The role of shame and self-consciousness in the relationship between attachment and paranoia in an Iranian sample: A moderated mediation analysis

The role of shame and self-consciousness in the relationship between attachment and paranoia in an Iranian sample: A moderated mediation analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The role of shame and self-consciousness in the relationship between attachment and paranoia in an Iranian sample: A moderated mediation analysis Maryam Amini-Fasakhoudi, Hossein Karsazi, Abbas Masjedi-Arani, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4007007/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Early life experiences increase vulnerability to paranoid thoughts, and attachment theory has been used as a conceptual framework to explain this causal pathway. The purpose of this study was to identify and highlight the mediating and moderating mechanisms in the relationship between attachment styles and paranoia in a non-clinical sample. Method The current research was a cross-sectional design. A sample of 331 university students was collected by available and online sampling at a period of 3 months. They completed the Paranoia scale (PS), Relationship scales questionnaire (RSQ), Internal and External Shame Scale (EISS), and Self-consciousness scale (SCS). Data analysis was conducted using descriptive statistics, correlation coefficients, and Process Macro. Results The results showed that avoidant and anxious attachment was related to paranoia and shame mediates this relationship. On the other hand, self-consciousness as a buffering moderated and weakened the relationship between attachment and paranoia. Conclusion The present study provided preliminary evidence for the mediating and moderating roles of shame and self-consciousness in the relationship between attachment and paranoia. Anxious attachment Avoidant attachment Paranoia Shame and Self- consciousness Figures Figure 1 Figure 2 Figure 3 Background Paranoia is defined as beliefs of persecution, conspiracies and threats in the absence of any corroborating evidence (Freeman, 2007 ). In addition to clinical populations, paranoia also exists in non-clinical populations and is arranged on a continuum from mild suspicion to severe distressing delusions (Freeman et al., 2005 ). According to evolutionary theory, paranoia is an adaptive response that allows prevention of social threats such as conspiracy and persecution by others (Gilbert & et al, 2005 ; Matos, Pinto-Gouveia, & Gilbert, 2013 ). Early life experiences have been found to increase vulnerability to paranoid thinking and, accordingly, attachment theory has been proposed as a key model in explaining this causal pathway (Lavin & et al, 2020 ). One systematic review of healthy individuals and psychiatric patients have revealed that increased anxious and avoidant attachment are associated with paranoia (Dančík & et al, 2023 ). Previous studies have reported a relationship between insecure attachment styles and paranoia in clinical and non-clinical samples (Pickeringa, Simpsona & Bentall, 2008 ; Sitko & et al, 2014 ; Wickham, Sitko & Bentall, 2015 ; Hutton, Ellett & Berry, 2017 ; Sood & Newman-Taylor, 2020 ; Murphy et al, 2020 ; Lavin et al., 2019). Insecure attachment may be association with paranoia because both involve a mistrust and negative view of other (Bentall & Fernyhough, 2008 ). In this regard, attachment theory suggests that the availability and responsiveness of primary attachment figures over time leads to the formation of internal working models (Bowlby, 1969 ). These internal working models influence perceptions of interactions and operate as templates for future relationships (Collins & Read, 1994). Working models affect cognitions, emotions and behaviors in interpersonal relationships and lie on two orthogonal dimensions: anxiety and avoidance (Brennan, Clark & Shaver, 1998 ). An anxious attachment style, is characterized by a negative view of the self, and a positive view of others, worry in relation to others, and increased negative affect. In contrast, avoidant attachment, is characterized by a positive view of the self, and a negative view of others, and is associated with social withdrawal and the suppression of negative affect (Mikulincer & Shaver, 2016 ). Evidence suggests that anxious and avoidant attachment is associated with both clinical and nonclinical paranoia (Murphy & et al, 2020 ). Recent studies show that paranoia has a stronger relationship with anxious attachment (Lavin & et al, 2020 ); For example, the results of a review study revealed that paranoia was significantly related to anxious attachment and the strength of this relationship did not differ between clinical and non-clinical samples (Murphy & et al, 2020 ). Whereas, results of a study found a stronger relationship between paranoia and avoidant attachment (Berry, Barrowclough & Wearden, 2007 ). In another study conducted by Berry et al., anxious and avoidant attachment were related to paranoia and hallucinations in a college student sample (Berry & et al, 2006 ). In general, during the last decade, an increasing number of studies have shown the relationship between both dimensions of attachment and paranoia in different samples, including: the general population (Meins & et al ,2008), individuals at high risk for developing psychosis (Russo & et al, 2018 ) and patients diagnosed with schizophrenia (Strand, Goulding & Tidefors, 2015 ). Insecure attachment as a non-specific risk factor for psychopathology is related to the tendency to experience shame (Remondi & et al, 2023 ). Shame is strongly related to early relationships with primary caregivers and occurs in response to perceived rejection or separation from attachment figures (Schore, 1998 ). Results of one study showed that the mother's critical and negative attitude during a challenging activity at 24 months is related to the experience of shame and avoidance at 36 months (Kelley, Brownell & Campbell, 2000 ). A study on 209 college students aged 19 to 24 found a significant relationship between insecure attachment with low self-esteem and high feelings of shame (Passanisi & et al., 2015 ). In addition, previous studies demonstrated that insecurely attached individuals are more prone to experience feelings of shame as compared to their securely attached counterparts (Gross and Hansen, 2000 ; Wei et al., 2005 ). In one study, both the insecure attachment dimensions had significant indirect effects on psychological distress through dispositional shame. Also, shame as a strong emotion predicted aspects of poor psychological functioning (Remondi & et al., 2023 ). Shame associated with withdrawal from others is likely to increase paranoia because fears about people's intentions are not revised through interactions with supportive others (Freeman et al., 2002 ). In this regard, some studies have investigated the relationship between shame and paranoia (Gilbert, et al, 2005 ; Matos, Pinto-Gouveia & Duarte, 2012 ; Matos et al., 2013 ; Mills et al., 2007 ; Pinto-Gouveia et al., 2014 ). According to the hierarchical model of paranoia, concerns about social judgment, fear of rejection, feeling of vulnerability, and the perception that the world is dangerous have been conceptualized at the bottom of the paranoia hierarchy (Freeman et al., 2005 ). Indeed, early dysfunctional interactions with attachment figures in early life can be organized into internal working models of self as worthless, undesirable, or defective (shame) and others as threatening, powerful, superior, hostile, and judgmental (paranoia) (Matos & Pinto-Gouveia, 2010 ; Matos, Pinto-Gouveia, & Costa, 2013 ). Shapiro ( 1965 ) noted that self-consciousness is often related to paranoia, and suggested that awareness of attention in relation to another person can create feelings of exposure and vulnerability. Humans evolved in a world of scarcity, disease, and injury, that these self-conscious emotions can have adaptive interpersonal functions. The evolutionary roots of human social valuation are key to understanding the self-conscious emotions (Sznycer, 2019 ). Laing ( 1969 ) presented suspiciousness as an aspect of self-consciousness. Self-consciousness means focusing on one's thoughts, feelings, and attitudes, which is accompanied by a tendency to focus on observable aspects (self-monitoring). Increased self-focused attention has been shown in most forms of psychopathology (Ingram, 1990 ). This heightened awareness of oneself or severe self-consciousness has always been seen as a central trait of paranoia and misleads individuals that they are the center of others' attention (Cameron, 1943 , Fenigstein, 1984 , Greenwald, 1980 , Kraepelin, 1968 , Laing, 1969 ). On the other hand, according to Muris and colleagues ( 2014 ), there is currently limited evidence supporting a connection between insecure attachment and the dysregulation of self-conscious emotions. Their study indicated that insecure attachment contributes to heightened self- conscious emotion. Lopez et al ( 1997 ) found, in a sample of 142 undergraduate students (average age of 21 years), that individuals with insecure attachment, particularly those exhibiting an ambivalent style, tend to experience higher levels of shame compared to securely attached individuals. Additionally, Lech, Andersson, and Holmqvists ( 2012 ) study revealed a correlation between high emotion consciousness and secure attachment, while low emotion consciousness was associated with insecure attachment. Although there is strong evidence that there is a relationship between attachment and paranoia, little is known about the mediating mechanisms of this relationship (Partridge, Maguire & Newman-Taylor, 2022 ), and we expect shame to play this role. It is clear that not all people with an insecure attachment style experience paranoia symptoms and that individual differences play an important role in this process. Therefore, the potential role of moderating variables that can strengthen or weaken this relationship is also important. In the present study, we investigate whether self-consciousness moderates this relationship? On the other hand, most research in attachment and paranoia has been completed in Western countries. So another gap in the literature, is to examine these relationships in non-Western cultures. Method Participants The current study used a cross- sectional design. We recruited 331 student of Shahid Beheshti University of Medical Sciences in Iran over a period of three months. Participation was voluntary, and information about the purpose of the study was provided to all participants before obtaining informed consent. Among 331 subjects, 182 were women (55%) and 149 were men (45%). The average age of the participants was 25.15 years with a standard deviation of 4.42. Most of the subjects had a professional doctoral education (64%). Inclusion criteria for participants were: informed consent to participate in the process of completing questionnaires, age over 18 years, no history of schizophrenia and mood disorders, no history of delusional disorder, no use of antipsychotic drugs, no use of drugs, learning and mental disabilities, medical or neurological diseases causing symptoms of paranoia. Data analysis was conducted using descriptive statistics, correlation coefficients, and PROCESS Macro. Measures Paranoia Scale (PS) This scale is a 20-item self-report instrument to assess paranoid beliefs in a sample of college students. The items are scored on a Likert scale from 1 to 5, and the total scores range from 20 to 100, with higher scores indicating higher levels of paranoid beliefs. In their study, the overall Cronbach's alpha was 0.84 and the test-retest reliability was 0.70, as well as the convergent validity of this tool with the items of the MMPI questionnaire was estimated well, and the results of the factor analysis indicated the existence of a general factor (Fenigstein & Vanable, 1992 ). In the present study, Cronbach's alpha of the whole scale was 0.89. Relationship Scales Questionnaire (RSQ) This questionnaire was designed by Griffin and Bartholomew ( 1994 ) to determine the attachment styles of adults and has 30 statements. The scores of each style are determined after averaging the sum of the scores in each subscale. In Kurdek et al.'s (2002) study, Cronbach's alpha was obtained for the two subscales of anxiety and avoidance, (0/83) and (0/77) respectively. The results of confirmatory factor analysis of RSQ in a sample of Iranian students were also consistent with the results of other studies, and the two-factor model with the best fit was reported. Also, Cronbach's alpha of the two dimensions of anxiety and avoidance was 0.86 and 0.64, respectively (Amini Fasakhoudi & Bakhshipour Roudsari, 2016 ). Internal and External Shame Scale (EISS) In the study of Ferreira et al ( 2020 ) an internal and external shame scale was developed to evaluate these two dimensions. This study was conducted in a sample including 665 participants (18 to 61 years old). Three models were tested through confirmatory factor analysis. A higher order factor (global shame) with two lower order factors (external and internal shame) showed a good fit with the data. Also, the results indicated that the subscales of EISS and global shame have good internal consistency and concurrent validity of the scale with depressive symptoms was obtained. In the present study, Cronbach's alpha of the whole scale and the internal and external shame subscales were obtained 0/88, 0/73, and 0/70, respectively. Self-Consciousness scale (SCS) : The self-consciousness scale consists of 23 statements and the results of the factor analysis of the initial version showed three subscales: private, public and social anxiety. The original study sample included 668 undergraduate students. In this study, the test-retest reliability for the three subscales and the total scale were 0.79, 0.84, 0.73, and 0.80, respectively. Also, the validity of the tool has been reported as high, and the results indicated that public self- consciousness has a moderate relationship with private self-consciousness and social anxiety, while the relationship between private self- consciousness and social anxiety fluctuated around zero (Fenigstein et al., 1975 ). In the present study, Cronbach's alpha coefficient for the total of scale was 0.79 and for the private, public and social anxiety subscales, were 0.71, 0.58 and 0.72, respectively. Statistical analyses First, descriptive statistics indices and correlation matrix between variables were calculated. Moderated mediation analysis was performed using PROCESS Macro version 4.2, model 5 (Hayes's, 2022). All continuous variables were converted to standard scores and the mediating and moderating effects were calculated based on these standardized scores. The bootstrapping method was used to estimate the significance of the parameters, which was conducted with 95% confidence intervals and 1000 re-sampling of the data. Confidence intervals that do not include zero indicate the significance of the effects. Results Mean, standard deviation, and correlations between research variables are presented in Table 1 . As expected, both insecure attachment styles were positively correlated with paranoia. Also, shame and self-consciousness showed a positive relationship with paranoia. Table 1 Mean (M), standard deviation (SD), and correlations of the variables M SD 1 2 3 4 5 1.Avoidant attachment 9.66 3.15 1 2.Anxious attachment 6.41 4.20 .286 *** 1 3.Shame 8.91 5.13 .308 *** .405 *** 1 4.Self-consciousness 56.41 10.66 .185 ** .213 *** .334 *** 1 5.Paranoia 42.70 12.20 .353 *** .387 *** .466 *** .335 *** 1 ** p < .01, *** p < .001 Mediation analysis showed that avoidant attachment had an effect on shame with a standardized coefficient of β = .308, p < .001. Shame had an effect on paranoia with a standardized coefficient of β = .350, p < .001. The direct effect of avoidant attachment on paranoia was also significant with the standard coefficient β = .257, p < .001 (Table 2 ) (Fig. 1 ). The bias-corrected percentile bootstrap method showed that the indirect effect of avoidant attachment on paranoia is significant through the mediation of shame β = .108, SE = .026, 95% CI = [.061, .162]. Table 2 The moderated mediation effect analysis of avoidant attachment on Paranoia Variable Mediator: Shame Outcome: Paranoia β SE p β SE p Avoidant attachment .308 .052 < .001 .257 .048 < .001 Shame .350 .049 < .001 Self-consciousness .189 .048 < .001 Avoidant attachment × Self-consciousness − .191 .044 < .001 R 2 .095 .332 F 34.43 ( p < .001) 40.58 ( p < .001) Note: SE, standard error In the model related to anxious attachment, the analysis showed that anxious attachment had an effect on shame with a standard coefficient of β = .405, p < .001. Shame had an effect on paranoia with a standardized coefficient of β = .307, p < .001. The direct effect of anxious attachment on paranoia was also significant with the standard coefficient β = .222, p < .001 (Table 3 ) (Fig. 1 ). The bias-corrected percentile bootstrap method showed that the indirect effect of anxious attachment on paranoia was significant through the mediation of shame β = .124, SE = .025, 95% CI = [.079, .182]. Table 3 The moderated mediation effect analysis of anxious attachment on Paranoia Variable Mediator: Shame Outcome: Paranoia β SE p β SE p Anxious attachment .405 .050 < .001 .222 .050 < .001 Shame .307 .053 < .001 Self-consciousness .184 .049 < .001 Anxious attachment × Self-consciousness − .106 .043 < .05 R 2 .163 .307 F 64.40 ( p < .001) 36.11 ( p < .001) Note: SE, standard error Moderation analysis was used to estimate the interactive effect of self- consciousness and insecure attachment on paranoia. The results showed that the interactive effect of self-consciousness and avoidant attachment on paranoia is significant (β = − .191, p < .001). Also, the interactive effect of self-consciousness and anxious attachment on paranoia symptoms is significant (β = − .106, p < .05). In order to visually display the interactive effects of self-consciousness and insecure attachment, simple slopes analysis was used. These graphs show the magnitude of the effect of insecure attachment style on paranoia symptoms according to different levels of self-consciousness. Different levels of the moderator variable (self-consciousness) were calculated as follows: 1) low level: one standard deviation smaller than the mean, 2) medium level: equal to the mean and 3) high level: one standard deviation larger than the mean. Simple slopes analysis showed that avoidant attachment had a positive effect on paranoia at low (β = .444, p < .001) and medium (β = .246, p .05). These results revealed that in people who had a high level of self-consciousness, the relationship between avoidant attachment style and paranoia was weaker. (Fig. 2 ). Analysis of simple slopes for anxious attachment was almost similar. The results showed that anxious attachment had a positive effect on paranoia at a low (β = .325, p < .001) and medium (β = .216, p .05). These results revealed that in people who had a high level of self-consciousness, the relationship between anxious attachment style and paranoia was weaker (Fig. 3 ). Discussion The findings of the present study in a sample of university students revealed that there is a significant relationship between anxious and avoidant attachment and paranoia. This result consistent with the results of previous studies, showed that insecure attachment styles are a risk factor for experiencing paranoia in clinical and non-clinical populations (Pickeringa & et al., 2008; Sitko & et al., 2014 ; Wickham & et al., 2015 ; Hutton & et al., 2017 ; Sood & Newman-Taylor, 2020 ; Murphy et al, 2020 ; Lavin et al., 2019). Based on the two-dimensional model of Bartholomew ( 1990 ), people with an avoidant style due to having a positive view of themselves and a negative view of others, reduce their negative feelings through emotion regulation strategies such as withdrawal and avoidance. On the other hand, both social withdrawal and negative beliefs about others are also implicated in paranoia. Therefore, this attachment style may play a role in the development or maintenance of paranoia (Freeman et al., 2002 ). According to Cassidy (1994), these people avoid intimate relationships with others due to previous learning related to primary attachment figures so that the experience of rejection, abandonment, loss and punishment does not repeat (Mikulincer & Shaver, 2007). In contrast, negative self-views are characteristic of anxious attachment and thus may cause individuals to perceive themselves as increasingly vulnerable, which can ultimately increase feelings of threat and harm from others (Freeman et al., 2014). These representations of insecure attachment figures lead to low self-esteem, which can trigger paranoid thinking (Freeman et al., 2002 ). In this regard, our findings also revealed that insecure attachment has an effect on paranoia through the mediation of shame. This result is in line with the results of other studies regarding the relationship between shame with paranoia and attachment (Freeman et al., 2002 ; Gilbert et al., 2005 ; Matos, Pinto-Gouveia & Duarte, 2012 ; Matos, Pinto-Gouveia, & Gilbert, 2013 ; Mills et al., 2007 ; Pinto-Gouveia et al., 2014 ; Passanisi & et al., 2015 ; Remondi & et al., 2023 ). However, the result of our study showed that self-consciousness could moderate this relationship and reduced the effect of insecure attachment on paranoia. To date, this study is the first to discover these relationships. According the bio-psycho-social model, shame is a self-conscious emotion that arises in competition for social attractiveness, and emerging from our evolved cognitive competences for processing social and self-information (Gilbert, 1998 ). Thus, shame evolved as a defensive strategy to keep oneself safe from potential attacks (e.g., punishment, rejection and criticism) from others. This experience of seeing the other as a threat to the self and the self-identity can trigger two major defenses: one is the shaming response, when the individual adopts a strategy associated with self-devaluation and self-criticism and another is the humiliating response, when the individual displays dominant and aggressive behaviors, e.g., anger (Gilbert, 1998 , 2003 ). In addition to, individuals who have more trait-anger and express it, tend to have more paranoid beliefs. Overall, individuals with difficulties in controlling the feelings of own anger also tend to have more paranoid beliefs. In fact, both the shame response and the anger response are related to paranoia. As mentioned in the introduction of the study, the pathological root of shame may be related to the attachment experiences of individuals in childhood, which are formed in response to rejection and separations early in life in relation to primary caregivers (Passanisi & et al., 2015 ; Schore, 1998 ; Mikulincer & Shaver, 2016 ; Remondi & et al, 2023 ). Adults with a secure attachment style are able to manage the emotion of shame because of their experience with primary responsive caregivers. On the contrary, an anxious or avoidant attachment pattern that is created as a result of unreliability or unavailability of primary caregivers are unable to effectively regulate own emotions (Main & Hesse, 1990 ). Tangney ( 1993 ) suggested that shame is often regulated by avoidant techniques such as a desire to hide or escape, which fits with the withdrawal definition. Therefore, was identified why this is the most common maladaptive shame coping style for individuals with an avoidant attachment style. Whereas, an anxious style is characterized by a tendency to exaggerate negative emotions such as shame, which can be seen as an attempt to portray oneself as a bad self. Indeed, an anxious style can regulate emotion by sustaining negative emotions or engaging in negative self-evaluations. This is style that designed to elicit help from others for regulating emotion. These traits may increase a person’s shame proneness (Mikulincer & Shaver, 2003 ). Now we turn to the question that in our study, how self-consciousness as a protective factor moderates the destructive effect of insecure attachment on paranoia? While previous studies indicate a positive relationship between self- consciousness and paranoia (Shapiro, 1965 ; Cameron, 1943 , Fenigstein, 1984 , Greenwald, 1980 , Kraepelin, 1968 , Laing, 1969 ). By recalling that suspiciousness may be the paramount characteristic of paranoia, one may readily draw parallels between self-consciousness and paranoia. Laing asserted, when individuals have an increased awareness of themselves in the presence of others, this may distort their perception such that they believe their minds are susceptible to the influence of others (Laing, 1969 ). Over perception of self is a bias common in paranoia, and occurs when people overestimate their role in an incident (Greenwald, 1980 ). As Ingram ( 1990 ) stated, heightened self-focused attention has been shown in most forms of psychopathology. In the findings section, different levels of self-consciousness (low, medium and high) had different effects as moderators on paranoia. In other words, in people with high self-consciousness, the effect of anxious and avoidant attachment on the experience of paranoia was moderated and reduced, and in contrast, in people with low self-consciousness, the effect of both anxious and avoidant styles on paranoia was moderated and increased. Whereas, both self-consciousness and insecure attachment alone have a significant positive effect on paranoia. In the possible explanation of this exploratory finding it can be said that, People with higher self-consciousness have more self-monitoring; because they are more aware of their thoughts and emotions. In the avoidant style, this awareness gives the individual insight into own negative view of others that can control own emotions and thoughts in interpersonal relationships and experience less anger. In contrast, in the anxious style, this awareness gives the individual insight to manage their emotions of shame and guilt in relation to others. On the other hand, in the avoidance style, low self-consciousness causes people to have little insight into their negative thoughts and emotions towards others, and their negative view towards others increases. This in turn can be linked to the development and maintenance of paranoid thoughts. Also, in the anxious style, low self-consciousness causes people to have little insight into their own negative thoughts and emotions. As a result, they imagine that others will reject them and persecutory them because of their weaknesses. Overall, evidence regarding the relationship between insecure attachment and self-consciousness is still in its infancy (e.g., Morris et al., 2014; Lech & et al., 2012 ). Findings of our study indicated the existence of a positive and significant relationship between self-consciousness and attachment styles with paranoia Meanwhile, evolutionary roots suggest that self-conscious emotions have interpersonal adaptive functions. Self-conscious emotions would have evolved as solutions to some adaptive problems related to social valuation. It seems that conscious emotions are adaptive strategies for processing information obtained by natural selection. Because they helped our human ancestors to resolve challenges and opportunities associated with social valuing in favor of their own well-being or that of others (Sznycer, 2019 ). Therefore, it makes sense to consider self-consciousness as an evolutionary solution to self-observation of one's thoughts, emotions, and internal states, leading to insight into one's positive or negative view of oneself and others. On the other hand, as mentioned earlier, heightened self-consciousness is seen as a central feature of paranoia (Cameron, 1943 , Fenigstein, 1984 , Greenwald, 1980 , Kraepelin, 1968 , Laing, 1969 ). Are these views inconsistent with our findings? Since the sample of the present study was a non-clinical sample, it is obvious that the hypothesized levels of high self-consciousness is not extreme compared to clinical samples. So, this level of self-consciousness can moderate the relationship between insecure attachment and paranoia and act as a buffering. Conclusion In summary, this study contributes to the research literature by establishing a moderated mediation model. Our findings highlight the importance of identifying mechanisms that underlie mediating and moderating pathways between insecure attachment and paranoia in nonclinical populations. In this way, shame intensified the effect of attachment on paranoia, and on the contrary, self-consciousness weakened this effect. These findings suggest that although self-consciousness and shame can each contribute to the formation and maintenance of paranoia, their interaction in the same relationship can produce different outcomes. Limitations and suggestions As an exploratory and novel finding, these results need to be replicated before definitive conclusions can be drawn. Also, the participants in this study were students; therefore, the representation of the sample for other groups is limited, and the study should be replicated with general population, analogue and clinical samples. Perhaps if our findings are replicated with a clinical sample, we may be able to assess and target shame and self-consciousness in psychological treatments for paranoia. Declarations Ethics approval and consent to participate The ethics committee of the Shahid Beheshti University of Medical Science first approved this study (Approval ID: IR.SBMU.RETECH.REC.1402.392), and the participants provided their written informed consent to participate in this study. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the first author upon reasonable request. Competing interests No potential competing interests was reported by the author(s). Funding The present article is financially supported by Taleghani Hospital Research Development Unit, School of Medicine, Shahid Beheshti University of Medical Sciences (Grant No 43003172). Author Contributions MA-F : Conceptualization, Methodology, Project administration, Writing – original draft, Writing – review & editing. HK : Conceptualization, Methodology, Formal analysis, Writing – review & editing. AM-A : Conceptualization, Writing – review & editing. HDAV : Writing – review & editing. ASK : Writing – review & editing Acknowledgments The authors thank Katherine Newman-Taylor for comments on an earlier draft. Also, we thank those who participated in this study. References Amini Fasakhoudi, M., & Bakhshipour Roudsari, A. (2016). 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Kraepelin, E. (1968). Psychiatrie: Ein Lehrbuch [Psychiatry: A textbook] (7th ed.). Barth. Kurdek, L. A. (2002). On being insecure about the assessment of attachment styles. Journal of Social and Personal Relationships , 19 (6), 811–834. Laing, R. D. (1969). The divided self . Pantheon Books. Lavin, R., Bucci, S., Varese, F., & Berry, K. (2020). The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. British Journal of Clinical Psychology , 59 (1), 39–65. Lech, B., Andersson, G., & Holmqvist, R. (2012). Affect Consciousness and Adult Attachment. Psychology , 3 , 675–680. Lopez, F. G., Gover, M. R., Leskela, J., Sauer, E. M., Schirmer, L., & Wyssmann, J. (1997). Attachment styles, shame, guilt, and collaborative problem-solving orientations. Personal Relationships , 4 (2), 187–199. Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research & intervention (pp. 161–182). University of Chicago Press. Matos, M., & Pinto-Gouveia, J. (2010). Shame as a traumatic memory. Clinical psychology & psychotherapy , 17 (4), 299–312. Matos, M., Pinto-Gouveia, J., & Costa, V. (2013). Understanding the importance of attachment in shame traumatic memory relation to depression: The impact of emotion regulation processes. Clinical psychology & psychotherapy , 20 (2), 149–165. Matos, M., Pinto-Gouveia, J., & Duarte, C. (2012). Above and beyond emotional valence: The unique contribution of central and traumatic shame memories to psychopathology vulnerability. Memory (Hove, England) , 20 (5), 461–477. Matos, M., Pinto-Gouveia, J., & Gilbert, P. (2013). The effect of shame and shame memories on paranoid ideation and social anxiety. Clinical psychology & psychotherapy , 20 (4), 334–349. Meins, E., Jones, S. R., Fernyhough, C., Hurndall, S., & Koronis, P. (2008). Attachment dimensions and schizotypy in a non-clinical sample. Personality and Individual Differences , 44 , 1000–1011. Mikulincer, M., & Shaver, P. R. (2016). Attachment in Adulthood: Structure, Dynamics, and Change (2nd ed.). The Guilford. Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. Advances in experimental social psychology , 35 , 56–152. Mikulincer, M., & Shaver, P. R. (2010). Attachment in adulthood: Structure, dynamics, and change . Guilford. Mills, A., Gilbert, P., Bellew, R., McEwan, K., & Gale, C. (2007). Paranoid beliefs and self-criticism in students. Clinical Psychology & Psychotherapy , 14 (5), 358–364. Muris, P., Meesters, C., Cima, M., Verhagen, M., Brochard, N., Sanders, A., & Meesters, V. (2014). Bound to feel bad about oneself: Relations between attachment and the self-conscious emotions of guilt and shame in children and adolescents. Journal of Child and Family Studies , 23 , 1278–1288. Murphy, R., Goodall, K., & Woodrow, A. (2020). The relationship between attachment insecurity and experiences on the paranoia continuum: A meta-analysis. British Journal of Clinical Psychology , 59 (3), 290–318. Partridge, O., Maguire, T., & Newman-Taylor, K. (2022). Pathways from insecure attachment to paranoia: the mediating role of emotion regulation. Behavioural and Cognitive Psychotherapy , 50 (4), 404–417. Passanisi, A., Gervasi, A. M., Madonia, C., Guzzo, G., & Greco, D. (2015). Attachment, self-esteem and shame in emerging adulthood. Procedia-Social and Behavioral Sciences , 191 , 342–346. Pickering, L., Simpson, J., & Bentall, R. P. (2008). Insecure attachment predicts proneness to paranoia but not hallucinations. Personality and Individual Differences , 44 (5), 1212–1224. Pinto-Gouveia, J., Matos, M., Castilho, P., & Xavier, A. (2014). Differences between depression and paranoia: The role of emotional memories, shame and subordination. Clinical psychology & psychotherapy , 21 (1), 49–61. Remondi, C., Casu, G., Pozzi, C., Greco, F., Gremigni, P., & Brugnera, A. (2023). A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles. International Journal of Environmental Research and Public Health , 20 (4), 3193. Russo, D. A., Stochl, J., Hodgekins, J., Iglesias-González, M., Chipps, P., Painter, M., & Perez, J. (2018). Attachment styles and clinical correlates in people at ultra high risk for psychosis. British Journal of Psychology , 109 (1), 45–62. Schore, A. N. (1998). Early shame experience and infant brain development. In P. Gilbert, & B. Andrews (Eds.), Shame: Interpersonal behaviour, psychopathology, and culture (pp. 57–77). Oxford University Press. Shapiro, D. (1965). Neurotic styles . Basic Books. Sitko, K., Bentall, R. P., Shevlin, M., & Sellwood, W. (2014). Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey. Psychiatry research , 217 (3), 202–209. Sood, M., & Newman-Taylor, K. (2020). Cognitive fusion mediates the impact of attachment imagery on paranoia and anxiety. Cognitive Therapy and Research , 44 , 1150–1161. Strand, J., Goulding, A., & Tidefors, I. (2015). Attachment styles and symptoms in individuals with psychosis. Nordic journal of psychiatry , 69 (1), 67–72. Sznycer, D. (2019). Forms and functions of the self-conscious emotions. Trends in cognitive sciences , 23 (2), 143–157. Tangney, J. P. (1993). Shame and guilt. In C. G. Costello (Ed.), Symptoms of Depression (pp. 161–180). Wiley. Wei, M., Shaffer, P. A., Young, S. K., & Zakalik, R. A. (2005). Adult attachment, shame, depression, and loneliness: the mediation role of basic psychological needs satisfaction. Journal of counseling psychology , 52 (4), 591. Wickham, S., Sitko, K., & Bentall, R. P. (2015). Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: The mediating role of negative self-esteem. Psychological Medicine , 45 , 1495–1507. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4007007","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276470338,"identity":"f287fb76-c0ab-4e72-b063-a8bf9311d420","order_by":0,"name":"Maryam Amini-Fasakhoudi","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Amini-Fasakhoudi","suffix":""},{"id":276470339,"identity":"4eed2d73-3713-4a7c-9155-9b55fb4ded78","order_by":1,"name":"Hossein Karsazi","email":"","orcid":"","institution":"University of Tehran","correspondingAuthor":false,"prefix":"","firstName":"Hossein","middleName":"","lastName":"Karsazi","suffix":""},{"id":276470340,"identity":"bf00fb68-237d-4adf-9aee-95977c3d8c92","order_by":2,"name":"Abbas Masjedi-Arani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYNACHgbGNjDDwIbBAC5GpJY0YrUwMDA2QOjDcC04AX8Dd+LHHzI2sn3sZx9+Lig4b28udsaA4UcNg4x5A3YtEgd4N0vz8KQZt/GkG0vPMLiduHN2jgFjzzEGHpkDOKw5wLtBmoHncGIbQxqDNI/B7QSD2zkGDLwNDDwSOHTIA235+YPnf2Ib/zPm3zwG5+xBWhj/4tFicIB3mwQPz4HENok0NqAtBxg3ALUw47PF8DDvNmsenmTjNolnbNY8BslAv6QVHJY5JoFTi9zx3s03f/bYyc7vT2O+zfPHzt5cOnnjwzc1Nva4tDAwAzFjD3qYAIMSlwYo+EFAfhSMglEwCkY2AADzak6J4QhE6gAAAABJRU5ErkJggg==","orcid":"","institution":"Shahid Beheshti University of Medical Science","correspondingAuthor":true,"prefix":"","firstName":"Abbas","middleName":"","lastName":"Masjedi-Arani","suffix":""},{"id":276470341,"identity":"1bad1a83-9365-40ca-a3bd-218fcf64ce90","order_by":3,"name":"Hoda Doos Ali Vand","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Hoda","middleName":"Doos Ali","lastName":"Vand","suffix":""},{"id":276470342,"identity":"2b5375d6-75c2-4e99-aa38-bb7c4fcc1d89","order_by":4,"name":"Amir Sam Kianimoghadam","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Amir","middleName":"Sam","lastName":"Kianimoghadam","suffix":""}],"badges":[],"createdAt":"2024-03-02 21:20:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4007007/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4007007/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52142781,"identity":"6211ed39-27a2-434b-addb-273440ae3de3","added_by":"auto","created_at":"2024-03-07 11:33:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32797,"visible":true,"origin":"","legend":"\u003cp\u003eThe moderated mediation model\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4007007/v1/efc7a6eae59d5855cd3722d9.jpg"},{"id":52142782,"identity":"92a025fe-523d-44f7-a80c-f337b4d2d346","added_by":"auto","created_at":"2024-03-07 11:33:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9096,"visible":true,"origin":"","legend":"\u003cp\u003eSimple slopes plot for the effect of avoidant attachment on paranoia at high, medium, and low levels of self-consciousness\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4007007/v1/f1556dfe3b8b9108c344887b.png"},{"id":52142783,"identity":"aa3ab269-078a-4cb5-9023-9b8c70ea9e48","added_by":"auto","created_at":"2024-03-07 11:33:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9835,"visible":true,"origin":"","legend":"\u003cp\u003eSimple slopes plot for the effect of anxious attachment on paranoia at high, medium, and low levels of self-consciousness\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4007007/v1/b82b691cd5558b698b85c725.png"},{"id":53231125,"identity":"a1a77e2c-9bb3-4d3b-80b2-8bd4cccc8cdb","added_by":"auto","created_at":"2024-03-22 07:30:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":404475,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4007007/v1/740d57a4-8de1-42f6-9d18-caef0a4634da.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The role of shame and self-consciousness in the relationship between attachment and paranoia in an Iranian sample: A moderated mediation analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eParanoia is defined as beliefs of persecution, conspiracies and threats in the absence of any corroborating evidence (Freeman, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In addition to clinical populations, paranoia also exists in non-clinical populations and is arranged on a continuum from mild suspicion to severe distressing delusions (Freeman et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). According to evolutionary theory, paranoia is an adaptive response that allows prevention of social threats such as conspiracy and persecution by others (Gilbert \u0026amp; et al, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Matos, Pinto-Gouveia, \u0026amp; Gilbert, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly life experiences have been found to increase vulnerability to paranoid thinking and, accordingly, attachment theory has been proposed as a key model in explaining this causal pathway (Lavin \u0026amp; et al, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). One systematic review of healthy individuals and psychiatric patients have revealed that increased anxious and avoidant attachment are associated with paranoia (Danč\u0026iacute;k \u0026amp; et al, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Previous studies have reported a relationship between insecure attachment styles and paranoia in clinical and non-clinical samples (Pickeringa, Simpsona \u0026amp; Bentall, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Sitko \u0026amp; et al, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Wickham, Sitko \u0026amp; Bentall, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Hutton, Ellett \u0026amp; Berry, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Sood \u0026amp; Newman-Taylor, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Murphy et al, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lavin et al., 2019). Insecure attachment may be association with paranoia because both involve a mistrust and negative view of other (Bentall \u0026amp; Fernyhough, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this regard, attachment theory suggests that the availability and responsiveness of primary attachment figures over time leads to the formation of internal working models (Bowlby, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1969\u003c/span\u003e). These internal working models influence perceptions of interactions and operate as templates for future relationships (Collins \u0026amp; Read, 1994). Working models affect cognitions, emotions and behaviors in interpersonal relationships and lie on two orthogonal dimensions: anxiety and avoidance (Brennan, Clark \u0026amp; Shaver, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). An anxious attachment style, is characterized by a negative view of the self, and a positive view of others, worry in relation to others, and increased negative affect. In contrast, avoidant attachment, is characterized by a positive view of the self, and a negative view of others, and is associated with social withdrawal and the suppression of negative affect (Mikulincer \u0026amp; Shaver, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Evidence suggests that anxious and avoidant attachment is associated with both clinical and nonclinical paranoia (Murphy \u0026amp; et al, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Recent studies show that paranoia has a stronger relationship with anxious attachment (Lavin \u0026amp; et al, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); For example, the results of a review study revealed that paranoia was significantly related to anxious attachment and the strength of this relationship did not differ between clinical and non-clinical samples (Murphy \u0026amp; et al, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Whereas, results of a study found a stronger relationship between paranoia and avoidant attachment (Berry, Barrowclough \u0026amp; Wearden, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In another study conducted by Berry et al., anxious and avoidant attachment were related to paranoia and hallucinations in a college student sample (Berry \u0026amp; et al, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). In general, during the last decade, an increasing number of studies have shown the relationship between both dimensions of attachment and paranoia in different samples, including: the general population (Meins \u0026amp; et al ,2008), individuals at high risk for developing psychosis (Russo \u0026amp; et al, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and patients diagnosed with schizophrenia (Strand, Goulding \u0026amp; Tidefors, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInsecure attachment as a non-specific risk factor for psychopathology is related to the tendency to experience shame (Remondi \u0026amp; et al, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Shame is strongly related to early relationships with primary caregivers and occurs in response to perceived rejection or separation from attachment figures (Schore, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Results of one study showed that the mother's critical and negative attitude during a challenging activity at 24 months is related to the experience of shame and avoidance at 36 months (Kelley, Brownell \u0026amp; Campbell, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). A study on 209 college students aged 19 to 24 found a significant relationship between insecure attachment with low self-esteem and high feelings of shame (Passanisi \u0026amp; et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In addition, previous studies demonstrated that insecurely attached individuals are more prone to experience feelings of shame as compared to their securely attached counterparts (Gross and Hansen, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Wei et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). In one study, both the insecure attachment dimensions had significant indirect effects on psychological distress through dispositional shame. Also, shame as a strong emotion predicted aspects of poor psychological functioning (Remondi \u0026amp; et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Shame associated with withdrawal from others is likely to increase paranoia because fears about people's intentions are not revised through interactions with supportive others (Freeman et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). In this regard, some studies have investigated the relationship between shame and paranoia (Gilbert, et al, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Matos, Pinto-Gouveia \u0026amp; Duarte, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Matos et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Mills et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Pinto-Gouveia et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). According to the hierarchical model of paranoia, concerns about social judgment, fear of rejection, feeling of vulnerability, and the perception that the world is dangerous have been conceptualized at the bottom of the paranoia hierarchy (Freeman et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Indeed, early dysfunctional interactions with attachment figures in early life can be organized into internal working models of self as worthless, undesirable, or defective (shame) and others as threatening, powerful, superior, hostile, and judgmental (paranoia) (Matos \u0026amp; Pinto-Gouveia, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Matos, Pinto-Gouveia, \u0026amp; Costa, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eShapiro (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1965\u003c/span\u003e) noted that self-consciousness is often related to paranoia, and suggested that awareness of attention in relation to another person can create feelings of exposure and vulnerability. Humans evolved in a world of scarcity, disease, and injury, that these self-conscious emotions can have adaptive interpersonal functions. The evolutionary roots of human social valuation are key to understanding the self-conscious emotions (Sznycer, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Laing (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1969\u003c/span\u003e) presented suspiciousness as an aspect of self-consciousness. Self-consciousness means focusing on one's thoughts, feelings, and attitudes, which is accompanied by a tendency to focus on observable aspects (self-monitoring). Increased self-focused attention has been shown in most forms of psychopathology (Ingram, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). This heightened awareness of oneself or severe self-consciousness has always been seen as a central trait of paranoia and misleads individuals that they are the center of others' attention (Cameron, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1943\u003c/span\u003e, Fenigstein, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1984\u003c/span\u003e, Greenwald, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1980\u003c/span\u003e, Kraepelin, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1968\u003c/span\u003e, Laing, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1969\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, according to Muris and colleagues (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), there is currently limited evidence supporting a connection between insecure attachment and the dysregulation of self-conscious emotions. Their study indicated that insecure attachment contributes to heightened self- conscious emotion. Lopez et al (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) found, in a sample of 142 undergraduate students (average age of 21 years), that individuals with insecure attachment, particularly those exhibiting an ambivalent style, tend to experience higher levels of shame compared to securely attached individuals. Additionally, Lech, Andersson, and Holmqvists (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) study revealed a correlation between high emotion consciousness and secure attachment, while low emotion consciousness was associated with insecure attachment.\u003c/p\u003e \u003cp\u003eAlthough there is strong evidence that there is a relationship between attachment and paranoia, little is known about the mediating mechanisms of this relationship (Partridge, Maguire \u0026amp; Newman-Taylor, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and we expect shame to play this role.\u003c/p\u003e \u003cp\u003eIt is clear that not all people with an insecure attachment style experience paranoia symptoms and that individual differences play an important role in this process. Therefore, the potential role of moderating variables that can strengthen or weaken this relationship is also important. In the present study, we investigate whether self-consciousness moderates this relationship?\u003c/p\u003e \u003cp\u003eOn the other hand, most research in attachment and paranoia has been completed in Western countries. So another gap in the literature, is to examine these relationships in non-Western cultures.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e \u003cb\u003eParticipants\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe current study used a cross- sectional design. We recruited 331 student of Shahid Beheshti University of Medical Sciences in Iran over a period of three months. Participation was voluntary, and information about the purpose of the study was provided to all participants before obtaining informed consent.\u003c/p\u003e \u003cp\u003eAmong 331 subjects, 182 were women (55%) and 149 were men (45%). The average age of the participants was 25.15 years with a standard deviation of 4.42. Most of the subjects had a professional doctoral education (64%). Inclusion criteria for participants were: informed consent to participate in the process of completing questionnaires, age over 18 years, no history of schizophrenia and mood disorders, no history of delusional disorder, no use of antipsychotic drugs, no use of drugs, learning and mental disabilities, medical or neurological diseases causing symptoms of paranoia. Data analysis was conducted using descriptive statistics, correlation coefficients, and PROCESS Macro.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eParanoia Scale (PS)\u003c/strong\u003e \u003cp\u003eThis scale is a 20-item self-report instrument to assess paranoid beliefs in a sample of college students. The items are scored on a Likert scale from 1 to 5, and the total scores range from 20 to 100, with higher scores indicating higher levels of paranoid beliefs. In their study, the overall Cronbach's alpha was 0.84 and the test-retest reliability was 0.70, as well as the convergent validity of this tool with the items of the MMPI questionnaire was estimated well, and the results of the factor analysis indicated the existence of a general factor (Fenigstein \u0026amp; Vanable, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1992\u003c/span\u003e). In the present study, Cronbach's alpha of the whole scale was 0.89.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRelationship Scales Questionnaire (RSQ)\u003c/strong\u003e \u003cp\u003eThis questionnaire was designed by Griffin and Bartholomew (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1994\u003c/span\u003e) to determine the attachment styles of adults and has 30 statements. The scores of each style are determined after averaging the sum of the scores in each subscale. In Kurdek et al.'s (2002) study, Cronbach's alpha was obtained for the two subscales of anxiety and avoidance, (0/83) and (0/77) respectively. The results of confirmatory factor analysis of RSQ in a sample of Iranian students were also consistent with the results of other studies, and the two-factor model with the best fit was reported. Also, Cronbach's alpha of the two dimensions of anxiety and avoidance was 0.86 and 0.64, respectively (Amini Fasakhoudi \u0026amp; Bakhshipour Roudsari, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInternal and External Shame Scale (EISS)\u003c/strong\u003e \u003cp\u003eIn the study of Ferreira et al (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) an internal and external shame scale was developed to evaluate these two dimensions. This study was conducted in a sample including 665 participants (18 to 61 years old). Three models were tested through confirmatory factor analysis. A higher order factor (global shame) with two lower order factors (external and internal shame) showed a good fit with the data. Also, the results indicated that the subscales of EISS and global shame have good internal consistency and concurrent validity of the scale with depressive symptoms was obtained. In the present study, Cronbach's alpha of the whole scale and the internal and external shame subscales were obtained 0/88, 0/73, and 0/70, respectively.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf-Consciousness scale (SCS)\u003c/b\u003e: The self-consciousness scale consists of 23 statements and the results of the factor analysis of the initial version showed three subscales: private, public and social anxiety. The original study sample included 668 undergraduate students. In this study, the test-retest reliability for the three subscales and the total scale were 0.79, 0.84, 0.73, and 0.80, respectively. Also, the validity of the tool has been reported as high, and the results indicated that public self- consciousness has a moderate relationship with private self-consciousness and social anxiety, while the relationship between private self- consciousness and social anxiety fluctuated around zero (Fenigstein et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1975\u003c/span\u003e). In the present study, Cronbach's alpha coefficient for the total of scale was 0.79 and for the private, public and social anxiety subscales, were 0.71, 0.58 and 0.72, respectively.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eFirst, descriptive statistics indices and correlation matrix between variables were calculated. Moderated mediation analysis was performed using PROCESS Macro version 4.2, model 5 (Hayes's, 2022). All continuous variables were converted to standard scores and the mediating and moderating effects were calculated based on these standardized scores. The bootstrapping method was used to estimate the significance of the parameters, which was conducted with 95% confidence intervals and 1000 re-sampling of the data. Confidence intervals that do not include zero indicate the significance of the effects.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMean, standard deviation, and correlations between research variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. As expected, both insecure attachment styles were positively correlated with paranoia. Also, shame and self-consciousness showed a positive relationship with paranoia.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean (M), standard deviation (SD), and correlations of the variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.Avoidant attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.Anxious attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.286\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.Shame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.308\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.405\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.Self-consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.185\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.213\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.334\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.Paranoia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.353\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.387\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.466\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.335\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMediation analysis showed that avoidant attachment had an effect on shame with a standardized coefficient of β\u0026thinsp;=\u0026thinsp;.308, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. Shame had an effect on paranoia with a standardized coefficient of β\u0026thinsp;=\u0026thinsp;.350, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. The direct effect of avoidant attachment on paranoia was also significant with the standard coefficient β\u0026thinsp;=\u0026thinsp;.257, p\u0026thinsp;\u0026lt;\u0026thinsp;.001 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The bias-corrected percentile bootstrap method showed that the indirect effect of avoidant attachment on paranoia is significant through the mediation of shame β\u0026thinsp;=\u0026thinsp;.108, SE\u0026thinsp;=\u0026thinsp;.026, 95% CI = [.061, .162].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe moderated mediation effect analysis of avoidant attachment on Paranoia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMediator: Shame\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eOutcome: Paranoia\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoidant attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoidant attachment \u0026times; Self-consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e34.43 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e40.58 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: SE, standard error\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the model related to anxious attachment, the analysis showed that anxious attachment had an effect on shame with a standard coefficient of β\u0026thinsp;=\u0026thinsp;.405, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. Shame had an effect on paranoia with a standardized coefficient of β\u0026thinsp;=\u0026thinsp;.307, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. The direct effect of anxious attachment on paranoia was also significant with the standard coefficient β\u0026thinsp;=\u0026thinsp;.222, p\u0026thinsp;\u0026lt;\u0026thinsp;.001 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The bias-corrected percentile bootstrap method showed that the indirect effect of anxious attachment on paranoia was significant through the mediation of shame β\u0026thinsp;=\u0026thinsp;.124, SE\u0026thinsp;=\u0026thinsp;.025, 95% CI = [.079, .182].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe moderated mediation effect analysis of anxious attachment on Paranoia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMediator: Shame\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eOutcome: Paranoia\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxious attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxious attachment \u0026times; Self-consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e64.40 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e36.11 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: SE, standard error\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eModeration analysis was used to estimate the interactive effect of self- consciousness and insecure attachment on paranoia. The results showed that the interactive effect of self-consciousness and avoidant attachment on paranoia is significant (β = \u0026minus;\u0026thinsp;.191, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Also, the interactive effect of self-consciousness and anxious attachment on paranoia symptoms is significant (β = \u0026minus;\u0026thinsp;.106, p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e \u003cp\u003eIn order to visually display the interactive effects of self-consciousness and insecure attachment, simple slopes analysis was used. These graphs show the magnitude of the effect of insecure attachment style on paranoia symptoms according to different levels of self-consciousness. Different levels of the moderator variable (self-consciousness) were calculated as follows: 1) low level: one standard deviation smaller than the mean, 2) medium level: equal to the mean and 3) high level: one standard deviation larger than the mean.\u003c/p\u003e \u003cp\u003eSimple slopes analysis showed that avoidant attachment had a positive effect on paranoia at low (β\u0026thinsp;=\u0026thinsp;.444, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and medium (β\u0026thinsp;=\u0026thinsp;.246, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) levels of self-consciousness, but its effect on paranoia was not significant in high level of self-consciousness (β\u0026thinsp;=\u0026thinsp;.068, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). These results revealed that in people who had a high level of self-consciousness, the relationship between avoidant attachment style and paranoia was weaker. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAnalysis of simple slopes for anxious attachment was almost similar. The results showed that anxious attachment had a positive effect on paranoia at a low (β\u0026thinsp;=\u0026thinsp;.325, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and medium (β\u0026thinsp;=\u0026thinsp;.216, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) level of self-consciousness, but its effect on paranoia was not significant at a high level self-consciousness (β\u0026thinsp;=\u0026thinsp;.117, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). These results revealed that in people who had a high level of self-consciousness, the relationship between anxious attachment style and paranoia was weaker (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of the present study in a sample of university students revealed that there is a significant relationship between anxious and avoidant attachment and paranoia. This result consistent with the results of previous studies, showed that insecure attachment styles are a risk factor for experiencing paranoia in clinical and non-clinical populations (Pickeringa \u0026amp; et al., 2008; Sitko \u0026amp; et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Wickham \u0026amp; et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Hutton \u0026amp; et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Sood \u0026amp; Newman-Taylor, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Murphy et al, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lavin et al., 2019).\u003c/p\u003e \u003cp\u003eBased on the two-dimensional model of Bartholomew (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1990\u003c/span\u003e), people with an avoidant style due to having a positive view of themselves and a negative view of others, reduce their negative feelings through emotion regulation strategies such as withdrawal and avoidance. On the other hand, both social withdrawal and negative beliefs about others are also implicated in paranoia. Therefore, this attachment style may play a role in the development or maintenance of paranoia (Freeman et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). According to Cassidy (1994), these people avoid intimate relationships with others due to previous learning related to primary attachment figures so that the experience of rejection, abandonment, loss and punishment does not repeat (Mikulincer \u0026amp; Shaver, 2007). In contrast, negative self-views are characteristic of anxious attachment and thus may cause individuals to perceive themselves as increasingly vulnerable, which can ultimately increase feelings of threat and harm from others (Freeman et al., 2014). These representations of insecure attachment figures lead to low self-esteem, which can trigger paranoid thinking (Freeman et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this regard, our findings also revealed that insecure attachment has an effect on paranoia through the mediation of shame. This result is in line with the results of other studies regarding the relationship between shame with paranoia and attachment (Freeman et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Gilbert et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Matos, Pinto-Gouveia \u0026amp; Duarte, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Matos, Pinto-Gouveia, \u0026amp; Gilbert, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Mills et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Pinto-Gouveia et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Passanisi \u0026amp; et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Remondi \u0026amp; et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, the result of our study showed that self-consciousness could moderate this relationship and reduced the effect of insecure attachment on paranoia. To date, this study is the first to discover these relationships. According the bio-psycho-social model, shame is a self-conscious emotion that arises in competition for social attractiveness, and emerging from our evolved cognitive competences for processing social and self-information (Gilbert, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Thus, shame evolved as a defensive strategy to keep oneself safe from potential attacks (e.g., punishment, rejection and criticism) from others. This experience of seeing the other as a threat to the self and the self-identity can trigger two major defenses: one is the shaming response, when the individual adopts a strategy associated with self-devaluation and self-criticism and another is the humiliating response, when the individual displays dominant and aggressive behaviors, e.g., anger (Gilbert, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1998\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). In addition to, individuals who have more trait-anger and express it, tend to have more paranoid beliefs. Overall, individuals with difficulties in controlling the feelings of own anger also tend to have more paranoid beliefs. In fact, both the shame response and the anger response are related to paranoia.\u003c/p\u003e \u003cp\u003eAs mentioned in the introduction of the study, the pathological root of shame may be related to the attachment experiences of individuals in childhood, which are formed in response to rejection and separations early in life in relation to primary caregivers (Passanisi \u0026amp; et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Schore, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e1998\u003c/span\u003e; Mikulincer \u0026amp; Shaver, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Remondi \u0026amp; et al, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Adults with a secure attachment style are able to manage the emotion of shame because of their experience with primary responsive caregivers. On the contrary, an anxious or avoidant attachment pattern that is created as a result of unreliability or unavailability of primary caregivers are unable to effectively regulate own emotions (Main \u0026amp; Hesse, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). Tangney (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e1993\u003c/span\u003e) suggested that shame is often regulated by avoidant techniques such as a desire to hide or escape, which fits with the withdrawal definition. Therefore, was identified why this is the most common maladaptive shame coping style for individuals with an avoidant attachment style. Whereas, an anxious style is characterized by a tendency to exaggerate negative emotions such as shame, which can be seen as an attempt to portray oneself as a bad self. Indeed, an anxious style can regulate emotion by sustaining negative emotions or engaging in negative self-evaluations. This is style that designed to elicit help from others for regulating emotion. These traits may increase a person\u0026rsquo;s shame proneness (Mikulincer \u0026amp; Shaver, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNow we turn to the question that in our study, how self-consciousness as a protective factor moderates the destructive effect of insecure attachment on paranoia? While previous studies indicate a positive relationship between self- consciousness and paranoia (Shapiro, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1965\u003c/span\u003e; Cameron, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1943\u003c/span\u003e, Fenigstein, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1984\u003c/span\u003e, Greenwald, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1980\u003c/span\u003e, Kraepelin, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1968\u003c/span\u003e, Laing, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1969\u003c/span\u003e). By recalling that suspiciousness may be the paramount characteristic of paranoia, one may readily draw parallels between self-consciousness and paranoia. Laing asserted, when individuals have an increased awareness of themselves in the presence of others, this may distort their perception such that they believe their minds are susceptible to the influence of others (Laing, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1969\u003c/span\u003e). Over perception of self is a bias common in paranoia, and occurs when people overestimate their role in an incident (Greenwald, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1980\u003c/span\u003e). As Ingram (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1990\u003c/span\u003e) stated, heightened self-focused attention has been shown in most forms of psychopathology.\u003c/p\u003e \u003cp\u003eIn the findings section, different levels of self-consciousness (low, medium and high) had different effects as moderators on paranoia. In other words, in people with high self-consciousness, the effect of anxious and avoidant attachment on the experience of paranoia was moderated and reduced, and in contrast, in people with low self-consciousness, the effect of both anxious and avoidant styles on paranoia was moderated and increased. Whereas, both self-consciousness and insecure attachment alone have a significant positive effect on paranoia. In the possible explanation of this exploratory finding it can be said that, People with higher self-consciousness have more self-monitoring; because they are more aware of their thoughts and emotions. In the avoidant style, this awareness gives the individual insight into own negative view of others that can control own emotions and thoughts in interpersonal relationships and experience less anger. In contrast, in the anxious style, this awareness gives the individual insight to manage their emotions of shame and guilt in relation to others. On the other hand, in the avoidance style, low self-consciousness causes people to have little insight into their negative thoughts and emotions towards others, and their negative view towards others increases. This in turn can be linked to the development and maintenance of paranoid thoughts. Also, in the anxious style, low self-consciousness causes people to have little insight into their own negative thoughts and emotions. As a result, they imagine that others will reject them and persecutory them because of their weaknesses.\u003c/p\u003e \u003cp\u003eOverall, evidence regarding the relationship between insecure attachment and self-consciousness is still in its infancy (e.g., Morris et al., 2014; Lech \u0026amp; et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Findings of our study indicated the existence of a positive and significant relationship between self-consciousness and attachment styles with paranoia\u003c/p\u003e \u003cp\u003eMeanwhile, evolutionary roots suggest that self-conscious emotions have interpersonal adaptive functions. Self-conscious emotions would have evolved as solutions to some adaptive problems related to social valuation. It seems that conscious emotions are adaptive strategies for processing information obtained by natural selection. Because they helped our human ancestors to resolve challenges and opportunities associated with social valuing in favor of their own well-being or that of others (Sznycer, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Therefore, it makes sense to consider self-consciousness as an evolutionary solution to self-observation of one's thoughts, emotions, and internal states, leading to insight into one's positive or negative view of oneself and others. On the other hand, as mentioned earlier, heightened self-consciousness is seen as a central feature of paranoia (Cameron, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1943\u003c/span\u003e, Fenigstein, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1984\u003c/span\u003e, Greenwald, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1980\u003c/span\u003e, Kraepelin, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1968\u003c/span\u003e, Laing, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1969\u003c/span\u003e). Are these views inconsistent with our findings? Since the sample of the present study was a non-clinical sample, it is obvious that the hypothesized levels of high self-consciousness is not extreme compared to clinical samples. So, this level of self-consciousness can moderate the relationship between insecure attachment and paranoia and act as a buffering.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study contributes to the research literature by establishing a moderated mediation model. Our findings highlight the importance of identifying mechanisms that underlie mediating and moderating pathways between insecure attachment and paranoia in nonclinical populations. In this way, shame intensified the effect of attachment on paranoia, and on the contrary, self-consciousness weakened this effect. These findings suggest that although self-consciousness and shame can each contribute to the formation and maintenance of paranoia, their interaction in the same relationship can produce different outcomes.\u003c/p\u003e"},{"header":"Limitations and suggestions","content":"\u003cp\u003eAs an exploratory and novel finding, these results need to be replicated before definitive conclusions can be drawn. Also, the participants in this study were students; therefore, the representation of the sample for other groups is limited, and the study should be replicated with general population, analogue and clinical samples. Perhaps if our findings are replicated with a clinical sample, we may be able to assess and target shame and self-consciousness in psychological treatments for paranoia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics committee of the Shahid Beheshti University of Medical Science first approved this study (Approval ID: IR.SBMU.RETECH.REC.1402.392), and the participants provided their written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the first author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential competing interests was reported by the author(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present article is financially supported by Taleghani Hospital Research Development Unit, School of Medicine, Shahid Beheshti University of Medical Sciences (Grant No 43003172).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMA-F\u003c/strong\u003e: Conceptualization, Methodology, Project administration, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eHK\u003c/strong\u003e: Conceptualization, Methodology, Formal analysis, Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eAM-A\u003c/strong\u003e: Conceptualization, Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eHDAV\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eASK\u003c/strong\u003e: Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Katherine Newman-Taylor for comments on an earlier draft. 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Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: The mediating role of negative self-esteem. \u003cem\u003ePsychological Medicine\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e, 1495\u0026ndash;1507.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxious attachment, Avoidant attachment, Paranoia, Shame, and Self- consciousness","lastPublishedDoi":"10.21203/rs.3.rs-4007007/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4007007/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEarly life experiences increase vulnerability to paranoid thoughts, and attachment theory has been used as a conceptual framework to explain this causal pathway. The purpose of this study was to identify and highlight the mediating and moderating mechanisms in the relationship between attachment styles and paranoia in a non-clinical sample.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe current research was a cross-sectional design. A sample of 331 university students was collected by available and online sampling at a period of 3 months. They completed the Paranoia scale (PS), Relationship scales questionnaire (RSQ), Internal and External Shame Scale (EISS), and Self-consciousness scale (SCS). Data analysis was conducted using descriptive statistics, correlation coefficients, and Process Macro.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results showed that avoidant and anxious attachment was related to paranoia and shame mediates this relationship. On the other hand, self-consciousness as a buffering moderated and weakened the relationship between attachment and paranoia.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe present study provided preliminary evidence for the mediating and moderating roles of shame and self-consciousness in the relationship between attachment and paranoia.\u003c/p\u003e","manuscriptTitle":"The role of shame and self-consciousness in the relationship between attachment and paranoia in an Iranian sample: A moderated mediation analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-07 11:33:09","doi":"10.21203/rs.3.rs-4007007/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6cb311ee-0920-4502-a696-7664cdad3676","owner":[],"postedDate":"March 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-22T07:22:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-07 11:33:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4007007","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4007007","identity":"rs-4007007","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}