Introduction
Today, the Internet is used for many purposes, such as searching for health information. Cyberchondria refers to an excessive pattern of using the Internet for health research that often leads to increased levels of anxiety or distress. One contributing factor that has been positively linked to both anxiety and problematic smartphone use and plays a significant role in maintaining obsessive-compulsive disorder (OCD) is the concept of cognitive fusion. However, it has not yet been studied in the field of cyberchondria. Cognitive fusion is defined as the tendency for both overt and covert behaviors to be overly influenced by cognition. According to Hayes, having a thought can sometimes lead to discomfort and suffering even when no painful external stimulus is present. This implies that individuals with higher levels of cognitive fusion may be at greater risk of experiencing distress across various health aspects. Another concept that is linked to anxiety and depression, OCD symptoms, and Internet addiction, but has not been explored in the field of cyberchondria, is self-compassion. Self-compassion involves treating oneself with kindness and support in tough times. 
It is important to understand how psychological mechanisms, such as self-compassion and cognitive fusion, interact with cyberchondria. One important factor that can influence the explanation of this relationship is the concept of anxiety sensitivity (AS), which is defined as the fear of emotions and physical symptoms related to anxiety. This fear stems from an individual’s belief that such anxiety-related experiences can lead to harmful physical, psychological, or social consequences. Research has shown a distinct positive association between AS and cyberchondria, indicating that AS may play a significant role in the development of cyberchondria. Repetitive negative thinking (RNT) is another significant factor that has been shown to be related to self-compassion, anxiety, depression, cognitive fusion, and OCD symptoms. It has been conceptualized as a transdiagnostic risk factor that contributes to the onset and maintenance of various depressive and anxiety disorders.
The relationship between cyberchondria and key concepts such as cognitive fusion and self-compassion has not been thoroughly explored. Additionally, the mediating role of AS in this relationship remains unclear. Therefore, the present study aimed to determine whether AS and RNT mediate the relationship of self-compassion and cognitive fusion with cyberchondria.

Methods
This is a descriptive-correlational study, utilizing structural equation modeling (SEM). The study population includes all university students in Tehran and Mazandaran provinces in 2024. Using Soper’s statistics calculator, and considering an effect size of 0.3, a test power of 0.8, and an alpha value of 0.5, the minimum sample size was calculated to be 137. The inclusion criteria were age 18-45 years, studying in one of the university courses, and consent to participate in the study. Exclusion criteria were a lack of cooperation or return of incomplete questionnaires. The data collection tools included:

Cyberchondria severity scale-12 (CSS-12)
 Developed by McElroy in 2019, CSS-12 has 12 items measuring four dimensions: Excessiveness, compulsion, distress, and reassurance seeking. Responses are rated on a five-point scale, ranging from 1 (never) to 5 (always). The Cronbach’s α for the overall scale is 0.94; for the subscales, it ranges from 0.75 (distress) to 0.95 (compulsion). In a study conducted in Iran by Foroughi et al. [68] the reported Cronbach’s α for the overall scale and the dimensions of excessiveness, distress, reassurance seeking, and compulsion were 0.91, 0.81, 0.73, 0.77, and 0.82, respectively. In our current study, the overall Cronbach’s α value was obtained as 0.85. For the subscales, it ranged from 0.73 to 0.84.

Cognitive fusion questionnaire (CFQ)
 Developed by Gillanders et al. [26] it has a one-factor structure with seven items. The Cronbach’s α of CFQ for various samples ranges from 0.88 to 0.93, and its test-retest reliability is 0.80. For its Persian version, Soltani et al. [58] demonstrated a single-factor model that explained 89.54% of the total variance. In our study, the Cronbach’s α was obtained as 0.91, confirming the instrument’s internal consistency.

Self-compassion scale (CSC)
 It is a 12-item tool developed by Neff in 2003 that measures six components of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification, rated on a five-point Likert scale from 1 (never) to 5 (always). Therefore, the total score is between 12 and 60, with higher scores indicating greater self-compassion. Neff reported an overall Cronbach’s α value of 0.92 for CSC. Each subscale also demonstrated good internal consistency, with alpha values ranging from 0.75 to 0.81. Additionally, the test-retest reliability at a two-week interval was reported as 0.93. For its Persian version, Shahbazi et al. [70] found that both concurrent validity and convergent validity of the CSC were satisfactory, and the overall Cronbach’s α value was 0.91, and for the subscales of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification were 0.83, 0.87, 0.91, 0.88, 0.92, and 0.77, respectively. In our study, we obtained an alpha value of 0.84 for the overall scale and 0.52-0.63 for the subscales. 

AS inventory (ASI)
 Developed by Floyd et al. [71] it is a self-report tool with 16 items, rated on a five-point Likert scale from 1 (very little) to 5 (very much). The Cronbach’s α value for ASI is between 0.80 and 0.90. Foroughi et al. [72] reported a Cronbach’s α of 0.90 for the Persian version. In our study, the Cronbach’s α value for the entire scale was 0.87.

Repetitive thinking questionnaire-10 (RTQ-10)
Developed in 2010 by McEvoy et al. [60] it is a 10-item tool to assess RNT, rated on a 5-point scale from one (not true at all) to five (very true). This instrument has high internal consistency (α=0.81) and a strong correlation with the 27-item RTQ score. Its test-retest reliability at a two-week interval ranges from 0.72 to 0.93. In Iran, Akbari reported a test-retest reliability of 0.76 at a two-week interval and a Cronbach’s α of over 0.91. In our study, the Cronbach’s α value for the entire scale was 0.90.
Before analyzing the data, we examined the assumptions of normality for the research variables by assessing the skewness and kurtosis values. The data were analyzed using SEM and path analysis in Amos software, version 29.

Results
Finally, 630 students participated in this study. The skewness and kurtosis values indicated the normality of data distribution. The structural model’s fit indices also fell within the desired range: χ2=384.36; χ2/df = 3.026, CFI=0.95, RMSEA=0.05, GFI=0.93, IFI=0.95, and SRMR=0.04. The two subscales, self-kindness and over-identification, were excluded from the research model due to Cronbach’s alpha values below the acceptable threshold.
The direct path from self-compassion to cyberchondria (t=1.253, β=0.079), from cognitive fusion to cyberchondria (t=0.540, β=0.054), and from RNT to cyberchondria (t=0.322, β=0.034) was not significant. However, the direct path from AS to cyberchondria was significant (t= 7.658, β=0.496). The direct path from self-compassion to AS (t=-6.130, β=-0.286) and from cognitive fusion to AS (t=9.811, β=0.375) was significant. Furthermore, the direct path from self-compassion to RNT (t=-7.324, β=-0.281) and from cognitive fusion to RNT (t=22.503, β=0.801) was significant. Figure 1 illustrates the direct relationships between variables in the SEM model.

The bootstrap method was employed with 5,000 sampling processes to assess the indirect effects. The results indicated that self-compassion had a significant indirect effect on cyberchondria through AS (b=-0.197, P<0.05). Similarly, cognitive fusion showed a significant indirect effect on cyberchondria through AS (b=0.157, P<0.05). However, the indirect effect of self-compassion on cyberchondria through RNT (b=-0.013, P>0.05) and the indirect effect of cognitive fusion on cyberchondria through RNT (b=0.023, P>0.05) were not significant. Table 1 presents the coefficients for indirect relationships. 



Conclusion
The relationship between self-compassion and cyberchondria was significantly mediated by AS. When a person has low self-compassion, they may experience self-blame in response to unfamiliar or unexpected bodily sensations. They might worry that they have contracted a serious illness due to their carelessness or inaction, which in turn can heighten their anxiety levels. Consequently, excessive and repetitive searching for health information online can become a maladaptive coping strategy for these individuals.
The relationship between cognitive fusion and cyberchondria was significantly mediated by AS. This finding suggests that cognitive fusion causes people to perceive their thoughts as if they are happening in the present moment. When a person’s behavior is heavily influenced by their thoughts—especially when they experience high cognitive fusion and have a strong sensitivity to anxiety—they may misinterpret bodily sensations and the implications of feeling anxious. As a result, they can become intensely anxious over even slight physical changes. This anxiety often leads them to engage in excessive and repetitive online health searches in an attempt to alleviate their concerns.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from the Ethics Committee of Alzahra University (Code: IR.ALZAHRA.REC.1403.046).

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization and investigation: Mehrane Pirzade; initial draft preparation: Mehrane Pirzade and Hadi Fazelirad; statistical analysis: Hadi Fazelirad; validation, editing & review: All authors.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this study.

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