Modeling Health Anxiety Based on Psychological Flexibility with the Mediating Role of Pain Perception in Women with Breast Cancer
Keywords:
Health anxiety, Psychological flexibility, Pain perception, Breast cancer, Structural equation modelingAbstract
The present study aimed to model health anxiety based on psychological flexibility with the mediating role of pain perception in women with breast cancer. This study employed a descriptive-correlational design using structural equation modeling (SEM). The statistical population consisted of women aged 30–55 years with early-stage breast cancer who were undergoing treatment or active follow-up in medical centers in Shiraz, Iran, in 2025. A total of 230 participants were selected through purposive sampling. Data were collected using the Short Health Anxiety Inventory (SHAI), the Acceptance and Action Questionnaire-II (AAQ-II), and the McGill Pain Questionnaire (MPQ). Data analysis was conducted using SPSS version 26 and AMOS. After evaluating normality, outliers, and multicollinearity assumptions, the measurement and structural models were tested. Model fit was assessed using χ²/df, RMSEA, CFI, NFI, GFI, and AGFI indices. The proposed structural model demonstrated acceptable fit to the data (χ²/df = 2.10, RMSEA = .05, CFI = .94, NFI = .91, GFI = .96, AGFI = .94). Psychological flexibility had a significant negative direct effect on health anxiety (β = −.22, p = .001) and pain perception (β = −.42, p = .001). Pain perception showed a significant positive direct effect on health anxiety (β = .39, p = .001). Furthermore, the indirect effect of psychological flexibility on health anxiety through pain perception was significant (β = −.15, p = .02), indicating a partial mediating role of pain perception. These findings suggest that higher psychological flexibility is associated with lower pain perception and reduced health anxiety among women with breast cancer. Psychological flexibility functions as a protective factor against health anxiety in women with breast cancer both directly and indirectly through its influence on pain perception. Interventions aimed at enhancing psychological flexibility and reducing maladaptive pain-related interpretations may contribute to lower health anxiety and improved psychological adjustment in this population.
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Copyright (c) 2026 Maryam Khorami (Author); Shahin Fathi Hafshejani; Ali Mohammad Rezaei (Author)
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