Metacognitive beliefs about biased thinking condition the role of anxiety sensitivity in the somatic symptom–health anxiety pathway

Somatic symptoms are closely linked to health anxiety, and anxiety sensitivity is often described as a trait-like amplifier of responses to bodily sensations. Metacognitive beliefs operate at a higher-order level and may influence the conditions under which this amplification is observed. A cross-sectional survey was completed by 564 university students, who reported on somatic symptom burden (PHQ-15), anxiety sensitivity focused on physical concerns (ASI-3 Physical), metacognitive beliefs about biased thinking (MCQ-HA Biased Thinking), and health anxiety (SHAI). Pearson correlations and regression-based conditional process analyses were used to estimate a two-way moderation model and a three-way moderated moderation model (PROCESS Models 1 and 3) with 5,000 bootstrap samples and Johnson-Neyman probing. Somatic symptoms, anxiety sensitivity, and biased-thinking beliefs were all positively associated with health anxiety. The two-way interaction between somatic symptoms and anxiety sensitivity was not clearly supported. A small but statistically significant three-way interaction indicated that anxiety sensitivity strengthened the somatic symptom to health anxiety association only at higher levels of biased-thinking beliefs, a range that applied to roughly one quarter of the sample. These findings provide preliminary support for the idea that anxiety sensitivity may act as a conditional vulnerability, increasing the impact of somatic symptoms on health anxiety primarily when metacognitive beliefs about biased thinking are high.