Moving toward a metacognitive conceptualization of cyberchondria: examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals
Open accessAbstract
Cyberchondria refers to the repeated use of the Internet to search for health information that leads to negative consequences. The present set of studies examined the tenability of a proposed metacognitive conceptualization of cyberchondria that includes metacognitive beliefs about health-related thoughts, beliefs about rituals, and stop signals. The contribution of those variables to cyberchondria was examined among 330 undergraduate students from a U.S. university in Study 1 and 331 U.S. community respondents in Study 2. All participants reported using the Internet to search for health information. Across both studies, metacognitive beliefs, beliefs about rituals, and stop signals shared positive bivariate associations with cyberchondria and accounted for unique variance in cyberchondria scores in multivariate analyses. Beliefs about rituals and stop signals emerged as relatively specific to cyberchondria versus health anxiety in multivariate analyses. Results provide preliminary support for a metacognitive conceptualization of cyberchondria, with extensions of the present findings discussed.
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In all studies, zero-order correlation analyses revealed that all metacognition subscales were significantly correlated with cyberchondria (MCQ-HA-C: rs=0.32-0.49; MCQ-HA-B: rs=0.47-0.58; MCQ-HA-U: rs=0.51-0.66).
“In all studies, zero-order correlation analyses revealed that all metacognition subscales were significantly correlated with cyberchondria (MCQ-HA-C: rs=0.32-0.49, all P<.001; MCQ-HA-B: rs=0.47-0.58, all P<.001; and MCQ-HA-U: rs=0.51-0.66, all P<.001).”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
The Study 2 Results (section 3.5.1) report moderate-to-strong positive zero-order associations between the metacognitive variables and cyberchondria, and the retrieved Table 3 row shows MCQ-HA-Biased at r=.47 (p<.001). The available passages do not establish the other quoted endpoints or confirm that every listed correlation met the stated significance threshold in both studies. (LLM, conf=0.76)
Experimental — accuracy not yet measuredHierarchical multiple linear regression analyses controlling for relevant covariates showed that negative metacognitions and obsessive-compulsive symptoms contributed significantly to the variance in cyberchondria.
“Hierarchical multiple linear regression analyses statistically controlling for relevant covariates (ie, age, gender, physical health status, HA negative affect, and anxiety sensitivity) showed that negative metacognitions (ie, uncontrollability of thoughts [22,31], beliefs about rituals [22], and beliefs about stop signals [22]) and obsessive-compulsive symptoms [22] contributed significantly to”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
Study 1’s Results (§2.6.2; page unavailable) report significant incremental variance from the regression blocks, including beliefs about rituals and stop signals. But negative metacognitive beliefs were associated with cyberchondria only in block 2, not the final model. Study 2 treats obsessive-compulsive symptoms as a covariate (§3), while the available passages do not establish that they made a significant individual contribution; the listed covariates also do not include age, gender, or physical health status. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe DOCS total scale is significantly correlated to the CSS total scales with and without mistrust and to all CSS subscales.
“It was shown that the DOCS total scale is significantly correlated to the CSS total scales with (r=0.49, P<.01 [16]; r=0.38, P<.01 [40]) and without mistrust (r=0.49, P<.01 [16]; r=0.56, P<.001 [22]; r=0.38, P<.0 [40]) and to all CSS subscales”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
Study 2 Measures says the authors used the DOCS total score and a revised CSS-15 total score excluding mistrust; Study 2 Results says the study variables generally positively intercorrelated. Our copy does not establish the quoted r=.38 or its significance, and it does not report DOCS correlations with a CSS total including mistrust or with all CSS subscales. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAversive negative affective states activate metacognitive beliefs that may represent plans for self-regulation strategies (health-related internet use), rituals, and stop signals to cope with aversive states (for elevated and pathological HA).
“Following Fergus and Spada [22,31] as well as Brown et al [26], we also propose for the field of elevated and pathological HA that aversive negative affective states activate metacognitive beliefs that may represent plans for self-regulation strategies (namely health-related internet use), rituals, and stop signals that are conducted to cope with aversive (affective) states.”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSeveral studies found medium-sized positive correlations between cyberchondria and intolerance of uncertainty.
“Several studies found medium-sized positive correlations between cyberchondria and intolerance of uncertainty (Multimedia Appendix 1 [20-23]).”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
Positive correlations were found between anxiety sensitivity and cyberchondria.
“Positive correlations were also found between anxiety sensitivity (ie, the tendency to interpret anxiety-related symptoms as signs of impending danger) and cyberchondria (Multimedia Appendix 2 [21,22,25]).”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
Neither anxiety sensitivity nor intolerance of uncertainty shared significant, unique associations with cyberchondria.
“Interestingly, neither anxiety sensitivity nor intolerance of uncertainty shared significant, unique associations with cyberchondria [22].”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
The relevance of metacognitive aspects for cyberchondria was supported by several results from 3 web-based questionnaire surveys using the Metacognitions Questionnaire-Health Anxiety.
“The relevance of metacognitive aspects for cyberchondria was supported by several results from 3 web-based questionnaire surveys by the same authors [22,31], in which the Metacognitions Questionnaire–Health Anxiety (MCQ-HA; [57]) was used.”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
A supplemental analysis using health anxiety as the criterion variable and cyberchondria as a covariate revealed that beliefs about rituals and stop signals distinguish cyberchondria from health anxiety.
“A supplemental analysis using HA as the criterion variable (instead of cyberchondria) and cyberchondria as a covariate revealed that beliefs about rituals and stop signals distinguish cyberchondria from HA.”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
The analyses yielded inhomogeneous findings regarding the relevance of positive metacognitive beliefs.
“However, the analyses yielded inhomogeneous findings regarding the relevance of positive metacognitive beliefs [22,31].”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
Significant positive associations were found between cyberchondria (CSS total score) and negative affect (PANAS) (r=0.31, P<.01 [19]; r=0.34, P<.001 [22]; r=0.44, P<.01 [63]).
“Moreover, significant positive associations (r=0.31, P<.01 [19]; r=0.34, P<.001 [22]; r=0.44, P<.01 [63]) between cyberchondria (operationalized by the CSS total score) and negative affect (operationalized by the Positive and Negative Affect Schedule) were found, indicating that the higher the level of cyberchondria, more negative the affect experienced is.”
From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [22]
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BackgroundRecent Insights Into Cyberchondria
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Exploring developmental trajectory of cyberchondria over time: A three-wave panel study
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An exploration of determinants of cyberchondria: A moderated mediation analysis
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Investigating the Obsessive and Compulsive Features of Cyberchondria: A Holistic Review
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The moderating effect of alexithymia on the relationship between stress and cyberchondria
Zhou, Y., Dai, L., Yun-long, D., Zeng, H., & Yang, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1043521 · Cited by 12 · see citing works
Arnáez, S., García‐Soriano, G., Castro, J., Berle, D., & Starčević, V. (2022) · Current Psychology · doi:10.1007/s12144-022-03170-3 · Cited by 11 · see citing works
Impact of Cyberchondria on Health and Quality of Life: Scoping Review
Yang, C., & Xu, R. H. (2025) · Journal of Medical Internet Research · doi:10.2196/77977 · Cited by 8 · see citing works
Jungmann, S. M., & Dessauer, E. (2025) · Journal of Medical Internet Research · doi:10.2196/65792 · Cited by 18 · see citing works
Amanak, K., & Bilgiç, F. Ş. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2524864 · Cited by 6 · see citing works
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Do metacognitions contribute to pathological health anxiety? A systematic review and meta-analysis
Ivan, L., Foerster, P., Bermpohl, F., Gerlach, A., & Pohl, A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325563 · Cited by 2 · see citing works
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Cyberchondria in students: an eHealth related problem. A review
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What is remembered?: The recall of health-related information in cyberchondria and health anxiety
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Cyberchondria and Information Seeking Behavior: A Bibliometric Analysis
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Cyberchondria among college students and associated factors: a latent profile analysis
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Cyberchondria and health: Exploring the linkages
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Jodra, M., & García-Villamisar, D. A. (2022) · Acción Psicológica · doi:10.5944/ap.19.1.34250 · Cited by 1 · see citing works
Noi psihopatologii în era digitală: ortorexia şi cybercondria
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Cyberchondria During the COVID-19 Pandemic
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Maine Shared Collections Strategy: Why now in Maine?
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Cyberchondrie – ein neues Verhaltenssyndrom?
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Русскоязычная адаптация шкалы тяжести киберхондрии
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Is There an Increased Risk of Cyberchondriasis Post ChatGPT Era?
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الخصائص السيكومترية للصورة المختصرة لمقياس اضطراب السايبركوندريا في البيئة السعودية
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Investigation of the Relationship Between Alexithymia and Cyberchondria in Nursing Students
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The Development of Cyberchondria Amid the Pandemic: An Autoregressive Cross-Lagged Model
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- Authors
- Fergus, T. A., & Spada, M. M.
- Affiliations
- Baylor University (US)
- London South Bank University (GB)
- Corresponding author
- Fergus, Thomas A.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 60
- Pages
- 11-19
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W2895155497
- Cited by
- 80
- References
- 58
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 7 · 2023: 11 · 2022: 20 · 2021: 7 · 2020: 14 · 2019: 1 · 2012: 1
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research Open (London South Bank University) (acceptedVersion, cc-by-nc-nd)
- Research Open (London South Bank University) (acceptedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- cyberchondria, metacognitive beliefs, stop signal, metacognition, health anxiety, online health information seeking
- MeSH terms
- Metacognition, Adult, Aged, Anxiety, Anxiety Disorders, Ceremonial Behavior, Compulsive Behavior, Concept Formation, Female, Humans, Hypochondriasis, Male, Middle Aged, Students, Universities, Internet, Young Adult
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