با همکاری مشترک دانشگاه پیام نور و انجمن روانشناسی اجتماعی ایران

نوع مقاله : علمی- پژوهشی

نویسندگان

1 دانشکده ادبیات و علوم انسانی، دانشگاه لرستان، خرم آباد، ایران

2 گروه روانشناسی، دانشکده ادبیات و علوم انسانی، دانشگاه لرستان، خرم آباد، ایران

10.30473/hpj.2026.74980.6271

چکیده

مقدمه: 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.
روش: 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.
یافته‌ها: 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 <p) و متغیرهای میانجی باورهای فراشناختی مرتبط با سلامت، سندرم شناختی­توجهی و سایبرکندریا بصورت مستقیم با اضطراب سلامت رابطه معنادار دارند (001/0 <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 <p).
نتیجه‌گیری: 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.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

The Structural Model of Health Anxiety based on Early Maladaptive Schemas, Health-Related Metacognition, Cognitive Attentional Syndrome, Emotion Dysregulation and Cyberchondria

نویسندگان [English]

  • Samane Ghadampour 1
  • Kourosh Amraei 2
  • Masoud Sadeghi 2

1 Faculty of Literature and Human Sciences, Lorestan University, Khorramabad, Iran

2 Department of Psychology, Faculty of Literature and Human Sciences, Lorestan University, Khorramabad, Iran

چکیده [English]

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.
 

کلیدواژه‌ها [English]

  • Attentional Cognitive Syndrome
  • Cyberchondria
  • Emotion Dysregulation
  • Health Anxiety
  • Metacognition
  • Schema
Arsenakis, S., Chatton, A., Penzenstadler, L., Billieux, J., Berle, D., Starcevic, V., Viswasam, K., & Khazaal, Y. (2021). Unveiling the relationships between cyberchondria and psychopathological symptoms. Journal of psychiatric research, 143, 254–261. DOI:10.1016/j.jpsychires.2021.09.014.
Asmundson, G. J. G., & Fergus, T. A. (2019). The Concept of Health Anxiety. The Clinician’s Guide to Treating Health Anxiety, 1–18. https://doi.org/10.1016/B978-0-12-811806-1.00001-9.
­Bailey, R., & Wells, A. (2015). Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. Journal of anxiety disorders, 34, 8–14. https://doi.org/10.1016/j.janxdis.2015.05.005.
Bailey, R., & Wells, A. (2015). Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry research,230(3),871–877. https://doi.org/10.1016/j.psychres.2015.11.035.
Bailey, R., & Wells, A. (2015). The contribution of metacognitive beliefs and dysfunctional illness beliefs in predicting health anxiety: An evaluation of the metacognitive versus the cognitive models. Clinical Psychologist, 20(3), 129–137. https://doi.org/10.1111/cp.12078.
Bailey, R., & Wells, A. (2016). Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study. Behaviour research and therapy,78,43–50. https://doi.org/10.1016/j.brat.2016.01.002.
Bardeen, J. R., & Fergus, T. A. (2014). An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies. Journal of anxiety disorders, 28(4), 394–401. https://doi.org/10.1016/j.janxdis.2014.03.002
Bati, A. H., Mandiracioglu, A., Govsa, F., & Çam, O. (2018). Health anxiety and cyberchondria among Ege University health science students. Nurse education today, 71, 169–173. https://doi.org/10.1016/j.nedt.2018.09.029.
Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., Bjärehed, J., DiLillo, D., Messman-Moore, T., Gumpert, C. H., & Gratz, K. L. (2016). Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16. Journal of psychopathology and behavioral assessment, 38(2), 284–296. https://doi.org/10.1007/s10862-015-9514-x.
Carter, J. D., McIntosh, V. V., Jordan, J., Porter, R. J., Frampton, C. M., & Joyce, P. R. (2013). Psychotherapy for depression: a randomized clinical trial comparing schema therapy and cognitive behavior therapy. Journal of affective disorders,151(2),500–505. https://doi.org/10.1016/j.jad.2013.06.034.
Camara, M., & Calvete, E. (2012). P-122 - Cognitive schemas predicting anxiety and depressive symptoms: the role of dysfunctional coping strategies. European Psychiatry, 27, 1. https://doi.org/10.1016/s0924-9338(12)74289-x.
  Capobianco, L., Faija, C., Husain, Z., & Wells, A. (2020). Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PloS one, 15(9), e0238457. https://doi.org/10.1371/journal.pone.0238457.
  Darvish, N., & Taklavi. S. (2023). The Role of Early Maladaptive Schemas and Emotional Knowledge in Predicting Employees’ Illness Anxiety. International Journal of Behavior Studies in Organizations, 9, 23-35. (in persian) https://doi.org/10.32038/JBSO.2023.09.03.
Dini, S., Hosseinnejad, Sh., Hossein-zadeh Khanmiri, B., & Seyed Hashemi, S. G. (2020). Internal consistency and confirmatory factor analysis of the short form of the Cyberchondria Severity Scale among users of virtual social network sites (in Persian). Paper presented at the 2nd National Conference on Psychology, Counseling, and Educational Sciences, Iran.
   Dutra, L., Callahan, K., Forman, E., Mendelsohn, M., & Herman, J. (2008). Core schemas and suicidality in a chronically traumatized population. The Journal of nervous and mental disease, 196(1), 71–74. https://doi.org/10.1097/NMD.0b013e31815fa4c1.
Ebrahimi sadr, F., & Bakhshipour, A. (2022). Correlation between Early Maladaptive Schemas with Automatic Negative Thoughts and Health Anxiety among School Students. International Journal of School Health, 9(4), 264-268. (in persian). https://doi.org/10.30476/intjsh.2022.96312.1251.
Farrokhi, H., Sohrabi, F. (2017). Investigating Reliability, Validity and Factor Structure of the Persian Version of the Cognitive Attentional Syndrome (CAS-1). Journal of Analytical - Cognitive Psychology, 8(30), pp.9-15. (in persian).
Fergus, T. A., & Spada, M. M. (2017). Cyberchondria: Examining relations with problematic Internet use and metacognitive beliefs. Clinical psychology & psychotherapy,24(6),1322–1330. https://doi.org/10.1002/cpp.2102.
Fergus, T. A., & Spada, M. M. (2018). Moving toward a metacognitive conceptualization of cyberchondria: Examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals. Journal of anxiety disorders, 60, 11–19. https://doi.org/10.1016/j.janxdis.2018.09.003.
Fergus, T. A., & Valentiner, D. P. (2010). Disease phobia and disease conviction are separate dimensions underlying hypochondriasis. Journal of behavior therapy and experimental psychiatry, 41(4),438–444. https://doi.org/10.1016/j.jbtep.2010.05.002.
Fergus, T.A.(2013). Repetitive Thought and Health Anxiety: Tests of Specificity. J Psychopathol Behav Assess35,366–374. https://doi.org/10.1007/s10862-013-9340-y.
Fouladi, A. khademi, A., & Shaker Dioulagh, A. (2023).Comparison the Effectiveness of Meta-Cognitive Therapy and Compassion Therapy on the Symptoms of Cyberchondria in Nurses. Quarterly Journal of Health Psychology. 12(46), 7-22. (in persian). https://doi.org/10.30473/hpj.2023.65641.5655.
Ghasemi K, Elahi T. (2019). The relationship between early maladaptive schemas and illness anxiety: The mediating role of experiential avoidance. Journal of Research in Psychological Health, 13 (3) :47-55. (in persian)
Hawke, L. D., & Provencher, M. D. (2011). Schema Theory and Schema Therapy in Mood and Anxiety Disorders: A Review. Journal of Cognitive Psychotherapy, 25(4), 257–276 https://doi.org/10.1891/0889-8391.25.4.257.
Henker, J., Keller, A., Reiss, N., Siepmann, M., Croy, I., & Weidner, K. (2019). Early maladaptive schemas in patients with somatoform disorders and somatization. Clinical Psychology & Psychotherapy,26(4),418–429. https://doi.org/10.1002/cpp.2363.
Janovsky, T., Rock, A., Thorsteinsson, E., Clark, G., & Murray, C. (2020). The relationship between early maladaptive schemas and interpersonal problems: A meta‐ analytic review. Clinical Psychology & Psychotherapy.27(3),408-447. https://doi.org/10.1002/cpp.2439.
Kaur, A., Butow, P. N., & Sharpe, L. (2013). Health threat increases attentional bias for negative stimuli. Journal of behavior therapy and experimental psychiatry,44(4),469–476. https://doi.org/10.1016/j.jbtep.2013.06.003.
Kaur, A., Butow, P., & Thewes, B. (2011). Do metacognitions predict attentional bias in healthanxiety?. Cognitive Therapy and Research, 35(6), 575-580.
Kaya, B., Gündogan, E.(2018). Evaluating reliability of question-disease relations in online health forms: A link prediction approach. Telematics Inform. 35 (7),1799–1808. https://doi.org/10.1016/j.tele.2018.05.009.
Khaleel, I., Wimmer, B. C., Peterson, G. M., Zaidi, S. T. R., Roehrer, E., Cummings, E., & Lee, K. (2020). Health information overload among health consumers: A scoping review. Patient education and counseling ,103(1), 15–32. https://doi.org/10.1016/j.pec.2019.08.008.
Love, S., Sharman, R., & Kannis-Dymand, L. (2018). Emotion Regulation and the Specific Associations with Health Anxiety. Psychological Studies.doi:10.1007/s12646-018-0469-3.
Mahdavi, S. and Azadi, M. (2021). Standardization of Young’s Maladaptive Schema Questionnaire in Students of Tehran. Quarterly of Educational Measurement12(45), 135-163. (in persian).  https://doi.org/10.22054/jem.2022.58601.2142.
Marino, C., Fergus, T. A., Vieno, A., Bottesi, G., Ghisi, M., & Spada, M. M. (2020). Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria. Clinical psychology & psychotherapy, 27(4), 581–596. https://doi.org/10.1002/cpp.2444.
Mathes, B. M., Norr, A. M., Allan, N. P., Albanese, B. J., & Schmidt, N. B. (2018). Cyberchondria: Overlap with health anxiety and unique relations with impairment, quality of life, and service utilization. Psychiatry research, 261, 204–211. https://doi.org/10.1016/j.psychres.2018.01.002.
McElroy, E., Kearney, M., Touhey, J., Evans, J., Cooke, Y., & Shevlin, M. (2019). The CSS-12: Development and Validation of a Short-Form Version of the Cyberchondria Severity Scale. Cyberpsychology, behavior and social networking, 22(5),330–335. https://doi.org/10.1089/cyber.2018.0624.
McMullan, R. D., Berle, D., Arnáez, S., & Starcevic, V. (2019). The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis. Journal of Affective Disorders. 245, 270–278. https://doi.org/10.1016/j.jad.2018.11.037.
Melli, G., Bailey, R., Carraresi, C., & Poli, A. (2018). Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample. Clinical Psychology & Psychotherapy, 25(2), 263–271. https://doi.org/10.1002/cpp.2159.
Melli, G., Carraresi, C., Poli, A., & Bailey, R. (2016). The role of metacognitive beliefs in health anxiety. Personality and Individual Differences, 89, 80–85. doi:10.1016/j.paid.2015.10.006.
Mohammadkhani, Sh., Akbari, M., & Nasiri, M. (2026). Unveiling metacognitive pathways: Psychometric validation of the Persian MCQ-HA in the context of COVID-19 anxiety [Manuscript submitted for publication]. BMC Psychiatry.
Mousavi Pakzad, S. S. (2021). The relationship between early maladaptive schemas and attachment styles with disease anxiety and death anxiety (Master's thesis). University of Tabriz.
Nadeem, F., Malik, N. I., Atta, M., Ullah, I., Martinotti, G., Pettorruso, M., Vellante, F., Di Giannantonio, M., & De Berardis, D. (2022). Relationship between Health-Anxiety and Cyberchondria: Role of Metacognitive Beliefs. Journal of clinical medicine,11(9),2590. https://doi.org/10.3390/jcm11092590.
Nadort, M., Arntz, A., Smit, J. H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., van Asselt, T., Wensing, M., & van Dyck, R. (2009). Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial. Behaviour Research and Therapy,47(11),961–973. https://doi.org/10.1016/j.brat.2009.07.013.
Nargesi, F. , izadi, F. , kariminejad, K. and rezaii sharif, A. (2017). The investigation of the reliability and validity of Persian version of Health anxiety questionnaire in students of Lorestan University of Medical Sciences. Quarterly of Educational Measurement,8(27),147-160. doi:10.22054/jem.2017.19621.1495. (in  persian)
Orei, Z. S., & Neshatdost, H. T. (2015). The relationship between early maladaptive schemas and self-diagnosis. 2nd International Research Conference in Behavioral and Social Sciences, Silvica. (in persian).
Pugh, M. (2015). A narrative review of schemas and schema therapy outcomes in the eating disorders. Clinical Psychology Review, 39, 30–41. https://doi.org/10.1016/j.cpr.2015.04.003.
Salkovskis, P. M., Rimes, K. A., Warwick, H. M., & Clark, D. M. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological medicine, 32(5), 843–853. https://doi.org/10.1017/s0033291702005822.
Santoro, G., Starcevic, V., Scalone, A., Cavallo, J., Musetti, A., & Schimmenti, A. (2022). The Doctor Is In(ternet): The Mediating Role of Health Anxiety in the Relationship between Somatic Symptoms and Cyberchondria. Journal of personalized medicine, 12(9), 1490. https://doi.org/10.3390/jpm12091490.
Shahabi, M., Hasani, J., & Bjureberg, J. (2018). Psychometric Properties of the Brief Persian Version of the Difficulties in Emotion Regulation Scale (The DERS-16). Assessment for Effective Intervention. 45:135-43. (in persian)
Shakhseniaei, M., Bigdeli, I., & Firoozabadi, A. (2024). The Relationship between Early Maladaptive Schemas and Psychosomatic Symptoms in infertile Women: The mediating Role of Cognitive Emotion Regulation Strategies. Quarterly Journal of Health Psychology,14(54),27-44. https://doi.org/10.30473/hpj.2025.72689.6136.
Reuman, L., Jacoby, R. J., Blakey, S. M., Riemann, B. C., Leonard, R. C., & Abramowitz, J. S. (2017). Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder. Psychiatry research,256,417–422. https://doi.org/10.1016/j.psychres.2017.07.012.
Vismara, M., Caricasole, V., Starcevic, V., Cinosi, E., Dell'Osso, B., Martinotti, G., & Fineberg, N. A. (2020). Is cyberchondria a new transdiagnostic digital compulsive syndrome? A systematic review of the evidence. Comprehensive psychiatry, 99, 152167. https://doi.org/10.1016/j.comppsych.2020.152167
Wang, X., & Lee, K. M. (2020). The paradox of technology innovativeness and risk perceptions – A profile of Asian smartphone users. Telematics and Informatics,51,101415. https://doi.org/10.1016/j.tele.2020.101415.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford press.
Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., & Mendel, E. (2010). A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour research and therapy, 48(5), 429–434. https://doi.org/10.1016/j.brat.2009.11.013.
White, R. W., & Horvitz, E. (2009). Experiences with web search on medical concerns and self diagnosis. AMIA  Annual Symposium proceedings. AMIA Symposium, 2009, 696–700.  Nov 14:2009:696-700.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2006). Schema Therapy: A Practitioner's Guide (1st Ed.). Guilford Press.
Young, J. E., & Rygh, J. (1994). Young-Rygh Avoidance Inventory. Cognitive Therapy Center of New York.
Young, J. E. (2005). Young Schema Questionnaire– Short Form 3 (YSQ-S3). NewYork, NY: Cognitive Therapy Center