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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.
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Pourandokht Niroumand; Mahnaz Aliakbari Dehkordi; Nazanin Abed; Ahmad Alipour
Abstract
Objective: Intimacy is conceptualized as the capacity for self-awareness in the presence of others, driven by a motivation to cultivate meaningful social integration. Given its pivotal role in psychological well-being, this study aims to elucidate the lived experiences of intimacy among resilient ...
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Objective: Intimacy is conceptualized as the capacity for self-awareness in the presence of others, driven by a motivation to cultivate meaningful social integration. Given its pivotal role in psychological well-being, this study aims to elucidate the lived experiences of intimacy among resilient Iranian women who have recovered from COVID-19. Method: Employing a descriptive phenomenological approach, Data were collected through semi-structured interviews with 12 Iranian women after reaching theoretical saturation. The purposive sampling method is criterion-based to select individuals who have real-life experience with the phenomenon in question. Participants were women who had recovered from COVID-19 and scored above 85 on the SPF-24 resilience scale. Interview transcripts were analyzed using Colaizzi’s seven-step method include Familiarization, identifying significant statements, formulating meanings, clustering themes, Developing an Exhaustive description, Producing the fundamental structure, and Seeking verification of the fundamental structure. Results: The participants conceptualized intimacy through three main themes—deep emotional connection, intimate physical and sexual interaction, and mutual understanding and coordination in daily matters—along with nine subthemes and 95 initial codes. They employed strategies such as conflict management and problem-solving, maintaining individual autonomy within the relationship, adaptability to change, balancing work and life, social support, strengthening spirituality and shared values, humor, and recreational activities. These strategies contributed to outcomes including marital satisfaction, trust and empathy, personal autonomy and empowerment, high-quality sexual relations, effective conflict resolution, joint decision-making, psychological security, a positive environment for children's development, happiness, and overall life satisfaction. To verify the reliability of the analysis process, the Holst reliability coefficient, which is a formula for determining the reliability of nominal data in terms of the percentage of agreement observed between the main researcher and another coding researcher, was used. PAO (Percentage Agreement over Observations) For the first theme (deep emotional connection), it is 0.864, for the second theme (intimate physical and sexual interaction), it is 0.883, and for the third theme (mutual understanding and coordination in daily), it is 0.865 and for all three themes of this study, it is 0.870, which confirmed the reliability of the analysis process.Conclusion: The results of the lived experiences of the meaning of intimacy of resilient Iranian women recovered from Corona in three subjects: 1) Deep Emotional Connection, comprising subthemes of emotional security, empathy and mutual understanding, and trust and honesty;2) intimate physical and sexual interaction comprising subthemes of satisfying and reciprocal sexual relations, affectionate and non-sexual touches, and maintaining personal and physical dignity and boundaries and 3) mutual understanding and coordination in daily matters including three sub-themes: cooperation in home and family affairs, effective interaction in decision-making, and effective conflict resolution indicative three type of intimacy is their emotional, sexual, understanding, and empathy. These findings can be used to empower therapists and couples therapy researchers and teaching marital relationship strategies used by these women, including constructive problem-oriented and emotion-oriented strategies such as "conflict management and problem solving" and "maintaining individual independence in the relationship", marital satisfaction, trust and empathy, personal independence and empowerment, quality sexual relationships, and a positive environment for children to grow.
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MohammadReza Tamannaeifar; Mahboobe Esmikhani
Abstract
Objective: Body dysmorphic disorder is a perceptual disorder in which a person is preoccupied with one or more parts of their body that they perceive as particularly ugly or misshapen. Women with body dysmorphic disorder are intensely concerned with their breasts, buttocks, thighs, and overall weight. ...
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Objective: Body dysmorphic disorder is a perceptual disorder in which a person is preoccupied with one or more parts of their body that they perceive as particularly ugly or misshapen. Women with body dysmorphic disorder are intensely concerned with their breasts, buttocks, thighs, and overall weight. The obsessive nature of body dysmorphic disorder can cause a person to experience repeated negative feelings and discomfort about their appearance and how others perceive them, and an overall decrease in psychological and social functioning. For example, people with body dysmorphic disorder may engage in self-checking activities, such as repeatedly looking at themselves in the mirror to assess the area(s) of concern and comparing their appearance to that of others. Body dysmorphic disorder concerns (or symptoms related to body dysmorphic disorder) are distressing and can cause significant suffering and are influenced by various factors, one of which is primary maladaptive schemas. Early maladaptive schemas serve as a framework for interpreting reality that provides a stable and coherent sense of self and the world. It is clear that early maladaptive schemas are associated with body dysmorphic disorder, but what could be important is to discover and examine the role of mediating variables in the relationship between early maladaptive schemas and body dysmorphic disorder, which in this study examined the mediating role of self-esteem, because self-esteem, in addition to being affected by the antecedents of this study, namely early maladaptive schemas, can affect dysmorphic disorder. For this reason, and based on research precedents, self-esteem can be an appropriate mediating variable in the relationshis between the variables in this study. The purpose of the present study was to investigate structural equation modeling of the body dysmorphic disorder based on early maladaptive schemas with mediating role of self-esteem in women with breast cancer. Method: The method of the present research is applied in terms of its purpose and descriptive in terms of survey type, which is considered quantitative research. The statistical population of the study was women with breast cancer referral to the oncology center of Imam Khomeini and Imam Hussein Hospital of Tehran city in autumn year 2024. The sample size was selected based on Klein's model (2023) and with subjectivw sampling of 300 women. Data collection tools include the body dysmorphic disorder scale (BDDS) of Hanley and et al (2020), Young schema questionnaire – short form version 3 (YSQ-S3) of Young (2005) and self-esteem scale (RSEs) of Rosenberg (1989). The inclusion criteria for the study were diagnosis of breast cancer, being in the radiotherapy treatment phase, having a minimum level of literacy, full consent to participate in the study, the right to withdraw from the study, having sufficient time to answer the questionnaires, and not receiving psychiatric treatment. Failure to fully answer the questionnaire questions and not having the necessary cooperation to participate in the study were exclusion criteria. For descriptive data analysis, mean and standard deviation were used; for inferential data analysis, Pearson correlation coefficient and structural equation modeling were used. Data analysis software was SPSS and AMOS version 28. Results: The number of respondents was 300, and no outliers or outliers were identified in this study. The mean age and standard deviation were 37.33 and 2.92, respectively. The results showed direct effect of early maladaptive schemas and self-esteem on body dysmorphic disorder is significant. The results also showed that self-esteem has a significant mediating role in the relationship between early maladaptive schemas with body dysmorphic disorder. Also, the final research model had a good fit (RMSEA=0.07, SRMR=0.05, p<0.05) and 84% of the variance of body dysmorphic disorder is explained. Conclusion: In explaining the mediating role of self-esteem in the relationship between early maladaptive schemas and dysmorphic disorder, it can be said that when a person experiences changes in their appearance and body due to illness and considers these changes to be a kind of defect in them, they judge their body and appearance based on this perceived defect. Therefore, it is possible that the emotions and cognitions present in the schemas of self-regulation and impaired functioning react to signs of defect and show sensitivity to appearance. Given that the activity of self-regulation and impaired functioning schemas is, to some extent, accompanied by negative judgments about themselves and the experience of feelings of failure and helplessness, this feeling of failure and helplessness can lower the self-esteem of women with breast cancer, leading them to exhibit weaker self-esteem than other women. Consequently, when women with breast cancer do not have sufficient self-esteem, they feel inadequate due to the removal of the breast and the defect in the breast area, and they believe that they have a serious and major defect in their body. In such cases, they are more likely to experience body dysmorphic disorder. It can be concluded that body dysmorphic disorder in women with breast cancer can be improved with schema therapy and self-esteem training. The present study had several limitations. First, this study was a cross-sectional design. Therefore, future studies could adopt experimental or longitudinal designs to explore the relationship between variables. Data were collected using self-report questionnaires only. Although the validity and reliability of these questionnaires have been well established, response bias or socially desirable responses may have existed in the present study. The participants in this study were a sample from Tehran, so the cross-cultural applicability of the results is limited. Given that this study was conducted among women with breast cancer, future studies could also collect data from different groups of women with other chronic physical illnesses to gain more insight into the factors affecting dysmorphic disorder. The results of the present study have theoretical and practical implications. Theoretically, this study using a mediation model may help to understand the mechanisms involved and affecting dysmorphic disorder. Also, the results of the present study showed that early maladaptive schemas and self-esteem are key factors for predicting body dysmorphic disorder. Therefore, it can be concluded that body dysmorphic disorder can be improved in women with breast cancer with schema therapy and self-esteem training.
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Ali Beheshti motlagh; mohammad narimani; Sajjad Basharpoor
Abstract
Objective: Substance use disorder is shaped by many factors, including biological, psychological, social, and cultural influences. Quantitative research has helped identify prevalence rates and common risk factors, but it often does not show how people themselves understand their first experiences with ...
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Objective: Substance use disorder is shaped by many factors, including biological, psychological, social, and cultural influences. Quantitative research has helped identify prevalence rates and common risk factors, but it often does not show how people themselves understand their first experiences with substance use. This matters even more in contexts where substance use can feel “normal,” for example through family habits, peer influence, or misunderstandings about medical benefits. In Iran, substances have long been used not only for recreation but also as informal remedies for physical and emotional pain. For this reason, a phenomenological approach can offer a clearer view of how individuals make sense of early substance use and what meanings they attach to it. This study explored the lived experiences of individuals with substance use disorders, focusing on the factors that influenced how they first began using substances. It aimed to identify key themes and common patterns showing how personal, social, and psychological influences interact and shape early substance use. Method: This qualitative study used a phenomenological design based on Colaizzi’s method. Participants were recruited in 2023 from Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) groups in Bojnord and Mashhad, Iran. In total, 121 men and women were selected through purposive sampling with maximum variation. We aimed for diversity in age, gender, educational level, socioeconomic status, and duration of abstinence. Recruitment continued until theoretical data saturation was reached. Data were collected through semi-structured, in-depth interviews. The interview guide was developed based on the study objectives and a review of relevant literature. It included open-ended questions about how participants began using substances, what they believed contributed to that decision, and what substance use meant to them at the time. During the interviews, probing questions were used to clarify points and encourage more detailed answers. Interviews were conducted face-to-face in safe locations agreed on by both sides and lasted 45 to 70 minutes. With informed consent, all interviews were audio-recorded and transcribed verbatim. Data analysis followed Colaizzi’s systematic seven-step approach. This included reading the transcripts several times, identifying significant statements, formulating meanings, clustering themes, and producing an exhaustive description of the phenomenon. To ensure rigor and trustworthiness, Lincoln and Guba’s criteria—credibility, dependability, confirmability, and transferability—were applied. Member checking, peer debriefing, and careful documentation of the analytic process were used to strengthen the findings. Results: The interview analysis identified three main themes and seventeen subthemes that reflect participants’ lived experiences of substance use initiation. Overall, the themes point to connected psychological, social, and contextual influences on early substance use. The subthemes were reported descriptively using qualitative frequency indicators (e.g., most participants, many participants, some participants), in line with qualitative research standards. The analysis produced three main themes: Pleasure-Seeking, Medical-Related Factors, and Internal and Psychological Problems. Participants often described starting substance use to experience pleasure, cope with emotional distress, manage physical pain, or gain social acceptance. Participants’ narratives showed that substance use often began in social or family settings where it was seen as normal. In these contexts, substances were sometimes viewed as harmless, useful, or even beneficial. Emotional deprivation, loneliness, and untreated psychological distress also appeared as especially important influences. Conclusion: The findings suggest that substance use initiation is a subjective, meaning-laden process shaped by pleasure-seeking motives, medical misconceptions, and unresolved psychological needs. These results highlight the need for prevention and relapse prevention programs that focus on emotional regulation, mental health awareness, and culturally embedded beliefs about substance use. Using individuals lived experiences to inform intervention design may improve the effectiveness of culturally sensitive and integrated prevention strategies.
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Javad Ayoubi; Iraj Shakerinia; Azra Zebardast
Abstract
Objective: The management of Type 2 diabetes mellitus (T2DM), a highly prevalent chronic metabolic disorder, necessitates a biopsychosocial framework that addresses its significant psychological comorbidities alongside physical health. The continuous burden of self-care, lifestyle modification, and treatment ...
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Objective: The management of Type 2 diabetes mellitus (T2DM), a highly prevalent chronic metabolic disorder, necessitates a biopsychosocial framework that addresses its significant psychological comorbidities alongside physical health. The continuous burden of self-care, lifestyle modification, and treatment adherence can lead to chronic stress, anxiety, depression, and diminished general health. Underlying these challenges, maladaptive cognitive schemas and pervasive self-criticism are recognized as key vulnerability factors that exacerbate psychological distress and impede effective glycemic control. To target these core mechanisms, Mode-Based Schema Therapy (MBST) has been established as an effective intervention for modifying dysfunctional schemas and enhancing emotional regulation. In a complementary fashion, self-compassion training aims to mitigate self-criticism and foster emotional acceptance and kindness toward the self. While the separate efficacy of each approach has been documented, their synergistic potential within an integrated treatment model remains largely unexamined. Crucially, there is a lack of empirical research investigating whether combining these interventions yields superior outcomes that span both psychological well-being and objective physiological markers. This gap limits the development of holistic treatment protocols that can simultaneously target the cognitive, emotional, and behavioral facets of diabetes distress. Therefore, the present study aimed to evaluate and compare the effectiveness of MBST alone versus MBST integrated with self-compassion training on improving general health and reducing glycated hemoglobin (HbA1c) levels in patients with T2DM. This comparative approach seeks to determine if augmenting schema-focused work with compassion-based strategies provides added value for comprehensive patient care. Method: This quasi-experimental study employed a pretest-posttest design with a control group. The statistical population included 2,400 patients with type 2 diabetes who were members of the Iranian Diabetes Association in Mashhad in 2024. After initial screening and Considering the criteria for entry and exit from research, 36 eligible participants were selected and randomly assigned to three groups: (1) Mode-Based Schema Therapy, (2) Mode-Based Schema Therapy combined with self-compassion training, and (3) a control group receiving no psychological intervention. Both intervention groups participated in 10 weekly group sessions, each session lasting 90 minutes. Mode-Based Schema Therapy sessions were conducted according to the protocol developed by Farrell et al. (2012), while self-compassion training followed Desmond (2015). Interventions aimed to modify maladaptive schemas, enhance healthy adult status, cultivate self-compassion, and learn adaptive coping with diabetes-related stress. Data collection tools included the General Health Questionnaire (GHQ-28) and HbA1C blood test. Data were analyzed using analysis of covariance (ANCOVA), controlling for pretest scores. Normality assumptions were checked with the Shapiro-Wilk test, and effect sizes were reported. The significance level was set at p<0.05. Results: Data analysis indicated significant improvements in general health and reductions in HbA1c levels in both intervention groups, whereas the control group showed no considerable changes. Results from a multivariate analysis of covariance (MANCOCOVA), controlling for pretest scores, revealed statistically significant differences among the three groups on the combined dependent variables (Wilks' Lambda = 76.14, p< .001). Follow-up univariate ANCOVAs confirmed that these differences were significant for both general health (F = 27.69, p < .001, η² = 0.634) and HbA1c (F = 16.29, p < .001, η² = 0.505). Pairwise comparisons with Bonferroni adjustment confirmed that both intervention groups performed significantly better than the control group. Furthermore, comparisons between the two active groups showed that the combined intervention group (MBST + self-compassion) demonstrated a statistically significant superiority over the MBST-only group in improving general health (p < .05). Regarding HbA1c, although the reduction was greater in the combined group, this difference approached marginal statistical significance (p = .052), indicating a strong trend in favor of the integrated intervention. Overall, this pattern of findings underscores the superior efficacy of the combined approach in achieving optimal psychological and physiological outcomes. Conclusion: The findings of this study demonstrate that Mode-Based Schema Therapy (MBST) is an effective intervention for improving general health and glycemic control (as measured by HbA1c) in patients with type 2 diabetes. Statistical analyses revealed significant and robust differences between the intervention groups and the control group, with the large effect sizes (η² = 0.634 for general health and η² = 0.505 for HbA1c) underscoring the clinical importance of these interventions. Notably, while both active interventions led to improvement, the combination of MBST with self-compassion training demonstrated statistically significant superiority in both psychological and physiological domains. This enhanced efficacy can be attributed to the complementary mechanisms of the two approaches. While MBST directly targets the identification and modification of maladaptive schemas and the de-escalation of negative emotional modes (e.g., the Vulnerable Child or Punitive Parent), self-compassion training directly reduces internal self-criticism, increases non-judgmental acceptance, and fosters a kinder self-attitude. This creates a more favorable emotional foundation for sustained change. Together, this integrated protocol provides a dual framework: it restructures deeper cognitive-emotional structures while simultaneously modifying the patient's daily responses to illness-related stress and potential lapses in self-care management. The combined approach appears to not only reduce rumination and psychological distress but also, by enhancing emotional resilience, facilitates greater adherence to health-promoting behaviors, which is ultimately reflected in the objective reduction of HbA1c levels. Given the chronic and stressful nature of diabetes, these findings emphasize the necessity of integrating deep, multi-dimensional psychological interventions into standard treatment protocols. Combining schema therapy modalities with mindfulness and compassion-based approaches can offer a powerful treatment model for achieving concurrent improvement in psychological and somatic indicators. Future research with larger sample sizes and longer follow-up periods is recommended to examine the sustainability of these effects and to elucidate the precise mediating mechanisms of change.
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ezzatollah ahmadi; Hamoun Babaei; Masoumeh Mirza
Abstract
Objective: Searching for symptoms related to health and illness, despite access to thousands of diverse information on the Internet, often causes confusion and uncertainty due to the high correlation of existing symptoms related to illnesses, and subsequently, causes cyberchondria in individuals. People ...
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Objective: Searching for symptoms related to health and illness, despite access to thousands of diverse information on the Internet, often causes confusion and uncertainty due to the high correlation of existing symptoms related to illnesses, and subsequently, causes cyberchondria in individuals. People with cyberchondria are very concerned about developing physical and sometimes psychological illnesses. Cyberchondria has been found to be more prevalent in young people, women, people with low education, and people with low digital literacy. The results showed that students with cyberchondria along with health problems scored high on the total scale and the subscale of confusion and uncertainty about medical services. Given the important role health plays in people's lives, it's no surprise that most people have health concerns at some point. One factor that is likely to be associated with cyberchondria is health anxiety. Health anxiety is defined as the persistent fear of developing a disease or worsening an existing disease. Given the increase in cyberchondria and health anxiety, it is very important to identify the factors that cause cyberchondria and health anxiety. Therefore, the aim of this study was to investigate the structural relationship between health anxiety and cyberchondria with the mediation of health literacy and metacognitive beliefs in students. Method: The present study was descriptive and used correlation and structural equation modeling. The statistical population of the study included all students of Khoy Azad University in the second semester of the academic year 1402-1403. Using the convenience sampling method, 200 students were selected as samples according to the inclusion and exclusion criteria of the study. Inclusion criteria: Being a student at Khoy Azad University in the academic year 2023-2024, age 18 to 30, not taking psychiatric medications and the exclusion criteria: unwillingness to continue the research and failure to complete the questionnaires completely, having a serious mental problem. While obtaining consent from the students to participate in the research, the purpose of the research was explained to them. In order to maintain ethical considerations in the research, the basic condition of informed consent to participate in the research was to maintain the subjects' personal information and confidentiality, and they were assured that their responses would only be used for research purposes. The instruments used in this study were the Cyberchondria Questionnaire of McElroy and Sholin (2014), Health Anxiety of Salkouskis and Warwick (2002), Health Literacy of Montazeri et al. (2015), and Metacognitive Beliefs of Wells and Cartwright-Haughton (2004). It should be noted that all four questionnaires were given to individuals at the same time and a brief explanation was provided if necessary. Structural equation modeling was used to analyze the data using Amos version 24 and SPSS version 24 software. Results: The results showed that there were appropriate correlations between the research variables. The correlation results show that among the exogenous variables, reading (one of the dimensions of health literacy) (-0.42) has the highest correlation coefficient with cyberchondria. In general, positive beliefs about worry (one of the dimensions of metacognitive beliefs) has the highest correlation with reading (0.56). The negative correlation means that with increasing reading, cyberchondria decreases. The fit indices of the modified model in Table 1 show that RMSEA is 0.067, CFI is 0.97, GFI is 0.94, AGFI is 0.89. The ratio of chi-square to degrees of freedom is 1.91. Comparison of the indices indicates that they have an acceptable fit..The results showed that the research model had acceptable empirical support and processing. Also, the path coefficients showed that all paths were significant (p<0.001). It can be said that health anxiety has an effect on cyberchondria through the mediation of health literacy and metacognitive beliefs. Of the health literacy components, the accessibility component (b=-0.27) had a higher effect than the other components in reducing cyberchondria. Also, of the metacognitive beliefs and health anxiety components, the need for control (b=0.22) and disease outcome (b=0.38) components have the greatest effect on the occurrence of cyberchondria in individuals, respectively. Conclusion: The results of the present study indicate the role and importance of metacognitive beliefs and health literacy education in reducing health anxiety. The present study was conducted to investigate the mediating role of health literacy and metacognitive beliefs in the relationship between health anxiety and cyberchondria. The results showed that all indicators in the hypothetical model had a good fit and the desired model was confirmed. Also, the path coefficients showed that all paths were significant. Metacognitive beliefs about uncontrollability and cognitive conflict predict health anxiety symptoms more than depression, general anxiety, anxiety sensitivity, and dysfunctional health-related beliefs. In such a way that metacognitive beliefs that can encourage maladaptive self-regulation strategies and exacerbate this anxiety in individuals. Also, low health literacy is associated with problems in the field of self-care against diseases and increased health concerns. In such a way that low health literacy leads to extreme self-care behaviors that are not only not useful but also predispose the individual to various anxiety problems and ultimately lead to frequent information search (cyberchondria). As a final conclusion, it can be stated that health literacy and metacognitive beliefs can be influential as key factors in the relationship between health anxiety and cyberchondria. It is possible to prevent the emergence of cyberchondria and reduce health anxiety by teaching how to search for information related to the symptoms of diseases on the Internet and ignoring redundant and irrelevant information related to disease and health.
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