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Samane Ghadampour; Kourosh Amraei; Masoud Sadeghi
Abstract
Objective: Health anxiety, characterized by excessive worry about having a serious illness, leads to significant functional impairment. Its etiology involves complex cognitive-emotional mechanisms. This study proposes and tests a novel integrated mediation model to elucidate these pathways. We posit ...
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Objective: Health anxiety, characterized by excessive worry about having a serious illness, leads to significant functional impairment. Its etiology involves complex cognitive-emotional mechanisms. This study proposes and tests a novel integrated mediation model to elucidate these pathways. We posit that Early Maladaptive Schemas (EMS)-deep-seated cognitive structures-predispose individuals to dysfunctional health interpretations. Building on schema and metacognitive theories, we hypothesize that EMS activate specific health-related metacognitive beliefs. These beliefs, in turn, are central in initiating maladaptive cognitive processes encapsulated by the Cognitive-Attentional Syndrome (CAS), which includes persistent worry, threat monitoring, and counterproductive coping, and its behavioral manifestation in online health-seeking, known as cyberchondria. Concurrently, emotion dysregulation is theorized to interact with and exacerbate these cognitive pathways, creating a vicious cycle that maintains health anxiety. The primary aim is to examine both direct and indirect associations between EMS and health anxiety, with health-related metacognitive beliefs, CAS, cyberchondria, and emotion dysregulation serving as sequential and parallel mediating variables. Testing this comprehensive model provides a holistic etiological framework for health anxiety, integrating predisposing vulnerabilities with maintaining factors. Confirmation of these pathways holds significant clinical implications, suggesting that effective interventions should target not only surface-level worries but also the underlying schemas,metacognitive beliefs, attentional processes, and emotion regulation strategies that perpetuate this debilitating condition. Method: This study employed a cross-sectional correlational design to examine the proposed model. The target population consisted of all single and married women aged 18 to 55 years in Tehran, Iran, with a clinically confirmed diagnosis of health anxiety, who had attended specialized or pain clinics at Shariati and Imam Khomeini Hospitals during the 2024 calendar year. A convenience sampling method was used to recruit an initial pool of 310 eligible participants. Following a comprehensive data screening procedure, which included checks for unengaged responding and multivariate outliers, data from 259 participants were retained for the final analysis, ensuring robust data quality. Participants completed a battery of validated self-report questionnaires, including: the Health Anxiety Inventory (HAI), the Schema Questionnaire—Short Form (YSQ-S3; Young, 2005), the Health-related Metacognitions Questionnaire (H-MCQ; Bailey & Wells, 2015), the Cognitive-Attentional Syndrome Scale (CAS-1; Wells., 2009), the Difficulties in Emotion Regulation Scale (DERS; Bjureberg et al,2016) and the Cyberchondria Severity Scale (McElroy et al., 2019). The hypothesized conceptual model, positing both direct and indirect pathways between early maladaptive schemas and health anxiety via multiple mediators, was tested using structural equation modeling (SEM). The analyses were conducted using two specialized statistical software packages, LISREL (version 8.80) and Mplus (version 7.4), to ensure the reliability and validity of the model fit indices and parameter estimates. Ethical approval for the study was obtained prior to data collection. Results: The structural equation modeling analysis revealed a differentiated pattern of significant and non-significant pathways within the hypothesized model. The following direct paths were not statistically significant: from the Vulnerability to Harm/Illness schema to Health Anxiety; from the Negativity/Pessimism schema to the Cognitive-Attentional Syndrome (CAS), Cyberchondria, and Health Anxiety; from the Insufficient Self-Control/Self-Discipline schema to CAS; and from Emotion Dysregulation to Health Anxiety. All other specified paths demonstrated significant coefficients. Regarding direct effects, the Vulnerability to Harm/Illness schema exerted significant, strong positive effects on Health-related Metacognitive Beliefs (β=0.59), CAS (β=0.68), Emotion Dysregulation (β=0.43), and Cyberchondria (β=0.72). The Negativity/Pessimism schema had significant, moderate positive effects on Metacognitive Beliefs (β=0.29) and Emotion Dysregulation (β=0.21). Conversely, the Insufficient Self-Control/Self-Discipline schema showed a significant but weak negative direct effect on Health Anxiety (β=-0.14), as well as negative effects on Metacognitive Beliefs (β=-0.14) and Cyberchondria (β=-0.13),alongside a positive effect on Emotion Dysregulation (β=0.21). Crucially, the mediating variables-Health-related Metacognitive Beliefs (β=0.33), CAS (β=0.25), and Cyberchondria (β=0.39)-all had significant positive direct effects on Health Anxiety. Analysis of indirect effects using bootstrapping was pivotal. For the Vulnerability to Harm/Illness schema, all specific indirect pathways to Health Anxiety were significant: via Metacognitive Beliefs (β=.194), via CAS (β=.168), and via Cyberchondria (β=.277), resulting in a significant total indirect effect (β=.640). In stark contrast, for the Negativity/Pessimism schema, none of the specific indirect pathways (via Metacognitive Beliefs: β=.096; via CAS: β=.009; via Cyberchondria: β = .030) nor the total indirect effect (β=.135) reached statistical significance. Similarly, for the Insufficient Self-Control schema, all specific indirect paths and the total indirect effect (β=-.069) were non-significant.Conclusion: This study provides evidence for a model of health anxiety, elucidating the pathways through which early maladaptive schemas contribute to the disorder. The findings demonstrate a direct effect of the insufficient self-control schema and an indirect effect of the vulnerability to harm schema, mediated by metacognitive processes and cyberchondria. These results advance our understanding of the underlying mechanisms of health anxiety.The results indicate that health anxiety is not a linear outcome of schema activation but rather the end product of a complex cognitive chain. Schemas require specific mediating factors namely, dysfunctional metacognitive beliefs and cyberchondric behaviors to manifest as clinical health anxiety symptoms. Consequently, therapeutic interventions for health anxiety, particularly in individuals with these schemas, should prioritize restructuring maladaptive metacognitive beliefs, modifying attentional biases, and reducing excessive online health-seeking behaviors (cyberchondria). Targeting these mediating processes is crucial for mitigating the influence of core cognitive schemas on the development and maintenance of health anxiety.
A
gholam reza manshaei; Farzaneh Bagherian
Abstract
Objective: In today's world, the Internet has become a very important and vital part of our lives. One of the harmful effects of excessive use of the Internet in relation to health is cyberchondria. This related to an increase in the level of anxiety or health distress, and in other words, it is a type ...
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Objective: In today's world, the Internet has become a very important and vital part of our lives. One of the harmful effects of excessive use of the Internet in relation to health is cyberchondria. This related to an increase in the level of anxiety or health distress, and in other words, it is a type of anxiety that leads to searching for health-related information online, and this causes an increase in the level of anxiety, worry and unnecessary expenses. The aim of this study was to investigate the Psychometric properties of the short form of Cyberchondria questionnaire. Method: The present study applied in terms of purpose and its method is descriptive and psychometric studies. The statistical population of the present study was students of public and private universities in Isfahan in 1398. For the present study, 566 students (344 females and 223 males) from Isfahan University students selected by stratified random sampling method using virtual self-examination questionnaires (McElroy and Shevlin, 2014) and health anxiety questionnaire. (Salkovskis and Warwick, 2002) responded. Research data analyzed using SPSS 23 and AMOS 22 software. Results: The findings showed that in the virtual Cyberchondria questionnaire measurement model, all factor loads including compulsion (0.714), distress (0.878), excessiveness (0.805), and reassurance (0.921) were significant. (P <0.001). In addition, the CVI coefficient for all items of the Cyberchondria questionnaire was higher than 0.9 and the intra-class correlation coefficient of the questionnaire resulting from its two implementation was equal to 0.971, which is at a safe distance and is higher than the acceptable value. The reliability obtained using Cronbach's alpha and halving coefficient for the whole questionnaire and all four dimensions is higher than 0.7. The findings also showed that there was a positive and significant relationship between Cyberchondria questionnaire and health anxiety (P <0.001) and the correlation coefficient of the two questionnaires was 0.782. Conclusion: Health-related internet use, in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. In general, according to the results of validity and reliability, the virtual autopsy questionnaire can used in psychological research. Also, these results support the psychometric characteristics and validity of the virtual self-diagnosis questionnaire among the non-clinical sample, and it can be said that this questionnaire is approved in the Iranian sample and has psychometric characteristics and practical tools for diagnosis. It can also used in a short period of time due to the short length of the too
Asghar Fouladi; Ali khademi; Ali Shaker Dioulagh
Abstract
Objective: Nurses are more often exposed to cyberchondria owing to their frequent contact with patients. Thus, the present study was carried out to compare the effectiveness of metacognitive and compassion therapies on the level of cyberchondria symptoms in nurses. Method: The research utilized an experimental ...
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Objective: Nurses are more often exposed to cyberchondria owing to their frequent contact with patients. Thus, the present study was carried out to compare the effectiveness of metacognitive and compassion therapies on the level of cyberchondria symptoms in nurses. Method: The research utilized an experimental method involving a pre-test, post-test and follow-up design. As for the sample size, 60 nurses from hospitals in Tabriz participated in the research in 2022. Through random selection, the nurses were assigned to three groups, i.e. metacognitive therapy, compassion therapy and control group. McLurry and Shevlin’s Cyberchondria Scale (CSS) was employed for data collection. Next, the researchers carried out data analysis with the use of the mixed analysis of variance model, Tukey's and Benferroni's post hoc tests, using SPSS statistical software (version 22). A significant P value of less than 0.05 was observed. Findings: The time factor proved to have a significant impact on the amount of cyberchondria dimensions. In other words, the level of cyberchondria dimensions decreased from pre-test to follow-up. Moreover, the interaction effect of time and group also revealed that there were significant variations among the three groups (i.e. metacognitive therapy group, compassion therapy group and control group) in terms of compulsion, distress, excessiveness and reassurance. In other words, the level of cyberchondria dimensions in the intervention groups was lower than that of the control group in the post-test and the follow-up phases. Conclusion: Given the effectiveness of metacognitive and compassion therapies on cyberchondria symptoms, it seems that the application of metacognitive therapy and compassion therapy interventions will alleviate and treat cyberchondria symptoms in nurses.
