4-STEP-Training Program for Doomscrolling, Cyberchondriac Behavior and Psychiatric Symptoms (4-STEP-TPS) Among Individuals With Social Media Addiction

Primary outcomes

1. Social Networking Addiction Scale (SNAS)

   Time frame: At screening, after 4 weeks, and reassessment up to 6 months

   The Social Networking Addiction Scale (SNAS) was developed to measure addiction of all forms of social networking across six-dimensions salience (items 1-4), mood modification (items 5-7), tolerance (items 8-10), withdrawal (items 11-14), conflict (item 15-17), and relapse (items 18-21) (Shahnawaz & Rehman, 2020). The SNAS is a self-reported scale which entails 21-items scale rated on 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The score can range from 21 to 147. Any score above a total score of 84 signifies addiction. The scale has demonstrated good test-retest reliability of 0.88 and good validity as reported by Shahnawaz and Rehman (2020).

2. Cyberchondria Severity Scale (CSS-12)

   Time frame: At screening, after 4 weeks, and reassessment up to 6 months

   The Cyberchondria Severity Scale-12 (CSS-12), developed by Eoin McElroy et al. (2019), is a 12-item self-report measure assessing excessive, anxiety-provoking online health searches across four dimensions: compulsion, distress, excessiveness, and reassurance-seeking. Items are rated on a 5-point Likert scale (1 = Never to 5 = Always), with total scores ranging from 12-60; higher scores indicate greater cyberchondria. The scale is brief, reliable, and valid, suitable for both clinical and non-clinical populations, and widely used to evaluate problematic health-related online behavior.

3. Doomscrolling Scale (DS)

   Time frame: At screening, after 4 weeks, and reassessment up to 6 months

   The Doomscrolling Scale was developed to assess compulsive engagement with negative online news content and excessive scrolling behavior, particularly during times of crisis (Sharma et al., 2022). The scale measures three core dimensions: obsessive news consumption, emotional distress, and behavioral compulsion. It is a self-report instrument consisting of 15 items rated on a 5-point Likert scale ranging from 1 (never) to 5 (always). The total score is calculated by summing all item responses, with higher scores indicating greater levels of doomscrolling behavior. The scale has demonstrated good internal consistency (Cronbach's α = 0.88) and satisfactory construct validity (Sharma et al., 2022).

4. Short Health Anxiety Inventory (SHAI)

   Time frame: At screening, after 4 weeks, and reassessment up to 6 months

   The Short Health Anxiety Inventory (SHAI) was developed to assess health-related anxiety and preoccupation with physical symptoms, independent of actual medical status (Salkovskis et al., 2002). The scale measures two main dimensions: perceived likelihood of illness and perceived negative consequences of illness. It is a self-report instrument consisting of 18 items, each presenting four response options scored from 0 to 3, reflecting increasing levels of health anxiety. Total scores range from 0 to 54, with higher scores indicating greater levels of health anxiety. The SHAI has demonstrated excellent internal consistency, with reported Cronbach's alpha values ranging from 0.86 to 0.95, and strong convergent and construct validity. The HAI is a reliable and valid measure of health anxiety (Salkovskis et al., 2002).

5. Patient Health Questionnaire-9 (PHQ-9)

   Time frame: At screening, after 4 weeks, and reassessment up to 6 months

   The Patient Health Questionnaire-9 (PHQ-9) was developed to measure the severity of depressive symptoms based on the diagnostic criteria of major depressive disorder (Kroenke et al., 2001). The scale assesses nine core symptoms of depression, including low mood, loss of interest, fatigue, sleep disturbances, appetite changes, concentration difficulties, feelings of worthlessness, psychomotor changes, and suicidal ideation. The PHQ-9 is a self-report instrument consisting of 9 items rated on a 4-point Likert scale ranging from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27, with higher scores indicating greater severity of depressive symptoms. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders(The PHQ-9 - Kroenke - 2001 - Journal of General Internal Medicine - Wiley Online Library, 2001).