Clinical Psychology: Research and Practice Innovations

Clinical Psychology: Research and Practice Innovations"

@Structural Equation Modeling of the Mediating Role of Social Anxiety in the Relationship Between Anxiety Sensitivity and Rejection Sensitivity with Safety Behaviors in students

Document Type : Original Article

Authors
Maryam Khademy 1
Soodabeh Bassak Nejad 2
Bahram peymannia 3
1 Ph.D Candidate in Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
2 Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz,
3 Assistant Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
10.22075/jcp.2025.37845.3200
Abstract
Background: Individuals with social anxiety disorder (SAD) exhibit two primary characteristics: anxiety sensitivity and social rejection sensitivity. Upon encountering social situations, they employ safety behaviors to reduce their anxious behaviors. The present study aimed to investigate the mediating role of social anxiety in the relationship between anxiety sensitivity and rejection sensitivity with safety behaviors in university students.
Method: The present study was a descriptive-correlational design utilizing structural equation modeling. The statistical population comprised all undergraduate students in the city of Isfahan during the academic year 2023-2024. The sample size was selected using Kline's model and a multi-stage cluster random sampling method. Data were collected using the Social Phobia Safety Behaviors Scale (Pinto-Gouveia et al, 2003), the Social Anxiety Inventory (Caballo et al, 2010), the Anxiety Sensitivity Index (Floyd et al, 2005), and the Rejection Sensitivity Scale (Downey & Feldman, 1996).
Results: The results using Bootstrap method indicated that indirect effect of anxiety sensitivity on safety behaviors through social anxiety (b= 0.21,p= 0.001) and the indirect effect of rejection sensitivity on safety behaviors through social anxiety (b= 0.41, p= 0.001) were statistically significant, and the model fit was confirmed.
Conclusion: Regarding the significant role of safety behaviors in social anxiety disorder and the importance of anxiety sensitivity and rejection sensitivity in development and maintenance of this disorder, findings of the study have implications for therapists in order to designing therapeutic interventions aimed at improving social anxiety
Keywords
Safety Behaviors
Social Anxiety
Anxiety Sensitivity
Rejection Sensitivity
University Students
Subjects

  1. Sources and references

    1. Lovibond PF, Mitchell CJ, Minard E, Brady A,

    Menzies RG. Safety behaviours preserve threat beliefs: Protection from extinction of human fear conditioning by an avoidance response. Behav Res Ther. 2009;47(8):716–20. https://doi.org/10.1016/j.brat.2009.04.013

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Menta Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.2013. https://psycnet.apa.org/doi/10.1176/appi.books.9780890425596
    2. Auyeung K, Alden LE. Accurate Empathy, Social Rejection, and Social Anxiety Disorder. Clinical Psychological Science. 2020;8(2):266–79. https://doi.org/10.1177/2167702619885410
    3. Jefferies P, Ungar M. Social anxiety in young people: A prevalence study in seven countries. PLoS One. 2020;15(9):e0239133. https://doi.org/10.1371/journal.pone.0239133
    4. Blanco C, Rubio J, Wall M, Wang S, Jiu CJ, Kendler KS. Risk factors for anxiety disorders: common and specific effects in a national sample. Depress Anxiety. 2014;31(9):756–64. https://doi.org/10.1002/da.22247
    5. Clark DM, Wells, A. A Cognitive Model of Social Phobia. In R.G. Heimberg, M.R. Liebowitz, D.A. Hope, F.R. Schneier, R.G. Heimberg, M.R. Liebowitz, D.A. Hope, F.R. Schneier (Eds.), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 69-93). New York: Guilford Press. 1995.
    6. Rowa K, Paulitzki JR, Ierullo MD, Chiang B, Antony MM, McCabe RE, et al. A false sense of security: safety behaviors erode objective speech performance in individuals with social anxiety disorder. Behav Ther. 2015;46(3):304–14. https://doi.org/10.1016/j.beth.2014.11.004
    7. Prieto-Fidalgo Á, Calvete E. Bidirectional relationships between interpretation biases, safety behaviors, and social anxiety. Current Psychology. 2023;43(3):2597–606. https://doi.org/10.1007/s12144-023-04461-z
    8. Gray E, Beierl ET, Clark DM. Sub-types of safety behaviours and their effects on social anxiety disorder. PLoS One. 2019;14(10):e0223165. https://doi.org/10.1371/journal.pone.0223165
    9. Favaregh L, Bassaknejad, S., Davodi, I. Psychometric characteristics of Safety behaviors Scale in Students. Clinical Psychology Achivements. 2019;5(2): 1–10 [Persian]. https://doi.org/10.22055/jacp.2022.22399.1040
    10. Okuno H, Rezeppa, T., Raskin, T., & De Los Reyes, A. Adolescent safety behaviors and social anxiety: Links to psychosocial impairments and functioning with unfamiliar peer confederates. Behavior Modification,. 2021:1–32. https://doi.org/10. 1177/ 0145445521 10540 19
    11. Chiu K, Clark DM, Leigh E. Prospective associations between peer functioning and social anxiety in adolescents: A systematic review and meta-analysis. J Affect Disord. 2021a;279:650–61. https://doi.org/10.1016/j.jad.2020.10.055
    12. Evans R, Chiu K, Clark DM, Waite P, Leigh E. Safety behaviours in social anxiety: An examination across adolescence. Behav Res Ther. 2021;144:103931. https://doi.org/10.1016/j.brat.2021.103931
    13. Piccirillo ML, Taylor Dryman M, Heimberg RG. Safety Behaviors in Adults With Social Anxiety: Review and Future Directions. Behav Ther. 2016;47(5):675–87. https://doi.org/10.1016/j.beth.2015.11.005
    14. Favaregh L, Bassaknejad, S., Davodi, I. Relationship between Internalized Shame, Safety Behaviors and Cognitive Avoidance Strategies with Multidimensional Social Anxiety in Students of Medical Science. Journal of Clinical Psychology. 2018;10(4):35–44 [Persian]. https://doi.org/10.22075/jcp.2019.10531.1012
    15. Norton PJ, Sears Edwards K. Anxiety Sensitivity or Interoceptive Sensitivity. European Journal of Psychological Assessment. 2017;33(1):30–7. https://doi.org/10.1027/1015-5759/a000269
    16. Jenadeleh K, Bassak-Nejad, S., Yunesi, A., Sadatmand, Kh. The relationship between anxiety sensitivity and experiential avoidance and resiliency with test anxiety in male students. Journal of Clinical Psychology. 2018;1(37):71–8. [Persian]. https://doi.org/10.22075/jcp.2018.13974.1361
    17. Stork M LM, Roma´n-Caldero´n JP. Differences in anxiety sensitivity and experiential avoidance between subtypes of social anxiety disorder. PLoS ONE. 2023;18(9). https://doi.org/10.1371/journal.pone.0290756
    18. Deacon BJ, Abramowitz JS, Woods CM, Tolin DF. The Anxiety Sensitivity Index - Revised: psychometric properties and factor structure in two nonclinical samples. Behav Res Ther. 2003;41(12):1427–49. https://doi.org/10.1016/s0005-7967(03)00065-2
    19. Bakhshipour Roudsari A, Hashemi Nosrat Abad, T., Joorbonyan, A., Alilou, M. M., and Abdi, R. The Role of Psychosocial Factors in Social Anxiety: A Structural Equation Modeling Approach.. Contemporary Psychology. 2020;15(1):83–98 [Persian]. https://dor.isc.ac/dor/20.1001.1.20081243.1399.15.1.4.5
    20. McCabe RE. Implicit and explicit memory for threat words in high-and low-anxiety-sensitive participants. Cognitive Therapy and Research. 1999;23(1):21–38. https://doi.org/10.1023/a:1018706607051
    21. Naragon-Gainey K, Rutter LA, Brown TA. The interaction of extraversion and anxiety sensitivity on social anxiety: evidence of specificity relative to depression. Behav Ther. 2014;45(3):418–29. https://doi.org/10.1016/j.beth.2014.01.004
    22. Alkozei A, Cooper PJ, Creswell C. Emotional reasoning and anxiety sensitivity: associations with social anxiety disorder in childhood. J Affect Disord. 2014;152-154:219–28. https://doi.org/10.1016/j.jad.2013.09.014
    23. Boswell JF, Farchione TJ, Sauer-Zavala S, Murray HW, Fortune MR, Barlow DH. Anxiety sensitivity and interoceptive exposure: a transdiagnostic construct and change strategy. Behav Ther. 2013;44(3):417–31. https://doi.org/10.1016/j.beth.2013.03.006
    24. Nadri M, Sadeghi, M., Rezaei, F. Structural Model of Early Maladaptive Schemas and Insecure Attachment Style with Social Anxiety Disorder: The Mediating Role of Anxiety Sensitivity. clinical Psychology. 2024;Volume 15, Issue 3:37–48 [Persian]. https://doi.org/10.22075/jcp.2024.31324.2693
    25. Du X, Ding C, Xiang G, Li Q, Liu X, Xiao M, et al. Rejection Sensitivity and Reactive Aggression in Early Adults: The Mediating Role of Loneliness and Maladaptive Coping. Psychol Rep. 2024;127(2):786–806. https://doi.org/10.1177/00332941221125771
    26. Shi C, Sun P, Shi J, Ye H, Tao J. The Effect of Cyber-Ostracism on Social Anxiety Among Undergraduates: The Mediating Effects of Rejection Sensitivity and Rumination. Behav Sci (Basel). 2025;15(1). https://doi.org/10.3390/bs15010037
    27. Bintaş-Zörer P, Dirik, G. Social anxiety from an attachment theory perspective: the mediating role of early maladaptive schema domains and rejection sensitivity. Journal of Evidence-Based Psychotherapies,. 2023;23(2):25–47. https://doi.org/10.24193/jebp.2023.2.9
    28. Downey G, Feldman SI. Implications of rejection sensitivity for intimate relationships. J Pers Soc Psychol. 1996;70(6):1327–43. https://doi.org/10.1037//0022-3514.70.6.1327
    29. Feldman S, Downey G. Rejection sensitivity as a mediator of the impact of childhood exposure to family violence on adult attachment behavior. Dev Psychopathol. 1994;6(1):231–47. https://doi.org/10.1017/S0954579400005976
    30. Hyun J-H, & Lim, J.Hyun, Jeong-hee. The Mediating Effect of Social Anxiety on the Relationship between Parenting Attitudes Perceived by Pre-Service Early Childhood Teachers and Their Rejection Sensitivity. Korean Academy Welfare Counseling. 2022;11(2):1–25. https://doi.org/10.20497/jwce.2022.11.2.1
    31. London B, Downey G, Bonica C, Paltin I. Social Causes and Consequences of Rejection Sensitivity. Journal of Research on Adolescence. 2007;17(3):481–506. https://doi.org/10.1111/j.15327795.2007.00531.x
    32. Rosenbach C, Renneberg B. Abgelehnt, ausgeschlossen, ignoriert: Die Wahrnehmung sozialer Zurückweisung und psychische Störungen – eine Übersicht. Verhaltenstherapie. 2011;21(2):87–98. https://doi.org/10.1159/000328839
    33. Mikaeili N, & Habibi, Y. Design and test of a causal model for the relationship between internet addiction and emotional self-regulation, rejection sensitivity, and online self-disclosure with the mediating role of social anxiety in students. Culture in the Islamic University,. 2016;3(20):395–417 [Persian]
    34. Kline RB. Principles and practice of structural equation modeling. Fourth Edition,. Guilford publications. 2015.
    35. Alavi M. Structural Equation Modeling (SEM) in Health Sciences Education Researches: An Overview of the Method and Its Application. Iranian Journal of Medical Education 2013;13(6):519–30. [Persian]. http://ijme.mui.ac.ir/article-1-2228-en.html
    36. Caballo VS, I. Arias, B. Irurtia, M. Calderero, M. Graña. J, et al.. Validation of the Social Anxiety Questionnaire for Adults (SAQ -A30) with Spanish university students: similarities and differences among degree subjects and regions.. Behavioral Psychology/ Psicologia Conductual;. 2010;18(1):5–34.
    37. Caballo VS, I. Irurtia, M. Arias, B. Nobre-Sandoval, L. T. The assessment of social anxiety through five selfreport measures, LSAS-SR, SPAI, SPIN, SPS, and SIAS: A critical analysis of their factor structure. Behavioral Psychology/Psicologia Conductual. 2013;21(3):423–48.
    38. Movahedian Z NMA, Pazhoohi T. Psychometric Properties of Social Anxiety Questionnaire for Adults (SAQ-A30) Among University Students.. MEJDS 2022;12(76):1–10 [Persian]. http://jdisabilstud.org/article-1-1445-en.html
    39. Floyd M, Garfield A, LaSota MT. Anxiety sensitivity and worry. Personality and Individual Differences. 2005;38(5):1223–9. https://doi.org/10.1016/j.paid.2004.08.005
    40. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1–8. https://doi.org/10.1016/00057967(86)90143-9
    41. Narimani M SA. Narimani, M., Sharbati, A. Comparison of anxiety sensitivity and cognitive function in students with and without dysgraphia.. Journal of Learning Disabilities. 2015;4(4):85–100. [Persian]. https://sid.ir/paper/210235/en
    42. Khoshkam samira bf, rahmatollahi farahnaz, najarpourian samaneh. Psychometric properties of rejection sensitivity questionnaire in university students in iran. Psychological research. 2014;17(1):24–44. [Persian]. https://sid.ir/paper/66320/en
    43. Pinto-Gouveia J, Cunha MI, do Cu Salvador M. Assessment Of Social Phobia By Self-Report Questionnaires: The Social Interaction And Performance Anxiety And Avoidance Scale And The Social Phobia Safety Behaviours Scale. Behavioural and Cognitive Psychotherapy. 2003;31(3):291–311. https://doi.org/10.1017/s1352465803003059
    44. Prieto-Fidalgo A, Miers AC, Calvete E. Interpretation Biases in Social Scenarios and Social Anxiety: The Role of Safety Behaviors. Psicothema. 2022;34(4):489–97. https://doi.org/10.7334/psicothema2021.406
    45. Hashemi S E HAM, Mehrabizadeh Honarmand M, Bassak Nejad S, Rabiei M. Evaluating The Structural Model for Causative and Maintaining Factors of Social Anxiety Disorder in Students of Medical Sciences. J Mazandaran Univ Med Sci. 2022;31(206):114–29. [Persian]. http://jmums.mazums.ac.ir/article-1-17268-en.html
    46. Brooke CM, Intrieri RC. The influence of anxiety sensitivity, & personality on social anxiety symptoms. Current Psychology. 2021;42(11):9249–60. https://doi.org/10.1007/s12144-021-02238-w
    47. Ellison L, Witcraft S, Dixon L. Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms. Archives of Dermatological Research. 2021;313(7). https://doi.org/10.1007/s00403-020-02130-w
    48. Esmailian M, Mohammadkhani Shahram, Hasani, Jafar.. Structural equation modeling of mindfulness skills, emotion regulation and anxiety sensitivity with social anxiety in Adolescent.. Knowledge & research in applied psychology. 2021;22((1 (83))):121–34. [Persian]. https://sid.ir/paper/384799/en
    49. Besharat M, Bahramizadeh, H., Fata, L,. Hasanabadi, HR,.. Mediating role of metacognitive beliefs and anxiety sensitivity on the relationship between nauroticism with comorbidity of anxiety and depression. Applied Psychology,. 2015;9(3):7–23. [Persian]. https://dor.isc.ac/dor/20.1001.1.20084331.1394.9.3.1.8
    50. Hezel DM, McNally RJ. Theory of mind impairments in social anxiety disorder. Behav Ther. 2014;45(4):530–40. https://doi.org/10.1016/j.beth.2014.02.010
    51. Kendall PC. Child and adolescent therapy: Cognitive-behavioral procedures.: Guilford Press.; 2011.
    52. Smink FR, van Hoeken D, Oldehinkel AJ, Hoek HW. Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. Int J Eat Disord. 2014;47(6):610–9. https://doi.org/10.1002/eat.22316
    53. Kutsal A, Özdemir M. Maladaptive Beliefs as a Mediator Between Rejection Sensitivity and Social Anxiety. Journal of Assessment and Research in Applied Counseling. 2025;7(1):230–9. https://doi.org/10.61838/kman.jarac.7.1.27
    54. Dabas G, Rowa K, Milosevic I, Moscovitch DA, McCabe RE. The impact of particular safety behaviours on perceived likeability and authenticity during interpersonal interactions in social anxiety disorder. Behav Cogn Psychother. 2023;51(1):46–60. https://doi.org/10.1017/S1352465822000492
    55. Ahmadi R SO, Rezaei M, Ahmadizadeh R. Anxiety Sensitivity as a Transdiagnostic Construct in Development and Maintenance of Emotional Disorders: A Literature Review. SJKU 2020;25(3):44–60 [Persian]. http://sjku.muk.ac.ir/article-1-5120-en.html
    56. Gao S, Assink M, Cipriani A, Lin K. Associations between rejection sensitivity and mental health outcomes: A meta-analytic review. Clin Psychol Rev. 2017;57:59–74. https://doi.org/10.1016/j.cpr.2017.08.007
    57. Albano G, Rowlands K, Baciadonna L, Coco GL, Cardi V. Interpersonal difficulties in obesity: A systematic review and meta-analysis to inform a rejection sensitivity-based model. Neurosci Biobehav Rev. 2019;107:846–61. https://doi.org/10.1016/j.neubiorev.2019.09.039
    58. Asher M, Aderka IM. How real do you feel? Self- and partner-authenticity in social anxiety disorder. J Abnorm Psychol. 2021;130(2):166–76. https://doi.org/10.1037/abn0000622
    59. Plasencia ML, Taylor CT, Alden LE. Unmasking One’s True Self Facilitates Positive Relational Outcomes. Clinical Psychological Science. 2016;4(6):1002–14. https://doi.org/
    60. Spence SH, Rapee RM. The etiology of social anxiety disorder: An evidence-based model. Behav Res Ther. 2016;86:50–67. https://doi.org/10.1177/2167702615622204
    61. Bates GW, Thompson, C., & Elphinstone, B. Issue Information. Psychology and Psychotherapy: Theory, Research and Practice. 2021;94(S1):1043–59. https://doi.org/10.1111/papt.12338

     

  • Receive Date 23 May 2025
  • Revise Date 13 December 2025
  • Accept Date 13 December 2025
  • First Publish Date 21 March 2026
  • Publish Date 21 March 2026