The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis

© 2018 Background: Cyberchondria refers to an abnormal behavioral pattern in which excessive or repeated online searches for health-related information are distressing or anxiety-provoking. Health anxiety has been found to be associated with both online health information seeking and cyberchondria. The aims of the present systematic review and meta-analysis were to examine the magnitude of these associations and identify any moderator variables. Methods: A systematic literature search was performed across several databases (PsycINFO, PubMed, Embase) and reference lists of included studies. Results: Twenty studies were included across two independent meta-analyses, with 7373 participants. Random effects meta-analyses showed that there was a positive correlation between health anxiety and online health information seeking [r = 0.34, 95% CI (0.20, 0.48), p <.0001], and between health anxiety and cyberchondria [r = 0.62, 95% CI (0.52, 0.71), p <.0001]. A meta-regression indicated that the age of study participants [Q(1) = 4.58, p =.03] was partly responsible for the heterogeneity found for the relationship between health anxiety and cyberchondria. Limitations: The generalizability and validity of our findings are restricted by the methodological limitations of the primary studies, namely, an over-reliance on a single measure of cyberchondria, the Cyberchondria Severity Scale. Conclusions: Our review found a positive correlation between health anxiety and online health information seeking, and between health anxiety and cyberchondria. Further research should aim to explore the contexts for these associations as well as address the identified limitations of the extant literature

Childhood emotional abuse and problematic social networking sites use in a sample of Italian adolescents: The mediating role of deficiencies in self-other differentiation and uncertain reflective functioning

Objective: Childhood emotional abuse (CEA) is associated with various negative mental health outcomes. This study aimed to investigate the association between CEA and problematic social networking site (SNS) use in a sample of Italian adolescents. Design: Using structural equation modeling, the study examined whether the relationship between CEA and problematic SNS use was sequentially mediated by self-other differentiation and uncertain reflective functioning in 1308 Italian adolescents (628 males, age range&nbsp;13–19 years). Results: A history of CEA was positively associated with problematic SNS use. Furthermore, deficiencies in self-other differentiation and uncertain reflective functioning partially mediated the relationship between CEA and problematic SNS use. Conclusions: The present study provides additional insight into the psychological dynamics underpinning problematic SNS use among adolescents. The clinical implications of these findings are discussed

Problematic social networking site use: a brief review of recent research methods and the way forward

Social networking site (SNS) use is a routine activity for millions of people around the world. Under certain circumstances, an increase in SNS use may lead to problematic social networking site use (PSNSU). Numerous studies have reported associations between PSNSU and various psychosocial variables. The present review briefly examines research methods that have been employed to investigate PSNSU. Cross-sectional studies have been a popular method of investigating PSNSU, but they have significant limitations. Longitudinal and neuroimaging studies may provide important insights, but they are more difficult to conduct and have been less utilised. The field would benefit from a clarification of research priorities, integration of research methods, and studies that include SNS users from various age groups

Childhood emotional abuse and problematic social networking sites use in a sample of Italian adolescents: The mediating role of deficiencies in self-other differentiation and uncertain reflective functioning.

Childhood emotional abuse (CEA) is associated with various negative mental health outcomes. This study aimed to investigate the association between CEA and problematic social networking site (SNS) use in a sample of Italian adolescents. Using structural equation modeling, the study examined whether the relationship between CEA and problematic SNS use was sequentially mediated by self-other differentiation and uncertain reflective functioning in 1308 Italian adolescents (628 males, age range 13-19 years). A history of CEA was positively associated with problematic SNS use. Furthermore, deficiencies in self-other differentiation and uncertain reflective functioning partially mediated the relationship between CEA and problematic SNS use. The present study provides additional insight into the psychological dynamics underpinning problematic SNS use among adolescents. The clinical implications of these findings are discussed

Measuring emptiness: Validation of the Italian version of the Subjective Emptiness Scale in clinical and non-clinical populations

Background: Although a feeling of emptiness is listed only as a symptom of the DSM-5 borderline personality disorder, it is commonly encountered in other disorders. The aim of this study was to validate the Italian version of the Subjective Emptiness Scale (SES-I), a 7-item self-report instrument assessing the feeling of emptiness. Methods: Participants in one clinical group (n = 63) and one non-clinical group (n = 48) completed the SES-I along with several other instruments. A principal component analysis was used to analyze the structure of the SES-I and Cronbach's alpha and Rho's Spearman were used to establish aspects of reliability and validity, respectively. Results: The SES-I has a unidimensional structure reflecting the core feature of the feeling of emptiness. It showed an excellent internal consistency (a = 0.92) and convergent validity, as demonstrated by significant correlations with scores on the Beck Depression Inventory – II and conceptually related scales and subscales of the Millon Clinical Multiaxial Inventory – III and Personality Inventory for DSM-5. Divergent validity was also demonstrated for the SES-I. SES-I scores in the clinical group were significantly higher than in the non-clinical group. A significant relationship was not found between the feeling of emptiness and self-harming behavior, impulsivity and acting-out. Limitations: A small sample size, several significant differences between the clinical and non-clinical groups and diagnostic heterogeneity in the clinical group limit generalizability of the study. Conclusion: The SES-I is a valid and reliable instrument, which should improve assessment of the feeling of emptiness and help clinicians better understand this complex phenomenon

Confirmatory Factor Analysis of the Nepean Dysphoria Scale in a Clinical Sample

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. The construct of dysphoria has been described inconsistently across a broad range of psychopathology. The term has been used to refer to an irritable state of discontent, but is also thought to incorporate anger, resentment and nonspecific symptoms associated with anxiety and depression, such as tension and unhappiness. The Nepean Dysphoria Scale has been developed to allow assessment of dysphoria, but its factor structure has not yet been investigated in clinical samples. We aimed to determine the latent structure of dysphoria as reflected by the Nepean Dysphoria Scale, using a clinical sample. Adults (N = 206) seeking treatment at a range of mental health services were administered the Nepean Dysphoria Scale. Four putative factor structures were investigated using confirmatory factor analysis: a single-factor model, a hierarchical model, a bifactor model and a four-factor model as identified in previous studies. No model fit the data except for a four-factor model when a revised 22-item version of the original 24-item scale was investigated. A four-factor structure similar to that identified in non-clinical samples was supported, albeit following the removal of two items. The Nepean Dysphoria Scale appears to have utility for the assessment of dysphoria in routine clinical settings

The Doctor Is In(ternet): The Mediating Role of Health Anxiety in the Relationship between Somatic Symptoms and Cyberchondria

Cyberchondria is a dysfunctional behavioral pattern characterized by an excessive and anxiety-amplifying engagement in searching for reassuring health information on the Internet. Research demonstrated that somatic symptoms and health anxiety might foster maladaptive health-related behaviors, such as cyberchondria. However, the relationships between somatic symptoms, health anxiety, and cyberchondria have been scarcely examined. Accordingly, this study aimed to test the mediating effect of health anxiety on the association between somatic symptoms and cyberchondria. Four hundred and thirty-one adults from the community (158 males, 36.66%), aged between 18 and 74, were recruited via an online survey. Participants completed self-report measures of somatic symptoms, health anxiety, and cyberchondria. A mediation analysis demonstrated that the severity of somatic symptoms predicted increased levels of cyberchondria and that health anxiety partially mediated this association. Therefore, interventions aimed at decreasing health anxiety may also play a role in decreasing the risk of developing cyberchondria

Does emotional reasoning change during cognitive behavioural therapy for anxiety?

© 2015 Swedish Association for Behaviour Therapy. Abstract: Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world. It is a key interpretative bias in cognitive models of anxiety disorders and appears to be especially evident in individuals with anxiety disorders. However, the amenability of emotional reasoning to change during treatment has not yet been investigated. We sought to determine whether emotional reasoning tendencies change during a course of routine cognitive-behavioural therapy (CBT). Emotional reasoning tendencies were assessed in 36 individuals with a primary anxiety disorder who were seeking treatment at an outpatient clinic. Changes in anxiety and depressive symptoms as well as emotional reasoning tendencies after 12 sessions of CBT were examined in 25 individuals for whom there was complete data. Emotional reasoning tendencies were evident at pretreatment assessment. Although anxiety and depressive symptoms decreased during CBT, only one of six emotional reasoning interpretative styles (pertaining to conclusions that one is incompetent) changed significantly during the course of therapy. Attrition rates were high and there was not enough information regarding the extent to which therapy specifically focused on addressing emotional reasoning tendencies. Individuals seeking treatment for anxiety disorders appear to engage in emotional reasoning, however routine individual CBT does not appear to result in changes in emotional reasoning tendencies

The structure and intensity of self-reported autonomic arousal symptoms across anxiety disorders and obsessive-compulsive disorder

© 2016 Elsevier B.V. All rights reserved. Background Heightened autonomic arousal symptoms (AAS) are assumed to be a central feature of anxiety disorders. However, it is unclear whether the magnitude and profile of AAS vary across anxiety disorders and whether heightened AAS characterises obsessive-compulsive disorder (OCD). Aims We sought to determine whether the intensity and structure of AAS varied across anxiety disorders and OCD. Method A sample of 459 individuals with a primary anxiety disorder or OCD were administered the Symptom Checklist-90R. Nine items referring to prototypic AAS were included in a latent class analysis. Results A 2-class solution (high and low AAS classes) best fitted the data. Participants comprising the high AAS class scored uniformly high across all assessed AAS symptoms. Older age and the presence of panic disorder, social anxiety disorder and generalized anxiety disorder predicted membership in the high AAS class. No OCD symptom dimension was significantly associated with membership in the high AAS class. Limitation AAS were assessed using a self-report measure and replication is needed using other methodologies. Conclusions These findings suggest that OCD may be sufficiently distinct from anxiety disorders and do not support subtyping of anxiety disorders on the basis of the predominant type of AAS. Therapeutic approaches that target AAS might best be applied in the treatment of panic disorder, social anxiety disorder and generalized anxiety disorder

Testing the spectrum hypothesis of problematic online behaviors: A network analysis approach.

The validity of the constructs of problematic Internet or smartphone use and Internet or smartphone addiction has been extensively debated. The spectrum hypothesis posits that problematic online behaviors (POBs) may be conceptualized within a spectrum of related yet distinct entities. To date, the hypothesis has received preliminary support, and further robust empirical studies are still needed. The present study tested the spectrum hypothesis of POBs in an Australian community sample (n = 1,617) using a network analysis approach. Psychometrically validated self-report instruments were used to assess six types of POBs: problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, and problematic online gambling. A tetrachoric correlation matrix was computed to explore relationships between online activities and a network analysis was used to analyze relationships between POBs. Correlations between online activities were positive and significant, but of small magnitude (0.051 ≤ r ≤ 0.236). The community detection analysis identified six distinct communities, corresponding to each POB, with strong relationships between items within each POB and weaker relationships between POBs. These findings provide further empirical support for the spectrum hypothesis, suggesting that POBs occur as distinct entities and with little overlap