Effectiveness of Cognitive Behavioral Therapy and Rational Emotive Behavior Therapy in Reducing Social Anxiety among Overweight Adolescents

Document Type : Original Article


1 Department of Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran.

2 Department of Psychology, West Tehran Branch, Islamic Azad University, Tehran, Iran.

3 Department of Psychology, Karaj Branch, Islamic Azad University, Alborz, Iran.


Background and objective: In recent decades, emphasis on diet and thinness has been considered by all social and racial classes. This study aimed to compare the cognitive-behavioral approach's effectiveness and rational-emotional behavior therapy in reducing social anxiety in overweight adolescents.
Methods: The research method was quasi-experimental with pre-test and post-test design with the control and two-month follow-up. The statistical population of this study consisted of male and female adolescents who had been referred to clinics in Tehran in 2019 with overweight and obesity problems, among whom 60 were selected by convenience sampling method. After selecting the subjects, they were randomly assigned to experimental and one control groups. Interventions in both groups were group therapy and consisted of eight sessions for 120 minutes. Data were obtained by social anxiety questionnaire and analyzed using repeated-measures ANOVA and SPSS.22 software. The significance level in this study was considered to be 0.05.
Results: The results showed that cognitive-behavioral approaches and rational-emotional behavior therapy effectively reduced social anxiety in overweight adolescents (p <0.001). However, there was no significant difference between the effectiveness of cognitive-behavioral and rational emotional behavior therapy on social anxiety.
Conclusion: It can be concluded that the cognitive-behavioral approach and rational-emotional behavior therapy can have positive effects on reducing social anxiety in adolescents.


  1. Mannan M, Mamun A, Doi S, Clavarino A. Prospective associations between depression and obesity for adolescent males and females-a systematic review and meta-analysis of longitudinal studies. PloS one. 2016;11(6):157-168. https://doi.org/10.1371/journal.pone.0157240 
  2. Elizondo-Montemayor L, Hernández-Escobar C, Lara-Torre E, Nieblas B, Gómez-Carmona M. Gynecologic and obstetric consequences of obesity in adolescent girls. Journal of pediatric and adolescent gynecology. 2017;30(2):156-68. https://doi.org/10.1016/j.jpag.2016.02.007 
  3. Prasad RV, Bazroy J, Singh Z. Prevalence of overweight and obesity among adolescent students in Pondicherry, South India. International Journal of Nutrition, Pharmacology, Neurological Diseases. 2016;6(2):72-98. https://doi.org/10.4103/2231-0738.179966 
  4. Shukla NK, Shukla M, Agarwal D, Shukla R, Sidhu HP. Prevalence of overweight and obesity among adolescentsin India: a systematic review. Int J Cur Res Rev|. 2016;8(18):21-41.
  5. Soares FC, Barros MV, Bezerra J, Santos SJ, Machado L, & et.al. The synergic relationship of social anxiety, depressive symptoms and waist circumference in adolescents: Mediation analysis. Journal of affective disorders. 2019;2(45):241-255. https://doi.org/10.1016/j.jad.2018.10.366 
  6. Spettigue W, Obeid N, Santos A, Norris M, Hamati R, & et.al. Binge eating and social anxiety in treatment-seeking adolescents with eating disorders or severe obesity. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2020;25(3):787-793. https://doi.org/10.1007/s40519-019-00689-6 
  7. Jaremka LM, Pacanowski CR. Social anxiety symptoms moderate the link between obesity and metabolic function. Psychoneuroendocrinology. 2019; 1 (10):104-125. https://doi.org/10.1016/j.psyneuen.2019.104425 
  8. Dalrymple KL, Clark H, Chelminski I, Zimmerman M. The interaction between mindfulness, emotion regulation, and social anxiety and its association with emotional eating in bariatric surgery candidates. Mindfulness. 2018;9(6):1780-1793. https://doi.org/10.1007/s12671-018-0921-4 
  9. Ozkan EA, Gul AI, Ozdemir ZT, Husrevsahi H, Yildirim Z, & et.al. Evaluation of depression and social anxiety symptoms in obese children. Dusunen Adam The Journal of Psychiatry and Neurological Sciences. 2016;29(1):8-32. https://doi.org/10.5350/DAJPN2016290101 
  10. Abdollahi A, Abu Talib M, Reza Vakili Mobarakeh M, Momtaz V, Kavian Mobarake R. Body-esteem mediates the relationship between self-esteem and social anxiety: The moderating roles of weight and gender. Child Care in Practice. 2016;22(3):296-308. https://doi.org/10.1080/13575279.2015.1054787 
  11. Pourmousa H, Mohammadifar MA, Pesand ST, Rezaei AM. The effectiveness of intimacy training with cognitive-behavioral approach on couples' life quality and happiness. Electronic Journal of General Medicine. 2018;15(6): 38-52. https://doi.org/10.29333/ejgm/93461 
  12. Rodríguez JE, Marzo JC, Piqueras JA. Efficacy of Sphincter Control Training (SCT) in the treatment of premature ejaculation, a new cognitive behavioral approach: A parallel-group randomized, controlled trial. PloS one. 2019;14(2): 212-244. https://doi.org/10.1371/journal.pone.0212274 
  13. Turner MJ. Rational emotive behavior therapy (REBT), irrational and rational beliefs, and the mental health of athletes. Frontiers in psychology. 2016; 7 (2):14-23. https://doi.org/10.3389/fpsyg.2016.01423 
  14. Wood AG, Barker JB, Turner MJ. Developing performance using rational emotive behavior therapy (REBT): A case study with an elite archer. The Sport Psychologist. 2017;31(1):78-87. https://doi.org/10.1123/tsp.2015-0083
  15. Ogbuanya TC, Eseadi C, Orji CT, Anyanwu JI, Ede MO, & ET.AL. Effect of rational emotive behavior therapy on negative career thoughts of students in technical colleges in Nigeria. Psychological reports. 2018;121(2):356-74. https://doi.org/10.1177/0033294117724449 
  16. Wilhelm S, Phillips KA, Greenberg JL, O'Keefe SM, Hoeppner SS, & et.al. Efficacy and posttreatment effects of therapist-delivered cognitive behavioral therapy vs supportive psychotherapy for adults with body dysmorphic disorder: a randomized clinical trial. JAMA psychiatry. 2019;76(4):363-373. https://doi.org/10.1001/jamapsychiatry.2018.4156 
  17. Al‐Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, & et.al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane database of systematic reviews. 2017: 4 (6): 123-138. https://doi.org/10.1002/14651858.CD012691 
  18. Connor KM, Davidson JR, Churchill LE, Sherwood A, Weisler RH, Foa E. Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry. 2000;176(4):379-86. https://doi.org/10.1192/bjp.176.4.379 
  19. Ebrahiminejad S, Poursharifi H, Roodsari AB, Zeinodini Z, Noorbakhsh S. The effectiveness of mindfulness-based cognitive therapy on Iranian female adolescents suffering from social anxiety. Iranian Red Crescent Medical Journal. 2016;18(11):132-148. https://doi.org/10.5812/ircmj.25116 
  20. Stewart RE, Chambless DL. Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of consulting and clinical psychology. 2009;77(4):595-615. https://doi.org/10.1037/a0016032 
  21. Ellis A. Rational emotive behavior therapy. Current psychotherapies. 1995;5(6):162-196.