Health, Spirituality and Medical Ethics

Zakiyeh Panahi1 , Majid Yazdi1 , Fatemeh Shahi Sadrabadi2*
1. Department of Educational Science, Faculty of Education and Psychology, University of Yazd, Yazd, Iran.
2. Department of Consuling, Faculty of Humanities, Yazd Farhangian University, Branch Fatemeh Alzahra, Yazd, Iran.
* Corresponding Author:
Fatemeh Shahi Sadrabadi, PhD.
Address: Department of Consuling, Faculty of Humanities, Yazd Farhangian University, Branch Fatemeh Alzahra, Yazd, Iran.
Phone: +98 (913) 2582502
E-mail: alshahid72@yahoo.com
Research Paper:
The Predictive Role of Spiritual Wellbeing in Social
Anxiety of Al-Zahra University Students, Iran, 2019
Background and Objectives: Social anxiety disorder is one of the most common anxiety
disorders. It presents with a persistent fear of one or more social or functional situations and
is highly prevalent. This study aimed to investigate the predictive role of spiritual wellbeing in
social anxiety.
Methods: The method of research was descriptive correlational. The study population included
all students of Al-Zahra University in the 2018-2019 academic year. The cluster random sampling
method was used to recruit 290 samples. Data collection tools included social phobia inventory
and spiritual wellbeing. A correlation and multivariate regression test was used to analyze the data.
Results: The results showed that the dimensions of spiritual wellbeing have a negative
relationship with social anxiety. Based on these results, the correlation coefficient (r=0.157)
between the total score of spiritual wellbeing and social anxiety is significant (P<0.01). Also, the
results showed that the spiritual wellbeing variable explains 10% of the changes in social anxiety.
Conclusion: According to these findings, planning, and teaching to promote students’ spiritual
wellbeing are essential in reducing their social anxiety.
A B S T R A C T
Keywords:
Social anxiety, Spirituality,
Wellbeing, University
students
Please cite this article as Panahi Z, Yazdi M, Shahi Sadrabadi F. The Predictive Role of Spiritual Wellbeing in Social
Anxiety of Al-Zahra University Students, Iran, in 2019. Health, Spirituality and Medical Ethics Journal. 2021; 8(3):143-148.
http://dx.doi.org/10.32598/hsmej.8.3.1
: http://dx.doi.org/10.32598/hsmej.8.3.1
Use your device to scan
and read the article online
Article info:
Received: 21 May 2021
Accepted: 12 Aug 2021
Publish: 01 Sep 2021
Introduction
ocial anxiety is one of the most common and
chronic anxiety disorders. Its prevalence rate
is about 8% to 13% [1]. People with this disorder
have a strong and significant fear of
presence in social or functional situations
[2]. These fears predominantly are the fear of embarrassment
or shame, rejection or humiliation, stupidity, and
clumsiness, being the center of attention, or negatively
evaluated by others [3]. The most common triggers for
fear include meeting new people, talking in public, talking
to peers, presenting in class, social activities, and
interacting with others [4]. Because they have negative
and distorted thoughts and images of themselves in front
of people [5]. They try to avoid social places and situa-
S
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tions that put them at risk of being reviewed, humiliated,
or negatively evaluated by others [4].
The prevalence of social anxiety is high, especially
among young people [6]. In one study, the prevalence of
this disorder in the Iranian community (Golestan City)
was reported at 10% [7].
This disorder starts in 80% of cases from the beginning
of adolescence to the second decade of life (youth) [8].
So students are at risk of this condition. Experiencing
social anxiety as a student, along with other stresses in
life, negatively affects different aspects of life, especially
since this period is a prelude to starting adult life and career
decision-making. About 85% of students with social
anxiety experience problems with their academic and
professional performance due to poor communication
skills, interpersonal relationships, and social needs [9].
Social anxiety is associated with several variables,
and influential factors lead to creating or coping with it.
However, after the emergence of positive psychology in
recent years, many tried to clarify concepts such as spiritual
and mental wellbeing and other positive psychological
structures. In recent years, spirituality and religious
confrontation have come to the attention of many psychologists
and counselors as effective strategies for dealing
with confusion and distress [10]. Much research supports
the hypothesis that spiritual wellbeing can enhance
psychological functioning and adaptability. Religion can
positively affect mental health by participating people
in social activities and creating social support [11]. In
this regard, the results of studies showed that spirituality
has a significant effect on interpersonal relationships so
that spirituality can strengthen the psychological function
of adaptation [12, 13]. However, contradictory findings
have been found in this regard, which adds to the
need for the present study [14, 15]. So far, studies have
focused on the pathology of social anxiety, but factors
on the occurrence and severity of this disorder have received
less attention. Spiritual health is one of the factors
that play a role in effective psychological function today.
Therefore, the present study aims to answer whether
spiritual wellbeing is related to students’ social anxiety.
Methods
This research is a descriptive correlational study. The
study population included all students of Al-Zahra University
in the 2018-2019 academic year. Using Krejcie and
Morgan table, the sample size was estimated at 300. The
samples were recruited by cluster random sampling method.
First, out of ten faculties, four faculties were selected
by lot. Then, three courses were chosen randomly from
each faculty. These courses are considered in each university
year, and students from all years participated in the
research. In the end, all individuals in the selected fields
completed the questionnaires. The age range of the participants
was 18 to 33 years. Due to incomplete completion
of the questionnaire by the 10 participants, 290 completed
questionnaires were used for final analysis. Also, the participants’
written informed consent was obtained.
Data collection tools included the Spiritual Wellbeing
questionnaire (SWB) and Social Phobia Inventory
(SPIN). The spiritual wellbeing questionnaire was developed
by Dehshiri et al. among students of Tehran universities.
It includes 40 questions scored on a 5-point Likert
scale from “strongly agree” to “completely disagree”
[16]. This questionnaire has four subscales of “connection
with God”, “connection with self”, “connection with
nature”, and “connection with others”. By adding scores
of 40 questions, the total score of spiritual wellbeing is
obtained. The minimum and maximum scores that a person
can receive in this questionnaire are 40 and 200, respectively.
The Cronbach α coefficient of the whole questionnaire
was 0.94, and its α subscale coefficients were
0.93, 0.92, 0.91, and 0.85. Also, the reliability coefficient
of retesting the questionnaire was 0.86, and its subscales
were 0.81, 0.89, 0.81, and 0.80, respectively [17].
Another tool for collecting information was the Social
Phobia Inventory (SPIN). The questionnaire measures
three clinical areas of social anxiety, namely physiological
signs, avoidance, and fear. This questionnaire has advantages
such as shortness and simplicity of scoring and
can be used in large populations such as students. This
tool is scored on a 5-point Likert scale from 4=very high
to 3=high, 2=somewhat, 1=low, and 0=not at all [18].
Based on the results obtained to interpret the scores, the
40 point cutoff point with 80% accuracy detection efficiency
and the 50 point cutoff point with 89% efficiency
distinguishes people with social phobia from those who
are not. This questionnaire has high reliability and validity.
Its reliability by retesting method in groups diagnosed
with a social anxiety disorder was 0.78 to 0.89,
and its internal consistency coefficient (the Cronbach α)
was reported to be 0.94 in the normal group [19]. In this
study, the Cronbach α coefficients to investigate the internal
consistency of the questionnaire were found for the
whole scale and subscales of physiological signs, avoidance,
and fear as 0.89, 0.83, 0.82, and 0.80, respectively.
The data were analyzed using descriptive statistics
(Mean±SD), and to examine the correlation between
spiritual wellbeing and social anxiety used the Pearson
Panahi et al. Predictive Role of Spiritual Wellbeing in Social Anxiety. Health Spiritual Med Ethics J. 2021; 8(3):143-148
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correlation coefficient was used in this study. Furthermore,
the effect of the predictive variable was investigated
using regression analysis.
Results
Based on the study’s findings, 235 participants were in
the age range of 17 to 28 years (81%), and 30 were in the
age group of 29 years and above (10.3%). About 44.8%
of the participants were undergraduates, and 55.2% were
graduates. Table 1 presents a summary of the descriptive
findings of the research variables. Table 2 presents the
correlation matrix with research variables.
The results show a significant negative correlation between
all subscales of spiritual wellbeing and social anxiety
with a confidence level of 0.99. This correlation was
not significant only in the subscales of connection with
others with physiological signs. Based on these results,
the correlation coefficient between the total score of spiritual
wellbeing and social anxiety (0.157) is significant
(P<0.01). These results mean that spiritual wellbeing is
inversely related to social anxiety, and higher spiritual
wellbeing is associated with lower social anxiety.
Table 3 shows the results of regression analysis of
spiritual wellbeing for predicting social anxiety. The
statistical test results of multivariate regression between
spiritual wellbeing and social anxiety showed that the
determination coefficient was 0.102. Therefore 10% of
the social anxiety variance is explained by spiritual wellbeing.
In other words, 10% of the changes in social anxiety
are due to the variable of spiritual wellbeing.
Discussion
The results of the present study showed a correlation
between social anxiety and spiritual wellbeing. Spiritual
wellbeing negatively predicted social anxiety. The
relationship of subscales in both variables is also significant.
Only the relationship of “communication with
others” with “physiological signs” is not significant.
These findings are consistent with the results of several
other studies [4, 6, 7]. In line with the present findings, a
study showed that spiritual intelligence has a significant
negative relationship with perceived stress, anxiety, and
depression. Increasing spiritual intelligence decreases
perceived stress, anxiety, and depression in students [20]
and old adults [21]. Some studies were inconsistent with
the present study [11, 14]. When people have a high spiritual
feeling, they have a meaningful relationship with
themselves, others, the world, and God, which significantly
reduces their fear and thus reduces the amount of
avoidance. The person feels confident and takes action to
do what they are afraid of.
Regarding the physiological signs and lack of relationship
with the subscale of communication with others, it
can be said that this variable depends on physiological
changes in the body. Besides, several physical factors are
involved in its experience. Also, communication with
oneself, the world, and God can be the basis of communication
with others and, as a result, have a strong relationship
with all variables of social anxiety. In addition, in explaining
the lack of relationship between communication
with others and physiological signs, it can be said that
people with social anxiety in front of others experience
Table 1. Mean±SD of spiritual wellbeing and social anxiety
Variables Mean±SD
Spiritual Wellbeing 174.37±17.62
Connection with God 44.91±5.28
Connection with self 42.43±6.11
Connection with nature 44.21±5.06
Connection with others 43.78±4.39
Social phobia 16.09±11.17
Fear 5.58±4.11
Avoidance 6.73±4.83
Physiological signs 3.83±3.17
Panahi et al. Predictive Role of Spiritual Wellbeing in Social Anxiety. Health Spiritual Med Ethics J. 2021; 8(3):143-148
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more excitement, shame, embarrassment, and sometimes
anger. As a result, they experience less anxiety in the
form of physical symptoms and experience other emotions
and symptoms more than anxiety [5]. Experiencing
emotions such as shame and embarrassment can also be
due to one’s fundamental thoughts. Because according to
the Diagnostic and Statistical Manual of Mental Disorders,
people with social anxiety in front of others think
they are going to be ridiculed or embarrassed.
A positive connection with God means a connection
to a powerful resource that can give a person a sense
of control. Having a sense of control leads to increased
mental health and adaptability, and positive interaction
with others. In addition, people who feel supported can
relax when they experience anxiety [8]. High spirituality
in individuals or high spiritual experience also leads to
a good connection with others [4]. Because spirituality
emphasizes a good connection with others. The presence
of a spiritual sense reduces the level of social anxiety
in people. Good connection with others creates positive
emotions that reduce anxiety [14]. A person with a good
connection with others has a source of support and a
sense of worth and confidence. Another study found that
spiritual intelligence leads to increased autonomy, environmental
mastery, personal growth, positive communication,
purposefulness in life, and self-acceptance [22].
From these findings, the correlation between spiritual
wellbeing and social anxiety can be understood. Promoting
personal growth, a sense of autonomy, positive communication,
purposefulness, and self-acceptance can all
affect a person’s relationship with themselves and others,
thus reducing their anxiety about dealing with others.
People with social anxiety are afraid of judging by
others, and when the components mentioned above are
high, people’s fear of judgment and, consequently, their
level of social anxiety decreases [23]. There is also a correlation
between spiritual wellbeing and effective coping
styles and reducing high-risk behaviors in adolescents
[24]. Thus, it can be said that spiritual wellbeing can help
people to deal with their anxiety by influencing coping
styles. In this regard, Koenig also states that people’s
spiritual beliefs provide rules for guiding and confronting
them with problems and enable them to cope [25].
Another study showed a correlation between spiritual
wellbeing and hope and student satisfaction [26]. The
same results are also found in the elderly group [27]
and linked to reduced death anxiety [28, 29]. In another
study, there was a relationship between spiritual intelligence
and religious orientation with psychological
wellbeing and students’ existential anxiety [30]. Low
spiritual intelligence also predicted high social anxiety in
students [31]. Peltzer and Koenig studied a large sample
Table 3. Regression analysis of spiritual wellbeing to predict social anxiety
Standard β t R R Squared F P
Model B Error
Constant 51.77 6.681 7.749
Spiritual wellbeing -0.205 0.038 -0.320 -5.370 0.320 0.102 28.837 0.0001
Table 2. Correlation matrix between spiritual wellbeing and social anxiety
Variables 1 2 3 4 5 6 7
1- Connection with God 1
2- Connection with self 0.605∗ 1
3- Connection with nature 0.496∗ 0.602∗ 1
4- Connection with others 0.599∗ 0.633∗ 0.690∗ 1
5- Fear -0.195∗ -0.40∗ -0.201∗ -0.217∗ 1
6- Avoidance -0.176∗ -0.324∗ -0.192∗ -0.224∗ 0.807∗ 1
7- Physiological signs -0.120∗ -0.120∗ -0.112∗ -0.099 0.806∗ 0.704∗ 1
* P<0.01.
Panahi et al. Predictive Role of Spiritual Wellbeing in Social Anxiety. Health Spiritual Med Ethics J. 2021; 8(3):143-148
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of black students in South Africa. They found that some
religiosity variables were positively associated with
mental health, while others were inversely related or unrelated
[14]. Some of the mechanisms were proposed in
the background of religion and optimal health behaviors
(substance abuse, diet), social and sensory support of the
meaning of life [32, 33], as another mechanism for how
religion and health work, religion and spirituality are essential
factors in a person’s life and pursuit of their daily
goals. A person’s connection with a supernatural force
may be called God, spirit, nature, or the force of unity.
A relatively significant amount of research has shown
that the general population, who identify themselves as
religious and spiritual, have less psychological distress,
more life satisfaction, and more success in their life goals
[34]. The inconsistency of some studies’ results [11, 14]
with the present finding could be due to differences in the
samples and the tools used in the research.
Conclusion
The present study showed a relationship between
spiritual wellbeing and its relations with social anxiety.
When spiritual wellbeing is high, a person has lower
social anxiety. This finding can be used for educational
programs to reduce student anxiety. Teaching and promoting
spiritual wellbeing can result in increased mental
health. Communicating with others and the community
is a prerequisite for students’ success, so reducing their
social anxiety can increase efficiency.
The study had some limitations. The sample was only
female students. It is also suggested for future studies
that other psychological variables in the relationship between
spirituality and social anxiety be examined using
the structural equation method.
Ethical Considerations
Compliance with ethical guidelines
In this article, ethical principles including informed
consent and confidentiality of information have been observed.
The study was confirmed by the Research Center
Faculty of Edcational Sciences and Psychology of Alzahra
University (IR.ALZAHRA.REC.1398.3245).
Funding
This research did not receive any grant from funding
agencies in the public, commercial, or non-profit sectors.
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgments
Our special appreciation and thanks go to all students
who participated in the current study.
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