0 : I never experience the feeling
1
2
3
4 : I experience the feeling continuously or almost continuously
¹
0
1
2
3
4
1
Embarrassment
2
Mild guilt
3
Feeling ridiculous
4
Worry about hurting or injuring someone
5
Self-consciousness
6
Feeling humiliated
7
Intense guilt
8
Feeling “stupid”
9
Regret
10
Feeling “childish”
11
Feeling helpless, paralyzed
12
Feelings of blushing
13
Feeling you deserve criticism for what you did
14
Feeling laughable
15
Feeling disgusting to others
16
Remorse
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.