From Certainty-Seeking to Health Preoccupation: The Mediating Role of Cognitive-Emotional Processes in Health Anxiety
DOI:
https://doi.org/10.13129/2282-1619/mjcp-5371Keywords:
Emotional schemas, Health anxiety, Interpretation bias, Intolerance to uncertainty, Need for closure, Somatic symptomsAbstract
Background: Health anxiety (HA) can cause significant distress in patients, leading to preoccupation with perceived illness and symptoms.
Objective: This study examines the mediating roles of cognitive-emotional processes such as need for closure (NFC), negative interpretation bias (NIB), emotional schemas (ES), intolerance of uncertainty (IU), and somatic symptom severity (SSS), in linking NFC to HA.
Method: The cross-sectional study sampled 276 participants from diverse backgrounds, with ages ranging from 18-80 years. Participants completed a 40-minute survey which consisted of standardized scales assessing these factors.
Results: Results demonstrated that while NFC does not directly predict HA, it exerts its influence through cognitive and emotional mechanisms. IU and NIB emerged as key independent mediators, while NIB and ES were associated with HA through serial paths involving somatic symptom severity.
Conclusions: Thus, our results suggest that interventions for HA may benefit from targeting constructs such as NFC, IU, NIB, and ES, which are associated with health anxiety, rather than focusing exclusively on health anxiety symptoms themselves.
References
Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007). Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy, 38(1), 86–94. https://doi.org/10.1016/j.beth.2006.05.001
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
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., Ametaj, A., Carl, J. R., Boettcher, H. T., & Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 74(9), 875. https://doi.org/10.1001/jamapsychiatry.2017.2164
Barsky, A. J. (1979). Patients who amplify bodily sensations. Annals of Internal Medicine, 91(1), 63–70. https://doi.org/10.7326/0003-4819-91-1-63
Baumgardner, M., LaGattuta, A. K., & Allen, K. B. (2024). A brief measure of positive and negative interpretation biases: development and validation of the ambiguous social scenarios questionnaire. Assessment, 31(3), 715–731. https://doi.org/10.1177/10731911231176275
Birrell, J., Meares, K., Wilkinson, A., & Freeston, M. (2011). Toward a definition of intolerance of uncertainty: A review of factor analytical studies of the Intolerance of Uncertainty Scale. Clinical Psychology Review, 31(7), 1198–1208. https://doi.org/10.1016/j.cpr.2011.07.009
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40(8), 931–945. https://doi.org/10.1016/S0005-7967(01)00092-4
Creed, F. (2011). The relationship between somatic symptoms, health anxiety, and outcome in medical out-patients. Psychiatric Clinics of North America, 34(3), 545–564. https://doi.org/10.1016/j.psc.2011.05.001
Du, X., Witthöft, M., Zhang, T., Shi, C., & Ren, Z. (2023). Interpretation bias in health anxiety: A systematic review and meta-analysis. Psychological Medicine, 53(1), 34–45. https://doi.org/10.1017/S0033291722003427
Elhamiasl, M., Dehghani, M., Heidari, M., Vancleef, L. M. G., & Khatibi, A. (2023). Negative interpretation of ambiguous bodily symptoms among illness-anxious individuals: Exploring the role of developmental and maintenance constructs. Frontiers in Psychiatry, 13, 985125. https://doi.org/10.3389/fpsyt.2022.985125
Fergus, T. A., & Asmundson, G. J. G. (2019). Cognitive and behavioral mechanisms of health anxiety. In E. Hedman-Lagerlöf (Ed.), The clinician's guide to treating health anxiety: Diagnosis, mechanisms, and effective treatment (pp. 43–64). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-811806-1.00004-4
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791–802. https://doi.org/10.1016/0191-8869(94)90048-5
Gu, Y., Gu, S., Lei, Y., & Li, H. (2020). From uncertainty to anxiety: how uncertainty fuels anxiety in a process mediated by intolerance of uncertainty. Neural Plasticity, 2020, 1–8. https://doi.org/10.1155/2020/8866386
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
Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online, 22(1), 1270009. https://doi.org/10.1080/10872981.2016.1270009
Interian, A., Allen, L. A., Gara, M. A., Escobar, J. I., & Díaz-Martínez, A. M. (2006). Somatic complaints in primary care: further examining the validity of the Patient Health Questionnaire (PHQ-15). Psychosomatics, 47(5), 392–398. https://doi.org/10.1176/appi.psy.47.5.392
Kossowska, M., Bukowski, M., Guinote, A., Dragon, P., & Kruglanski, A. W. (2016). Self-image threat decreases stereotyping: the role of motivation toward closure. Motivation and Emotion, 40(6), 830–841.https://doi.org/10.1007/s11031-016-9582-6
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002). The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms. Psychosomatic Medicine, 64(2), 258-266. https://doi.org/10.1097/00006842-200203000-00008
Kruglanski, A. W., & Webster, D. M. (1996). Motivated closing of the mind: “seizing” and “freezing.” Psychological Review, 103(2), 263–283. https://doi.org/10.1037/0033-295X.103.2.263
Leahy, R. L. (2002). A model of emotional schemas. Cognitive and Behavioral Practice, 9(3), 177–190. https://doi.org/10.1016/S1077-7229(02)80048-7
Leahy, R. L., Tirch, D. D., & Napolitano, L. A. (2011). Emotion regulation in psychotherapy: a practitioner’s guide. Guilford Press.
Lorimer, S. B., Sansom‐Daly, U. M., Stech, E. P., & Newby, J. M. (2020). Predictors of health anxiety in cancer patients’ loved ones: A controlled comparison. Psycho-Oncology, 29(11), 1874–1882. https://doi.org/10.1002/pon.5517
Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27(2), 127–139. https://doi.org/10.1016/j.cpr.2006.09.003
Murphy, K. M., McGuire, A. P., Erickson, T. M., & Mezulis, A. H. (2017). Somatic symptoms mediate the relationship between health anxiety and health-related quality of life over eight weeks: somatic symptoms prospectively mediate. Stress and Health, 33(3), 244–252. https://doi.org/10.1002/smi.2694
Roets, A., & Van Hiel, A. (2011). Item selection and validation of a brief, 15-item version of the Need for Closure Scale. Personality and Individual Differences, 50(1), 90–94. https://doi.org/10.1016/j.paid.2010.09.004
Sahib, A., Chen, J., Cárdenas, D., & Calear, A. L. (2023). Intolerance of uncertainty and emotion regulation: A meta-analytic and systematic review. Clinical Psychology Review, 101, 102270. https://doi.org/10.1016/j.cpr.2023.102270
Salkovskis, P. M., & Warwick, H. M. C. (2001). Meaning, misinterpretations, and medicine: a cognitive behavioral approach to understanding health anxiety and hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis Modern Perspectives on an Ancient Malady (pp. 202–222). Oxford University Press New York, NY. https://doi.org/10.1093/oso/9780195126761.003.0009
Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & 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
Shi, C., Du, X., Chen, W., & Ren, Z. (2024). Predictive roles of cognitive biases in health anxiety: A machine learning approach. Stress and Health, 40(5), e3463. https://doi.org/10.1002/smi.3463
Sun, L., Zou, H., Li, W., Li, H., Pang, J., Cui, H., & Li, C. (2025). Intolerance of uncertainty and emotion regulation in generalized anxiety disorder: the role of reappraisal and suppression. Behavioral Sciences, 15(9), 1238. https://doi.org/10.3390/bs15091238
Tyrer, P. (2018). Recent advances in the understanding and treatment of health anxiety. Current Psychiatry Reports, 20(7), 49. https://doi.org/10.1007/s11920-018-0912-0
Webster, D. M., & Kruglanski, A. W. (1994). Individual differences in need for cognitive closure. Journal of Personality and Social Psychology, 67(6), 1049–1062. https://doi.org/10.1037/0022-3514.67.6.1049
Zerna, J., Strobel, A., & Strobel, A. (2024). The Role of Need for Cognition in Well-Being – Review and Meta-Analyses of Associations and Potentially Underlying Mechanisms. Collabra. Psychology, 10(1), 92885. https://doi.org/10.1525/collabra.92885
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