the following online survey.
If you have any questions, now or later, you may contact us at the number below. Thank you very much for your time and assistance. If you have any questions regarding your rights as a research participant in this study, you may contact the SDSU Research compliance Coordinator at 605-688-6975, [email protected].

Sincerely, 
Jordan Bierbrauer
[email protected]
715-781-6517

JeRyan Butler
[email protected]
480-244-5063
 
Mikala Hora
[email protected]
605-660-5221
 
Natalia Ramirez
[email protected] 
605-691-1883
 
Molly Wermers
[email protected]

605-661-2712
 
 
 
Please select True or False
 
 
 
I feel relaxed even in unfamiliar social situations
 
True
 
False
 
 
 
I try to avoid situations which force me to be very sociable
 
True
 
False
 
 
 
It is easy for me to relax when I am with strangers.
 
True
 
False
 
 
 
I have no particular desire to avoid people.
 
True
 
False
 
 
 
I often find social occasions upsetting.
 
True
 
False
 
 
 
I usually feel calm and comfortable at social occasions.
 
True
 
False
 
 
 
I am usually at ease when talking to someone of the opposite sex.
 
True
 
False
 
 
 
I try to avoid talking to people unless I know them well.
 
True
 
False
 
 
 
If the chance comes to meet new people, I often take it.
 
True
 
False
 
 
 
I often feel nervous or tense in casual get-togethers in which both sexes are present.
 
True
 
False
 
 
 
I am usually nervous with people unless I know them well.
 
True
 
False
 
 
 
I usually feel relaxed when I am with a group of people.
 
True
 
False
 
 
 
I often want to get away from people.
 
True
 
False
 
 
 
I usually feel uncomfortable when I am in a group of people I don't know.
 
True
 
False
 
 
 
I usually feel relaxed when I meet someone for the first time.
 
True
 
False
 
 
 
Being introduced to people makes me tense and nervous.
 
True
 
False
 
 
 
Even though a room is full of strangers, I may enter it anyway.
 
True
 
False
 
 
 
I would avoid walking up and joining a large group of people.
 
True
 
False
 
 
 
When my superiors wants to talk with me, I talk willingly.
 
True
 
False
 
 
 
I often feel on edge when I am with a group of people.
 
True
 
False
 
 
 
I tend to withdraw from people.
 
True
 
False
 
 
 
I don't mind talking to people at parties or social gatherings.
 
True
 
False
 
 
 
I am seldom at ease in a large group of people.
 
True
 
False
 
 
 
I often think up excuses in order to avoid social engagements.
 
True
 
False
 
 
 
I sometimes take the responsibility for introducing people to each other.
 
True
 
False
 
 
 
I try to avoid formal social occasions.
 
True
 
False
 
 
 
I usually go to whatever social engagements I have.
 
True
 
False
 
 
 
I find it easy to relax with other people.
 
True
 
False
 
 
Indicate how characteristics or descriptive each of the following statements is of you by using the code given below +3= Very characteristic of me, extremely descriptive +2= Rather characteristic of me,quite descriptive +1= Somewhat uncharacteristic of me, slightly descriptive -1= Somewhat uncharacteristic of me, slightly non descriptive -2= Rather uncharacteristic of me, extremely non descriptive
+3 +2 +1 -1
__ 1. Most people seem to be more aggressive and assertive than I am
__ 2. I have hesitated to make or accept dates because of "shyness"
__ 3. When the food served at a restaurant is not done to my satisfaction, I complain about it to the waitress.
__ 4. I am careful to avoid hurting other people's feelings, even when I feel that I have been injured
__ 5. If a salesman has gone to considerable trouble to show me merchandise that is not quite suitable, I have a difficult time saying "No".
__ 6. When I am asked to do something, I insist upon knowing why.
__ 7. There are times when I look for a good, vigorous argument
__ 8. I strive to get ahead as well as most of people in my position
__ 9. To be honest, people often take advantage of me
__ 10. I enjoy starting conversations with new acquaintances and strangers
+3 +2 +1 -1
__ 11. I often don't know what to say to attractive persons of the opposite sex.
__ 12. I will hesitate to make phone calls to business establishments and institution.
__ 13. I would rather apply for a job or for admission to a college by writing letters than by going through with personal interviews.
__ 14. I find it embarrassing to return merchandise
__ 15. If a close respected relative were annoying me, I would smother my feelings rather than express my annoyance
__ 16. I have avoided asking questions for fear of sounding stupid
__ 17. During an argument I am sometimes afraid that I will get so upset that I will shake all over.
__ 18. If a famed and respected lecturer makes a statement which I think is incorrect, I will have the audience hear my point of view as well.
__ 19. I avoid arguing over prices with clerks and salesman
__ 20. When I have done something important or worthwhile, I manage to let other know about it
+3 +2 +1 -1
__ 21. I am open and frank about my feelings
__ 22. If someone has been spreading false and bad stories about me, I see him/her as soon as possible to "have a talk about it"
__ 23. I often a have a hard time saying 'No'.
__ 24. I tend to bottle up my emotions rather than make a scene.
__ 25. I complain about poor service in a restaurant and elsewhere
__ 26. When I am given a compliment, I sometimes just don't know what to say
__ 27. If a couple near me in a theater or at a lecture were conversing rather loudly, I would ask them to be quite or to take their conversation elsewhere
__28. Anyone attempting to push ahead of me in a lone is in for a good battle
__ 29. I am quick to express an emotion
__30. There are times when I just can't say anything
 
 
 
Please answer the following demographic questions
 
 
 
Gender
 
Male
 
Female
 
 
 
What is your date of birth?
 
 
 
Age
   
 
 
 
Handedness
 
Left
 
Right
 
 
 
Highest
educational attainment: 
 
some HS
 
BA/BS
 
MD/DDS
 
HS diploma/GED
 
some post-grad
 
PhD/EdD
 
Some College
 
Master’s
 
JD
 
 
 
To
what ethnic group do you belong?  Please
check below: (Optional) 
 
Caucasian/White (non-Hispanic): Persons with origins in any of the original peoples of Europe, North Africa, or the Middle East.
 
 
Black (non-Hispanic): Persons with origins in any of the black racial groups of Africa.
 
 
Asian or Pacific Islander: Persons with origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.
 
 
American Indian or Alaskan Native: Persons with origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.
 
 
Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
 
 
Other
 
 
 
How
would you rate your health at the present time?
 
poor
 
fair
 
O.K.
 
good
 
excellent
 
 
 
Have
you required medical treatment within the past two months for any of the
following? 
 
heart disease
 
stroke
 
high-blood pressure
 
depression
 
anxiety
 
 
 
Are
you a native English speaker?
 
Yes
 
No
 
 
 
Have
you ever experienced brain injury?
 
Yes
 
No
 
 
 
What was your Grade Point Average (GPA) last semester?
   
 
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