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

Background: 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. Methods: 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. Results: 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. Conclusion: 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.