Participant ID number: ………………………..

06237028

Part 1

Please go to this website:

http://www.psychbytes.com/Quizzes/Self%20Consciousness%20-
%20Multiple%20Scores/Self%20Consciousness%20Scale.htm and do this
questionnaire the ‘self consciousness scale’. For each of your answers to the
questions, put your answer or the number here. Thanks.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.

Put an asterix * either side of your answer.

Like this:

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Participant ID number: ……………………….. 06237028

1 *2* 3 4 5 6 7

Thanks again.

Part A)__________________Oral Appearance Questionnaire__________________

This questionnaire should take you around 10 minutes to complete, but don’t worry if
you take longer. The first part of the questionnaire, part A will ask you about your own
personal feelings about the appearance of your teeth. Part B will ask you about your
feelings regarding your body image. If you have any questions regarding this
questionnaire feel free to ask the experimenter.

Part A) Please answer by circling the one value that that most applies to you. Try to
answer as honestly as possible.

1. How do you feel about the appearance of your teeth?

1 2 3 4 5 6 7
Not concerned Very concerned
at all

2. Have you found that other people have commented on the appearance of your
teeth?
1 2 3 4 5 6 7
Not at all All the time

3. Have you found that other people have teased you about the appearance of
your teeth?
1 2 3 4 5 6 7
Not at all All the time

4. Do you try to avoid smiling because of the appearance of your teeth?

1 2 3 4 5 6 7
Not at all All the time

5. Do you ever cover your mouth because of the appearance of your teeth?

1 2 3 4 5 6 7
Not at all All the time
Part B) Answer this part of the questionnaire in the same way you did for the first
part, but answer accordingly to your satisfaction with the attractiveness of that
individual characteristic. Again try and be as honest as possible.

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Participant ID number: ……………………….. 06237028

6. Eyes,
1 2 3 4 5 6 7
Very attractive Very unattractive

7. Nose,
1 2 3 4 5 6 7
Very attractive Very unattractive

8. Smile,
1 2 3 4 5 6 7
Very attractive Very unattractive

9. Ears,
1 2 3 4 5 6 7
Very attractive Very unattractive

10. Teeth,
1 2 3 4 5 6 7
Very attractive Very unattractive

11. Chin,
1 2 3 4 5 6 7
Very attractive Very unattractive

12. Hair,
1 2 3 4 5 6 7
Very attractive Very unattractive

13. Skin,
1 2 3 4 5 6 7
Very attractive Very unattractive

14.Body build,
1 2 3 4 5 6 7
Very attractive Very unattractive

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Participant ID number: ……………………….. 06237028

15. Legs,
1 2 3 4 5 6 7
Very attractive Very unattractive

16. Hands,
1 2 3 4 5 6 7
Very attractive Very unattractive

17. Face in general

1 2 3 4 5 6 7
Very attractive Very unattractive

18.Overall appearance
1 2 3 4 5 6 7
Very attractive Very unattractive

19. How is the appearance of your teeth compared to the teeth of your friends?
1 2 3 4 5 Much
better Much worse

20. Rate how satisfied you are with the colour of your teeth:

1 2 3 4
Very Satisfied Not satisfied at all

21. How satisfied are you with the shape of your teeth?
1 2 3 4
Very Satisfied Not satisfied at all

22. How satisfied are you with the alignment of your teeth?
1 2 3 4
Very Satisfied Not satisfied at all

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Participant ID number: ……………………….. 06237028

23. How old are you? ____________

24. Are you male or female? ______________

25. Have you received orthodontic treatment (in the form of braces, teeth
whitening etc)? (please circle your answer) Yes/No

26. If yes, what treatment did you receive? (please tick)

Fixed Braces □ Overcrowding of teeth □

Removable Braces □ Unerupted tooth/teeth □

Teeth whitening □ Missing permanent teeth

□

Overbite □ Not sure □

Cross bite/underbite □ Other (please state)

Tooth in the palate □ _________________________________

27. How old were you when you started treatment? ___________
How old were you/will you be when you finish(ed) treatment? ____________

28. Circle the image which is most like your teeth (obviously there will be
differences, however there will be a picture which is more representative of
your teeth than the others).

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Participant ID number: ……………………….. 06237028

Part C) ____________ Self-efficacy for Social Situations Scale_________________

This is the last part of the questionnaire. The aim of this part is to measure your self
efficacy, which is your belief in how successful you feel you are at performing
socially.

1. One reason some people have difficulties in certain social situations is because they
don’t believe they have the skills necessary to do a good job. How confident are you
that you have the basic skills to perform well in social situations?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Confident Confident Confident

2. How much do you think that any shortcomings you may have in social skills will
bother you in social situations?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Bothersome Bothersome
Bothersome
3. Is it possible for you to perform well in social situations in spite of any weaknesses
you may have in social skills?

1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Possible Possible Possible

4. One reason that some people may have difficulties in certain social situations is
because they are bothered by thoughts and worries that enter their mind. How well are
you able to handle your thoughts and worries about your teeth appearance during
social situations?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Confident Confident Confident

5. How much do you think your thoughts and worries about the appearance of your
teeth bother you during social situations?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Bothersome Bothersome
Bothersome

6. Is it possible for you to perform well in social situations without dismissing

bothersome thoughts and worries about the appearance of your teeth from your mind?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Possible Possible Possible
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Participant ID number: ……………………….. 06237028

7. One reason some people may have difficulties in certain social situations is because
they are bothered by their nervousness. How well are you able to handle your
nervousness during social situations?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Confident Confident Confident

8. How much does your nervousness (regarding the appearance of your teeth) bother
you during social situations?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Bothersome Bothersome
Bothersome

9. Is it possible for you to perform well during social situations without directly doing
something about your nervousness?
1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Very
Possible Possible Possible