The Shyness & Social Anxiety Workbook
190
Exposure Monitoring Form
Exposure Situation            Date and Time        
Initial Fear Level (0-100)           Fear Level at End (0–100)             Duration of Exposure            
COMPLETE BEFORE THE EXPOSURE PRACTICE COMPLETE AFTER THE EXPOSURE PRACTICE
What emotions (e.g., 
fear, anger) do you 
have as you think 
about doing this 
exposure?What anxiety-provoking thoughts, 
predictions, and assumptions do 
you have about the exposure? 
What do you expect will happen 
during the exposure practice?What  
evidence do 
you have that 
your fearful 
thoughts are 
true?1. What was the outcome  of this practice? What 
actually happened?
2. What evidence  did you gain from this practice? 
How accurate were your original thoughts and 
predictions?
1. Outcome of Practice
2. Evidence Gained
Fear Ratings (0–100)
Provide occasional fear ratings (0–100) over the course of the exposure practice. For example, for a 20-minute exposure practice, record 
ratings every 5 minutes or so. For a 2-hour exposure practice, record ratings every 15 minutes or so. Space is provided for a total of 20 
ratings over the course of the practice.
1.    2.    3.    4.    5.    6.    7.    8.    9.    10.    
11.    12.    13.    14.    15.    16.    17.    18.    19.    20.    
Based on this experience, what exposure practice will you complete next?