The Shyness & Social Anxiety Workbook
202
Symptom Exposure Diary
Instructions : This form should be completed each time you practice symptom exposure. For each symptom exposure trial: (1) list the 
physical symptoms that you experienced; (2) rate the intensity of your fear using a scale of 0 (no fear) to 100 (maximum fear); (3) list your 
speciﬁc anxious predictions regarding the exercise (What might happen during the exercise?); and (4) list alternative nonanxious predictions 
and evidence supporting these nonanxious predictions (countering).
Exposure Exercise             
Date and Time          
Trial 
#Sensations Experienced Fear Anxiety-Provoking Thoughts 
and PredictionsCountering
1
2
3
4
5
6
7
Adapted from Antony, M.M., and R. P.  Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment . Washington, DC: American Psychological 
Association. Used with permission.