Document Type : Research Article (s)


1 Department of Educational Sciences, Parsian Branch, Islamic Azad University, Parsian, Iran

2 Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

3 School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Existence of social anxiety in adolescents have been examined in various cognitive behavioral models such as Clark and Wells Cognitive Model that has been tried to justify the maintenance of this anxiety in them. The present study aimed to investigate the correlation between the variables of Clark and Wells (1995) Cognitive Model and Social Anxiety in Iranian Adolescent students.
Methods: This was a cross-sectional descriptive study; a student sample (N=220) was selected from Parsian and Asaluyeh schools in 2021-2022. An online form was used to collect data on Social Anxiety Scale for Adolescents (SAS-A), Social Phobia Weekly Summary Scale (SPWSS), Focus of Attention Questionnaire – Self-focus subscale (FAQ-S), Report of Youth Social Cognitions (RYSC), Subtle Avoidance Frequency Examination (SAFE), Post-event Processing Questionnaire-5 item version (PEPQ-5), and Birleson Depression Self-Rating Scale (DSRS). Pearson correlation and regression analysis were used for data analysis.
Results: A positive correlation was found between social anxiety and anticipatory processing (P<0.001, r=0.33), maladaptive social-evaluative beliefs (P<0.001, r=0.58), safety behaviors (P<0.001, r=0.63), and post-event processing (P<0.001, r=0.28). The high socially anxious group had significantly greater scores on the social anxiety measure and all the maintaining factors (P<0.001) except the self-focus measure (P=0.235).
Conclusion: The study results suggested that there is a positive correlation between the variables of Clark and Wells (1995) Cognitive Model and Social Anxiety in Iranian adolescent students.


Ali Ghasemi: (Google Scholar)

Esmail Soltani: (Google Scholar), (PubMed)



How to Cite: Ghasemi A, Soltani E, Hejazi N. Social Anxiety in Iranian Adolescent Students based on Clark and Wells Cognitive Model (1995). Int. J. School. Health. 2024;11(1):67-76. doi: 10.30476/INTJSH.2024.100203.1350.


1-  Mohammadi MR, Salehi M, Khaleghi A, Hooshyari Z, Mostafavi SA, Ahmadi N, et al. Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities. J Affect Disord. 2020;263:450-457. doi: 10.1016/j.jad.2019.12.015. PubMed PMID: 31969277. ##
2- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, Inc; 2013. ##
3- Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, editors. Social Phobia: Diagnosis, assessment and treatment. New York: Guilford Press; 1995. p. 69–93. ##
4-Heimberg RC, Brozovich FA, Rapee RM. A cognitive behavioural model of social anxiety disorder: Update and extension. In Hofmann SG, DiBartolo PM, editors. Social anxiety: Clinical, developmental, and social perspectives. Elsevier Academic Press; 2010. p. 395–422. doi: 10.1016/B978-0-12-375096-9.00015-8. ##
5-Hofmann SG, Otto MW. Cognitive-behavior therapy of social anxiety disorder: Evidence-based and disorder specific treatment techniques. New York, NY: Routledge; 2008. ##
6- Wong QJJ, Rapee RM. The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. J Affect Disord. 2016;203:84-100. doi: 10.1016/j.jad.2016.05.069. PubMed PMID: 27280967. ##
7-Hodson KJ, McManus FV, Clark DM, Doll H. Can Clark and Wells' (1995) cognitive model of social phobia be applied to young people. Behavioural and Cognitive Psychotherapy. 2008;36(4):449–461. doi: 10.1017/S1352465808004487. ##
8- Ranta K, Tuomisto MT, Kaltiala-Heino R, Rantanen P, Marttunen M. Cognition, imagery and coping among adolescents with social anxiety and phobia: testing the Clark and Wells model in the population. Clin Psychol Psychother. 2014;21(3):252-63. doi: 10.1002/cpp.1833. PubMed PMID: 23348846. ##
9- Blöte AW, Miers AC, Heyne DA, Clark DM, Westenberg PM. The relation between social anxiety and audience perception: examining Clark and Wells' (1995) model among adolescents. Behav Cogn Psychother. 2014;42(5):555-67. doi: 10.1017/S1352465813000271. PubMed PMID: 23635882; PubMed Central PMCID: PMC5091739. ##
10- Chiu K, Clark DM, Leigh E. Cognitive predictors of adolescent social anxiety. Behav Res Ther. 2021;137:103801. doi: 10.1016/j.brat.2020.103801. PubMed PMID: 33421893; PubMed Central PMCID: PMC7846721. ##
11-Wong QJJ, Gregory B, McLellan LF, Kangas M, Abbott MJ, Carpenter L, et al. Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder. Behav Ther. 2017;48(5):651-663. doi: 10.1016/j.beth.2017.03.004. PubMed PMID: 28711115. ##
12- Lidle LR, Schmitz J. Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing. Res Child Adolesc Psychopathol. 2021;49(11):1447-1459. doi: 10.1007/s10802-021-00837-6. PubMed PMID: 34143352; PubMed Central PMCID: PMC8455401. ##
13-Kley H, Tuschen-Caffier B, Heinrichs N. Manipulating self-focused attention in children with social anxiety disorder and in socially anxious and non-anxious children. Journal of Experimental Psychopathology. 2011;2(4):551-570. doi: 10.5127/jep.014511. ##
14-Leigh E, Chiu K, Clark DM. Self-focused attention and safety behaviours maintain social anxiety in adolescents: An experimental study. PLoS One. 2021;16(2):e0247703. doi: 10.1371/journal.pone.0247703. PubMed PMID: 33635891; PubMed Central PMCID: PMC7909699. ##
15-Vassilopoulo SP, Brouzos A, Moberly NJ, Spyropoulou M. Linking shyness to social anxiety in children through the Clark and Wells cognitive model. Hellenic Journal of Psychology. 2017;14(1):1–19. ##
16- Vogel F, Reichert J, Hartmann D, Schwenck C. Cognitive Variables in Social Anxiety Disorder in Children and Adolescents: A Network Analysis. Child Psychiatry Hum Dev. 2023;54(3):625-638. doi: 10.1007/s10578-021-01273-9. PubMed PMID: 34708304; PubMed Central PMCID: PMC10150579. ##
17- 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. Behav Modif. 2022;46(6):1314-1345. doi: 10.1177/01454455211054019. PubMed PMID: 34763552. ##
18- Schmitz J, Krämer M, Blechert J, Tuschen-Caffier B. Post-event processing in children with social phobia. J Abnorm Child Psychol. 2010;38(7):911-9. doi: 10.1007/s10802-010-9421-2. PubMed PMID: 20496109. ##
19- Spence SH, Donovan C, Brechman-Toussaint M. The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. J Child Psychol Psychiatry. 2000;41(6):713-26. PubMed PMID: 11039684. ##
20- Leigh E, Clark DM. Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clin Child Fam Psychol Rev. 2018;21(3):388-414. doi: 10.1007/s10567-018-0258-5. PubMed PMID: 29654442; PubMed Central PMCID: PMC6447508. ##
21- Stavridou A, Kapsali E, Panagouli E, Thirios A, Polychronis K, Bacopoulou F, et al. Obesity in Children and Adolescents during COVID-19 Pandemic. Children (Basel). 2021;8(2):135. doi: 10.3390/children8020135. PubMed PMID: 33673078; PubMed Central PMCID: PMC7918914. ##
22- La Greca AM, Stone WL. Social Anxiety Scale for Children—Revised: Factor structure and concurrent validity. Journal of Clin Child Psychol. 1993;22(1):17-27. doi: 10.1207/s15374424jccp2201_2. ##
23- La Greca AM, Lopez N. Social anxiety among adolescents: linkages with peer relations and friendships. J Abnorm Child Psychol. 1998;26(2):83-94. doi: 10.1023/a:1022684520514. PubMed PMID: 9634131. ##
24-Ostavar S, Razaviye A. The Study of Psychometric Properties of Social Anxiety Scale for Adolescents (SAS-A) for Use in Iran. Psychological Methods and Models. 2013;3(12):69-78. Persian. ##
25- Clark DM, Ehlers A, McManus F, Hackmann A, Fennell M, Campbell H, et al. Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. J Consult Clin Psychol. 2003;71(6):1058-67. doi: 10.1037/0022-006X.71.6.1058. PubMed PMID: 14622081. ##
26- Woody SR. Effects of focus of attention on anxiety levels and social performance of individuals with social phobia. J Abnorm Psychol. 1996;105(1):61-9. doi: 10.1037//0021-843x.105.1.61. PubMed PMID: 8666712. ##
27- Khayyer M, Ostovar S, Latifian M, Taghavi M R, Samani S. The Study of Mediating Effects of Self-Focused Attention and Social Self-Efficacy on Links between Social Anxiety and Judgment Biases. IJPCP. 2008;14(1):24-32. Persian. ##
28- Wong QJJ, Certoma SP, McLellan LF, Halldorsson B, Reyes N, Boulton K, et al. Development and validation of a measure of maladaptive social-evaluative beliefs characteristic of social anxiety disorder in youth: The Report of Youth Social Cognitions (RYSC). Psychol Assess. 2018;30(7):904-915. doi: 10.1037/pas0000539. PubMed PMID: 29283592. ##
29-Cuming S, Rapee RM, Kemp N, Abbott MJ, Peters L, Gaston JE. A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: development and psychometric properties. J Anxiety Disord. 2009;23(7):879-83. doi: 10.1016/j.janxdis.2009.05.002. PubMed PMID: 19556098. ##
30- Favaregh L, BassaK nzhad S, Davoudi I. Relationship between Internalized Shame, Safety Behaviors and Cognitive Avoidance Strategies with Multidimensional Social Anxiety in Students of Medical Science. Journal of Clinical Psychology. 2019;10(4):35-44. doi: 10.22075/jcp.2019.10531.1012. Persian. ##
31- Rachman S, Grüter-Andrew J, Shafran R. Post-event processing in social anxiety. Behav Res Ther. 2000;38(6):611-7. doi:10.1016/s0005-7967(99)00089-3. PubMed PMID: 10846809. ##
32- McEvoy PM, Kingsep P. The post-event processing questionnaire in a clinical sample with social phobia. Behav Res Ther. 2006;44(11):1689-97. doi: 10.1016/j.brat.2005.12.005. PubMed PMID: 16458852. ##
33- Wong QJ. Psychometric evaluation of the English version of the Extended Post-event Processing Questionnaire. Anxiety Stress Coping. 2015;28(2):215-25. doi: 10.1080/10615806.2014.925546. PubMed PMID: 24841332. ##
34- Ziaee SS, Zarrani F, Motabi F, Kareshki H, Shahidi S. Psychometric Properties of Post Event Processing Questionnaire in student population. Quarterly of Educational Measurement. 2015;6(22):135-163. doi: 10.22054/jem.2017.6239.1191. Persian. ##
35- Ivarsson T, Lidberg A, Gillberg C. The Birleson Depression Self-Rating Scale (DSRS). Clinical evaluation in an adolescent inpatient population. J Affect Disord. 1994;32(2):115-25. doi: 10.1016/0165-0327(94)90069-8. PubMed PMID: 7829763. ##
36-Mokhtarnia I, Habibi M, Kholghi H, Mohammadi E, Kalantari F. The Study of psychometric properties of the self-rating depression scale for children and adolescents. Rooyesh. 2018;7(4):1-22. Persian. ##
37- Kilford EJ, Garrett E, Blakemore SJ. The development of social cognition in adolescence: An integrated perspective. Neurosci Biobehav Rev. 2016;70:106-120. doi: 10.1016/j.neubiorev.2016.08.016. PubMed PMID: 27545755. ##
38- Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741-56. doi: 10.1016/s0005-7967(97)00022-3. PubMed PMID: 9256517. ##
39- Schultz LT, Heimberg RG. Attentional focus in social anxiety disorder: potential for interactive processes. Clin Psychol Rev. 2008;28(7):1206-21. doi: 10.1016/j.cpr.2008.04.003. PubMed PMID: 18555570. ##