دانشگاه پیام نور روانشناسی سلامت 2322-1283 مقالات آماده انتشار 2026 06 18 The Structural Model of Health Anxiety based on Early Maladaptive Schemas, Health-Related Metacognition, Cognitive Attentional Syndrome, Emotion Dysregulation and Cyberchondria مدل ساختاری اضطراب سلامت بر اساس طرحواره‌های ناسازگار، فراشناخت‌های مرتبط با سلامت، سندرم شناختی توجهی، بدتنطیمی هیجان و سایبرکندریا 7 26 12783 10.30473/hpj.2026.74980.6271 FA سمانه قدمپور دانشکده ادبیات و علوم انسانی، دانشگاه لرستان، خرم آباد، ایران کوروش امرایی گروه روانشناسی، دانشکده ادبیات و علوم انسانی، دانشگاه لرستان، خرم آباد، ایران مسعود صادقی گروه روانشناسی، دانشکده ادبیات و علوم انسانی، دانشگاه لرستان، خرم آباد، ایران Journal Article 2025 07 03 <strong>Objective:</strong> 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. <strong>Method: </strong>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. <strong>Results:</strong> 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.<strong>Conclusion: </strong>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.<br />  <strong>مقدمه:</strong> اضطراب سلامت وضعیتی است که فرد به دلیل تفسیر نادرست از احساسات بدنی تجربه می‌کند. هدف پژوهش بررسی مدل ساختاری اضطراب سلامت بر­ اساس طرحواره­ها و میانجی‌گری باورهای فراشناختی مرتبط با سلامت، سندرم شناختی­توجهی، بدتنظیمی هیجان و سایبرکندریا بود.<br /><strong>روش:</strong> پژوهش حاضر با استفاده از مدل‌سازی معادلات ساختاری روی نمونه 310 نفری از زنان 18 تا 55 ساله دارای اضطراب سلامت انجام گرفت و آزمودنی‌ها پرسشنامه‌های اضطراب سلامت سالکوسکیس و همکاران (2002)، فرم کوتاه پرسشنامه طرحواره­­ یانگ (2005)، فراشناخت­های مرتبط با سلامت بیلی و ولز (2015)، سندرم شناختی­توجهی ولز (2009)، بدتنظیمی هیجان بیوربرگ و همکاران (2016) و سایبرکندریا مک ارولی و همکاران (۲۰۱۹) را تکمیل نمودند. مدل مفهومی پژوهش با روش مدل­یابی معادلات ساختاری با بکارگیری نرم­افزارهای لیزرل80/8 و ام پلاس 4/7 مورد آزمون قرار گرفت.<br /><strong>یافته‌ها:</strong> نتایج شاخص‌های برازش نشان داد مدل ساختاری پژوهش به خوبی با داده‌های تجربی مطابقت دارد و طرحوارة خودانضباطی ناکافی به­صورت مستقیم و معکوس  (01/0 <strong><</strong>p) و متغیرهای میانجی باورهای فراشناختی مرتبط با سلامت، سندرم شناختی­توجهی و سایبرکندریا بصورت مستقیم با اضطراب سلامت رابطه معنادار دارند (001/0 <strong><</strong>p). همچنین طرحوارة آسیب­پذیری به ضرر و بیماری بصورت غیرمستقیم از طریق متغیرهای میانجی باورهای فراشناختی مرتبط با سلامت، سندرم شناختی­توجهی و سایبرکندریا بر اضطراب سلامت تاثیر می‌گذارند (001/0 <strong><</strong>p).<br /><strong>نتیجه‌گیری:</strong> نتایج پژوهش نشان داد طرحواره­های خودانضباطی ناکافی و آسیب­پذیری به ضرر و بیماری، فرد را نسبت به اضطراب سلامت آسیب‌پذیر می‌کنند. اما این رابطه همیشه مستقیم نیست و عوامل واسطه‌ای مثل فراشناخت‌های مرتبط با سلامت، سندرم شناختی­توجهی و سایبرکندریا نقش مهمی در انتقال اثر این ویژگی‌ها به اضطراب سلامت دارند. https://hpj.journals.pnu.ac.ir/article_12783_9333903a4fca7dc7ec9a90396e5bf719.pdf