Elsevier

Journal of Affective Disorders

Volume 184, 15 September 2015, Pages 305-309
Journal of Affective Disorders

Preliminary communication
Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria: A replication and extension examining dimensions of each construct

https://doi.org/10.1016/j.jad.2015.06.017Get rights and content

Highlights

  • Extended extant research examining potential vulnerability for cyberchondria.

  • Potential vulnerability include sensitivity (AS) and intolerance of uncertainty (IU).

  • Examined associations among AS, IU, and cyberchondria dimensions.

  • Physical AS and inhibitory IU uniquely related to distress cyberchondria dimension.

  • Cognitive AS and social AS uniquely related to other cyberchondria dimensions.

Abstract

Background

Preliminary findings suggest that anxiety sensitivity (AS) and intolerance of uncertainty (IU) may confer vulnerability for cyberchondria, defined as repeated internet searches for medical information that exacerbates health anxiety. Prior studies are limited because it remains unclear whether specific AS or IU dimensions differentially relate to certain cyberchondria dimensions.

Methods

The present study examined associations among AS, IU, and cyberchondria dimensions using a sample of community adults (N=578) located in the United States.

Results

As predicted, physical AS and inhibitory IU were the only AS or IU dimensions to share unique associations with the distress cyberchondria dimension after controlling for the overlap among the AS dimensions, IU dimensions, and health anxiety. Cognitive AS and social AS unexpectedly evidenced unique associations with cyberchondria dimensions.

Limitations

The results are limited by the cross-sectional study design and use of a community, rather than clinical, sample.

Conclusions

This study provides evidence that specific AS and IU dimensions may confer vulnerability to certain cyberchondria dimensions. Further clarifying associations among AS, IU, and cyberchondria may lead to improvements in our conceptualization and, ultimately, treatment of cyberchondria.

Introduction

Cyberchondria refers to the phenomenon in which repeated internet searches for medical information exacerbates health anxiety (Starcevic and Berle, 2013). Cyberchondria consists of four core dimensions, including that internet searches for medical information: (a) are repetitive (excessiveness), (b) increase negative affect (distress), (c) interrupt daily living (compulsion), and (d) engender reassurance seeking (reassurance seeking; Fergus, 2014; McElroy and Shevlin, 2014; Norr et al., 2015b). Preliminary studies suggest anxiety sensitivity (AS, fear of anxiety symptoms; Reiss, 1987) and intolerance of uncertainty (IU, fear of the unknown; Carleton, 2012) may confer vulnerability for cyberchondria (Fergus, 2013a, Norr et al., 2015a).

Fergus (2013a) found an association between IU and cyberchondria, but assessed IU using a total composite score. Extending that study, Norr et al. (2015a) found that only one IU dimension (i.e., inhibitory IU) shared a unique association with cyberchondria. IU consists of two dimensions – prospective (cognitively focused reactions) and inhibitory (behaviorally focused reactions) – within contemporary conceptualizations (Carleton et al., 2007a). Although Norr et al. (2015a) examined these separate IU dimensions, AS was assessed using a general latent factor. As such, associations between AS dimensions and cyberchondria remain unexamined. AS consists of three dimensions – physical (concerns about immediate medical complications), cognitive (concerns about mental incapacitation), and social (concerns about social rejection due to publically observable symptoms of anxiety) – within contemporary conceptualizations (Taylor et al., 2007). Interestingly, physical AS has consistently shared the most robust association with health anxiety (Fergus and Bardeen, 2013; Olatunji et al., 2009; Stewart et al., 2008). The overlap between health anxiety and cyberchondria (Fergus, 2014, Norr et al., 2015b) suggests physical AS could be the AS dimension most relevant to cyberchondria. Finally, although distress and excessiveness share the most robust association with health anxiety (Fergus, 2014, Norr et al., 2015b), neither Fergus (2013a) nor Norr et al. (2015a) examined whether AS or IU dimensions differentially relate to cyberchondria dimensions.

The lack of data speaking to such possible differential associations represents a gap in the literature, as prior research has found that AS and IU dimensions differentially relate to symptom types (Deacon and Abramowitz, 2006, McEvoy and Mahoney, 2011). Finding that AS and IU dimensions differentially relate to cyberchondria dimensions could highlight the possibility that specific concerns surrounding anxiety symptoms or the unknown may become targets of intervention for certain aspects of cyberchondria. To fill the identified gap in the literature, the present study provided the first known examination of differential associations among AS, IU, and cyberchondria dimensions. It was predicted that, although each of the AS and IU dimensions would share significant raw associations with the cyberchondria dimensions, only physical AS and inhibitory IU would uniquely associate with distress and excessiveness while controlling for the overlap among the other AS/IU dimensions and health anxiety.

Section snippets

Participants

The sample was 578 adults recruited using Amazon's Mechanical Turk (MTurk), an online crowd-sourcing website. Only participants denying being diagnosed with a physical health condition were included to ensure minimal effects of physical health status on health anxiety following Abramowitz et al. (2007) and, consequently, cyberchondria. The mean age was 31.2 years (SD=9.8). Participants were primarily male (56.3%), white (74.0%), had completed an associate degree or higher (59.6%), and were

Results

Descriptive statistics and zero-order correlations are presented in Table 1. Skew and kurtosis statistics fell below cutoffs identified by Kline (2011) for indicating “extreme” skew (>3.0) or kurtosis (>10.0). As expected, the study variables shared significant raw correlations. The main study predictions were examined using hierarchical multiple linear regressions. Health anxiety was entered into Step 1 and both the AS and IU dimensions were simultaneously entered into Step 2. The increased

Discussion

Inhibitory IU shared a predicted unique association with distress. Inhibitory IU is marked by behavioral reactions to uncertainty, including negative reactions to uncertainty and the desire to avoid uncertainty (Carleton et al., 2007a). Internet searches for medical information often lead to the consideration of multiple medical possibilities (White and Horvitz, 2009). Individuals who react negatively to and/or want to avoid uncertainty may consequently be especially likely to experience

Role of funding source

Nothing declared.

Conflict of interest

No conflict declared.

Acknowledgments

None.

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      Intolerance of uncertainty seems to be an important predictor of health anxiety appearing in the context of online searches for health information (Fergus, 2013; Starcevic et al., 2019). A moderately strong relationship between cyberchondria and the inhibitory type of intolerance of uncertainty (interpretation of uncertainty as paralyzing) has been found, with correlation coefficients of 0.47 (Fergus, 2015), 0.50 (Norr et al., 2015a), and 0.52 (Fergus and Spada, 2017). Cyberchondria is less strongly related to prospective intolerance of uncertainty (intolerance of uncertainty with regard to the future), with correlation coefficients of 0.33 (Fergus, 2015), 0.38 (Norr et al., 2015a), and 0.44 (Fergus and Spada, 2017).

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