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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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Reza Rahimi; Ali khodaei
Abstract
Objective: Avoidance, understood as an attempt to escape internal experiences such as emotions, thoughts, and memories, is generally adaptive but becomes maladaptive when excessive, contributing to the maintenance of anxiety and depression. Within the Third Wave of psychological therapies, growing attention ...
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Objective: Avoidance, understood as an attempt to escape internal experiences such as emotions, thoughts, and memories, is generally adaptive but becomes maladaptive when excessive, contributing to the maintenance of anxiety and depression. Within the Third Wave of psychological therapies, growing attention has been directed to emotional, behavioral, and particularly cognitive avoidance (Panjwani et al., 2024). Cognitive avoidance includes strategies such as distraction, thought suppression, and worry, which aim to prevent engagement with unwanted thoughts (Hearn et al., 2018). Evidence shows that thought control strategies are strongly linked to anxiety disorders, where worry is seen as a verbal, problem‑focused chain of negative thoughts. According to the avoidance theory of worry, worry functions to block threatening mental imagery and related autonomic arousal, reducing immediate anxiety but maintaining long‑term vulnerability (Mihailova & Jobson, 2020). To assess this construct, Gosselin et al. (2002) introduced the French Cognitive Avoidance Questionnaire, followed by the English 25‑item, five‑factor version developed by Sexton & Dugas (2008), which demonstrated strong psychometric validity. In individuals with multiple sclerosis, fluctuating disease progression increases intolerance of uncertainty, chronic pain, and anxiety through mechanisms such as cognitive avoidance, negative problem orientation, and positive beliefs to worry (Kusec et al., 2024; Chang, 2024). Given the high uncertainty associated with MS, patients frequently anticipate further functional decline, often relying on avoidance‑oriented coping strategies (Lleraa & Newman, 2023).Because coping resources influence MS outcomes and cognitive avoidance plays a central role in anxiety processes, evaluating the psychometric properties of the Persian Cognitive Avoidance Questionnaire among individuals with MS is essential. This study was
therefore conducted to examine its validity and reliability in this population. Method: This descriptive survey study examined the psychometric characteristics of the Persian version of the Cognitive Avoidance Questionnaire (CAQ) among patients with Multiple Sclerosis (MS). A sample of 350 patients (175 women and 175 men) was recruited through convenience sampling from the Iranian MS Society in Tehran. Sample size estimation followed Klein’s (2023) guideline for factor analysis based on the 25‑item CAQ. Several validated psychological instruments were administered. The Intolerance of Uncertainty Scale by Freeston et al. assesses responses to ambiguous situations; prior findings by Buhr & Dugas supported its strong reliability, which was replicated in this study (α=.96). The Metacognition Beliefs Questionnaire by Wells & Cartwright‑Hatton was used, specifically the Positive Beliefs about Worry subscale (α=.95). The Negative Problem Orientation Questionnaire by Robichaud & Dugas showed similarly high reliability (α=.94). The primary instrument, the Cognitive Avoidance Questionnaire, measures five dimensions of cognitive avoidance: thought substitution, converting images into thoughts, distraction, avoidance of threat, and thought suppression. The CAQ was translated and adapted into Persian using a rigorous back‑translation protocol to ensure conceptual and linguistic equivalence. Data analysis employed Classical Test Theory principles, and confirmatory factor analysis using maximum likelihood estimation was conducted. Model fit was evaluated using standard indices (χ², χ²/df, CFI, GFI, AGFI, RMSEA). In alignment with earlier studies by Sexton & Dugas, Gosselin et al., and Latari et al., the five‑factor structure showed satisfactory fit and was retained as the preferred model. Overall, the findings provide strong psychometric support for the Persian CAQ and its associated constructs, highlighting its applicability for MS populations. Results: In this study, data were analyzed using SPSS-26 and AMOS-24. Prior to confirmatory factor analysis, normality and multicollinearity assumptions were tested. Results showed no outliers, acceptable skewness (<|3|) and kurtosis (<|8|) values, and no multicollinearity issues (tolerance >0.1, VIF <3).
Three competing models were compared: the independence model, single-factor model, and five-factor model. Results indicated that the five-factor model showed good fit (χ²=1185.96, df=2.69, CFI=0.95, GFI=0.94, AGFI=0.91, RMSEA=0.063), while the single-factor model showed poor fit. Factor loadings ranged from 0.65 to 0.90, all statistically significant (p<0.001). Cronbach's alpha for subscales ranged from 0.86 to 0.92. For criterion validity, significant positive correlations were found between the Cognitive Avoidance Questionnaire dimensions and Intolerance of Uncertainty (r=0.60-0.70), Negative Problem Orientation (r=0.59-0.70), and Positive Worry Orientation (r=0.60-0.67). Conclusion: This study aimed to evaluate the psychometric properties of the Persian version of the Cognitive Avoidance Questionnaire (CAQ) in patients with Multiple Sclerosis (MS). Using confirmatory factor analysis, the findings replicated the original questionnaire’s five‑factor structure, comprising thought suppression, thought substitution, distraction, avoidance of threatening stimuli, and converting images into thoughts. These factors were empirically supported in the MS patient population, indicating that cognitive avoidance in this group is a multidimensional construct. Evidence for criterion validity was demonstrated through significant associations between CAQ subscales and related psychological variables, including intolerance of uncertainty, negative problem orientation, and positive beliefs about worry. These correlations align with cognitive models of psychopathology, suggesting that MS patients’ reliance on maladaptive avoidance strategies may be linked to heightened uncertainty, negative cognitive appraisals, and perceived benefits of worry. The unpredictable and stressful nature of MS symptoms may erode coping resources, thereby increasing dependence on avoidant cognitive responses. Reliability was confirmed through item‑level analyses and internal consistency indices, supporting the Persian CAQ as a stable and coherent measure. The results parallel earlier research validating the multidimensional structure of cognitive avoidance, further reinforcing the theoretical foundation underlying the construct. Despite the positive findings, the study noted limitations, including non‑random sampling from an MS association in Tehran, restricted psychometric assessment methods, and the absence of gender invariance testing. These limitations suggest the need for further research with broader samples and additional methodological approaches. In conclusion, the study provides strong support for the validity and reliability of the Persian CAQ and recommends its use for assessing cognitive avoidance strategies among individuals with Multiple Sclerosis.
F
Hengameh Boloorsaz Mashhadi; Eisa Jafari; Fereshteh Fereshteh Pourmohseni koluri
Abstract
Objective: Irritable bowel syndrome is the most common diagnosis among functional gastrointestinal disorders and is the cause of 25 to 50 percent of referrals to gastroenterologists (Frozanfar et al., 2023). In a review study, the prevalence of this syndrome in Iran was reported to be between 1.1 and ...
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Objective: Irritable bowel syndrome is the most common diagnosis among functional gastrointestinal disorders and is the cause of 25 to 50 percent of referrals to gastroenterologists (Frozanfar et al., 2023). In a review study, the prevalence of this syndrome in Iran was reported to be between 1.1 and 25 percent (Sheykhan and Goudarzi 2024). People with this syndrome report significant symptoms of psychological disorders and emotional disturbances. Among the symptoms that may be important in this disease, emotional dysregulation can be mentioned (Khoshchin Gol et al., 2021). A review of scientific reports over the past decade clearly shows that emotional dysregulation is of particular importance in the field of physical diseases (Boloorsaz Mashhadi et al., 2025). Irritable bowel syndrome does not lead to dangerous conditions in most patients, but due to side effects such as chronic pain and fatigue, it can increase the patient's medical costs and increase the patients' absence from work (Liu et al., 2025). In this context, Qian and Zhang (2024) showed in a study that stress and emotional dysregulation affect digestive function by activating the brain-gut axis, hormonal changes, and neuroimmune pathways, and thus, one of the most common health problems that causes patients with digestive disorders to seek medical care and treatment is abdominal pain. A review of the findings shows that sensitivity to pain and anxiety-related experiences are higher in patients with irritable bowel syndrome than in other digestive disorders (Prospero et al., 2025; Erfan et al., 2021). Because irritable bowel syndrome reduces the strength of the patient's immune system and muscles, the person may report high muscle and abdominal pain during the disease. For this reason, patients may sometimes experience greater pain intensity for various reasons, such as pain catastrophizing, which should be evaluated (Bagheri Sheykhangafshe et al., 2024). Various pharmacological and non-pharmacological treatments have been used for patients with irritable bowel syndrome. According to research evidence, one of the non-pharmacological treatments to reduce adverse psychological effects in these patients is mindfulness-based cognitive therapy, a type of cognitive therapy. This treatment, which uses mindfulness and includes various meditations, stretching yoga, education about stress management, anxiety, anger, and depression, and cognitive therapy practice (Seng et al., 2025). For example, Reilly et al (2025) concluded in a systematic review and meta-analysis that mindfulness-based cognitive therapy reduced perceived pain intensity and symptoms of depression and anxiety in patients with spinal cord injury. The present study aimed to investigate the effectiveness of mindfulness-based cognitive therapy on emotional dysregulation and pain indicators (acceptance-catastrophizing) in patients with irritable bowel syndrome. Method: The research method was a quasi-experimental study with a pre-test and post-test design with a control group and a two-month follow-up. All male patients with irritable bowel syndrome who referred to the internal medicine clinic of Moheb Hospital, Tehran, in 1404 constituted the statistical population of the study. For experimental and quasi-experimental studies, 15 people were recommended for each of the experimental and control groups. The Dysregulation of Emotion Questionnaire (DERS), Pain Acceptance Questionnaire (CPAQ), and Pain Catastrophizing Questionnaire (PCS) were among the instruments used in the present study. The statistical method used for data analysis was two-way analysis of variance with repeated measures. Before statistical analysis, the assumptions of parametric statistics related to analysis of variance were first examined and confirmed. Results: According to the results of Table 1, since the significance level related to time is less than 0.05, it can be accepted that there is a significant difference between the mean scores of emotional dysregulation and its components, as well as between the mean scores of pain acceptance, pain catastrophizing and their components in different stages of measurement (pre-test-post-test and follow-up).Conclusion: The present study was conducted with the aim of investigating the effectiveness of mindfulness-based cognitive therapy on emotional dysregulation and pain indices in patients with irritable bowel syndrome. The results showed that participating in mindfulness-based cognitive therapy sessions reduced emotional dysregulation in patients with irritable bowel syndrome, and this effect remained stable during the follow-up period. Another result of the study showed that participating in mindfulness-based cognitive therapy sessions increased pain acceptance in patients with irritable bowel syndrome, and this effect remained stable during the follow-up period. The final finding of the study indicated that participating in mindfulness-based cognitive therapy sessions reduced pain catastrophizing in patients with irritable bowel syndrome, and this effect remained stable during the follow-up period.
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Samaneh Babaei; Simin Bashardoust; Mina Mojtabaie
Abstract
Objective: Childhood cancer profoundly affects not only the diagnosed child but also the entire family system. Primary caregivers, especially parents, face persistent emotional strain, uncertainty regarding treatment outcomes, and overwhelming caregiving demands. According to the World Health Organization ...
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Objective: Childhood cancer profoundly affects not only the diagnosed child but also the entire family system. Primary caregivers, especially parents, face persistent emotional strain, uncertainty regarding treatment outcomes, and overwhelming caregiving demands. According to the World Health Organization (2023), nearly 400,000 children worldwide are diagnosed annually, most commonly with leukemia, brain tumors, and lymphomas. In Iran, the incidence rate is estimated at 12–15 per 100,000 children under fifteen (Ministry of Health, 2022). The chronic, life‑threatening nature of pediatric cancer exposes caregivers to severe psychological distress, including anxiety, depression, post‑traumatic stress, and burnout, which often persist beyond treatment and reduce caregiving effectiveness, potentially impacting child recovery (Rensen et al., 2022). Although some caregivers gradually adapt, many remain psychologically vulnerable, highlighting the need to strengthen modifiable resilience factors. One essential factor is Distress Tolerance (DT)—the capacity to endure aversive emotional states without avoidance. As a transdiagnostic construct, DT strongly relates to emotion regulation (Leyro et al., 2010). Low DT contributes to emotional exhaustion under chronic stress (Dekadt et al., 2021). Therefore, this study aimed to compare the efficacy of Transdiagnostic Treatment and Emotion Efficacy Therapy in improving caregivers’ distress tolerance through a quasi‑experimental pretest–posttest–follow‑up design. Method: This quasi-experimental study used a pretest–posttest–three-month follow-up design with three parallel groups: transdiagnostic treatment (TDT), emotion efficiency therapy (EET), and a control group. Participants were 36 primary caregivers of children with cancer (12 per group), recruited through convenience sampling from the pediatric oncology ward of Afzalipour Hospital in Kerman, Iran, during 2023–2024. Inclusion criteria were age 18–60 years, being the child’s primary caregiver, and absence of severe psychiatric disorders based on clinical interview. Exclusion criteria included withdrawal from the study, missing more than two intervention sessions, or changes in caregiving responsibility.The TDT intervention was conducted according to Frank and Davidson’s protocol and included eight weekly 90-minute group sessions focusing on emotion regulation, cognitive restructuring, and distress tolerance skills. The EET intervention also consisted of eight weekly sessions emphasizing mindfulness, emotional acceptance, and values-based behavioral strategies. The control group received no psychological intervention during the study period. Data were analyzed using multivariate analysis of variance (MANOVA) to examine between-group differences and repeated measures ANOVA to assess changes over time. Bonferroni post hoc tests were applied for pairwise comparisons. Statistical assumptions were evaluated using the Shapiro–Wilk, Mauchly’s, and Box’s M tests (P > 0.05). Results: Significant main effects of group and time, as well as group × time interactions, were found for all distress tolerance components and the total score (P ≤ 0.005). Both the transdiagnostic treatment (TDT) and emotion efficiency therapy (EET) groups showed significantly greater improvements than the control group (Bonferroni, P ≤ 0.019), with large effect sizes (partial η² = 0.20–0.64). No significant differences were observed between the two interventions (P > 0.05). Improvements achieved at post-test were maintained at the three-month follow-up, with no significant post-test–follow-up differences Conclusion: The findings indicate that both Transdiagnostic Treatment (TDT) and Emotion Efficiency Therapy (EET) significantly improve distress tolerance among caregivers of children with cancer, with effects maintained over time. Improvements across all dimensions of distress tolerance suggest enhanced emotional resilience, more adaptive coping, and greater acceptance of emotional experiences under chronic caregiving stress. The lack of significant differences between the two interventions implies that shared therapeutic mechanisms—such as increased emotional awareness, reduced experiential avoidance, and greater engagement in values-consistent behaviors—may play a central role in strengthening distress tolerance. Clinically, these results support the flexible integration of both approaches into psychosocial services in pediatric oncology settings, with intervention choice guided by therapist expertise, caregiver preferences, and contextual considerations. Enhancing caregivers’ distress tolerance may also indirectly reduce emotional exhaustion and psychological burden, thereby supporting more effective caregiving and potentially improving child-related outcomes. Overall, both TDT and EET appear to be effective and sustainable interventions for promoting emotional resilience in caregivers facing chronic stress. Future studies should employ randomized multicenter designs with larger samples and longer follow-up periods to further clarify mechanisms of change and improve generalizability.
A
Tayebeh Ghafari Aghdam; Afsaneh Taheri; Nasrin Bagheri
Abstract
Objective: Students with a wide spectrum of personal, social and educational obstacles are faced with a broad spectrum of personal, social and educational obstacles that influence their welfare or well-being; however, the general health of students in the university, especially to deal with obstacles ...
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Objective: Students with a wide spectrum of personal, social and educational obstacles are faced with a broad spectrum of personal, social and educational obstacles that influence their welfare or well-being; however, the general health of students in the university, especially to deal with obstacles in educational and educational environments, depends on their well-being and self-care behaviors. On the other hand, it can be said that ensuring healthy life and promoting well-being in all ages is one of the goals of sustainable development of the world health organization until 2030. A promising strategy to promote health for all and improve health outcomes is self-care, an individual-oriented approach that is based on human rights and equity in health. However, the world health organization emphasized the urgent need to better conceptualize self-care to support clinical and interventions. Self-care is important at all stages of life and health status to promote well-being, prevent disease, and improve health outcomes. Currently, there is a need to better conceptualize self-care in the general adult population and provide an instrument to measure self-care in this group. Therefore, the aim of this study was to psychometric properties of the persian version of the self-care inventory and its relationship with internet addiction and self-esteem in students University. 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 students University of Islamic Azad University, Rodehen Tehran city in winter year 2025. The sample size was selected based on Klein's model and with subjectivw sampling of 300 students University to be a undergraduate. complete consent for the study and the right to withdraw from continuing research and lack of physical and psychological disorders were based on the students' self-report, lack of complete accountability to questions of questionnaires, lack of necessary information for participation in the research was the criteria of departure. Data collection tools include the self-care inventory (SCI) of Luciani and et al (2022), internet addiction test (IAT) of Young 1998) and Rosenberg self-esteem scale (RSEs) of Rosenberg (1989). The internal consistency, as well as the internal consistency (Cronbach's alpha), composite reliability, Omega coefficient, exploratory, confirmatory, criterion validity, convergent and divergent validity, and Pearson correlation coefficient were evaluated using the SPSS software version 29 and AMOS software version 24. Results: The results indicated that this scale had a one-factor structure with an explained variance of 89.49%. Cronbach's alpha was 0.90 to 0.96, composite reliability was 0.79 to 0.82, and Omega coefficient was 0.87 to 0.89. The results of the factor analysis confirmed the one-factor structure of this scale (RMSEA=0/05, GFI=0/96, TLI=0/91 and SRMR=0/04). In this study, the parameter estimation method used was the maximum likelihood (MLE) method. According to the results, the RMSEA index was 0.07, and the root mean square residual (SRMR) was 0.04; therefore, it can be concluded that the model has a very good fit with the data and is appropriate. Additionally, the 95% confidence interval around the RMSEA index is between 0.047 and 0.056, which indicates a favorable state of model fit. The results of the correlation test also showed the positive correlation of this scale with self-esteem (r=0/53, p<0/01) and negative correlation between internet addiction (r=-0/63, p<0/01) with self-care, which convergent validity of this instrument. Conclusion: This research aimed to psychometric properties of the persian version of the self-care inventory and its relationship with internet addiction and self-esteem in students University. It can be said that is one of the most important factors that is considered in the use of a scale. In this study, convergent, divergent and concurrent validity were used to construct validity of scale .The coordination of the factor structure of this scale with its theoretical structure, is considered as an indicator of construct validity for this scale. In this regard, it can be said that in the validity of the structure, factor analysis method is powerful and inevitable. In this study, the omega factor and omega ratio in the range of 0.87 to 0.89 were obtained which indicates that the persian version of self-care inventory with very high accuracy or reliability of self - care behaviors will measure .how self-esteem can affect the psychological and physical function of the person can be said that self - esteem will lead to better management of our lives and have a higher value to deal with these challenges. Therefore, students who have higher self-esteem could be better self-care because of their ability to cope with different problems. It is reasonable to say that self-care is positively correlated with sel -care in students. It could be said that the Persian version of the self-care inventory has acceptable validity and reliability and its factor structure is reliable. Since this study was conducted in Tehran, it is suggested that such a study be repeated in other cities due to cultural, ethnic, and religious differences. In summary, it can be said that the Persian version of the self-care inventory is promising as an effective screening tool for identifying self-care behaviors and measuring the level of self-care in students, which has not previously existed in Iran. Using an appropriate and valid tool to identify self-care behaviors can lead to the early identification of poor self-care behaviors in students and can potentially prevent significant harm caused by these behaviors. This short and concise scale is freely available, easy to administer, and can also be used for other adults.
