1. Introduction
The prevalence of Coronavirus Disease 2019 (COVID-19) caused by the Corona virus’s highly acute respiratory syndrome presented adverse effects on global health systems. It also had multiple consequences on every aspect of human life, especially mental health [4]. 
Hypochondriasis is the preoccupation with having a severe illness or the possibility of having it for at least 6 months when there are no signs or symptoms, or they are very few and cause functional impairment in critical areas of life [7].  The metacognitive model in the etiology of mental disorders emphasizes the role of metacognition in the etiology and persistence of mental disorders, including hypochondriasis. Furthermore, the lack of sufficient research on hypochondriasis disorder and the prevalence of COVID-19 as an epidemic at the community level, we aimed to comparatively study the metacognitive beliefs between COVID-19 hypochondriasis patients and healthy individuals.
2. Methods 
This was a causal-comparative study. The study’s statistical population included all patients with hypochondriasis COVID-19 referring to Imam Reza Clinic and Amirkabir Hospital in Arak City, Iran, and 30 members of the healthy population of Arak Islamic Azad University employees. The study subjects were selected by the convenience sampling method from February 2020 to June 2020 and matched on age and educational level. The hypochondriasis specimens were individuals who had recurrence or exacerbation of hypochondriasis following the outbreak of COVID-19. There was not necessarily a cause-and-effect relationship between COVID-19 and hypochondriasis disorder.
The inclusion criteria included being diagnosed by COVID-19 hypochondriasis by a psychiatrist, the age range of 30 to 50 years, and providing an informed consent form. The exclusion criteria included not having a generalized anxiety disorder, panic disorder, delusional physical disorder, or obsessive-compulsive disorder.
The necessary data were collected based on the 1997 Wells Metacognition Questionnaire (MCQ 30) short form. Finally, the collected data were analyzed by SPSS using Multivariate Analysis of Variance (MANOVA).
3. Results
The present study findings suggested the following data in individuals with COVID-19 hypochondriasis, compared with their healthy counterparts: in the cognitive self-awareness, it included positive beliefs about anxiety with an average of 15.06 negative beliefs about thought control with an average of 17.40, and cognitive uncertainty with an average of 16.50; the need to control thoughts with an average of 16.23, and cognitive self‐consciousness with an average of 12.23 scored higher.
The obtained results also outlined a significant difference in the linear composition of metacognitive beliefs concerning the group (P=0.001, F=30.59). Moreover, the results of the ETA coefficient revealed that 86% of the variance of dependent variables is explained by grouping the variables of normal individuals and patients with COVID-19 hypochondriasis.
The MANOVA results reflected a significant difference in metacognitive beliefs between the healthy subjects and hypochondriasis patients in the form of positive beliefs about anxiety (F=23.64), negative beliefs about thought control (F=11.48), cognitive uncertainty (F=6.91), a need to control thoughts (F=13.01), and cognitive self‐consciousness (F=9.09).
4. Discussion and conclusion:
The test results revealed a significant difference in metacognitive beliefs between patients with COVID-19 hypochondriasis and healthy individuals. This result is in line with the findings of Bailey and Wells (2011) [20], (2015) [16], Kor et al. (2011) [21], Melli et al. (2016) [22], and Zolfaghari and Hashemi (1398) [23]. The existence of dysfunctional metacognitive beliefs of patients compared to healthy individuals was consistent.
The research results by Wright Hutton Wells Wells and Papa Giorgio [24] suggest that positive and negative metacognitive beliefs positively correlate with individual talent versus pathological concern.
 The high need for thought control in patients with COVID-19 hypochondriasis compared to normal individuals was also consistent with those of Boalda et al. (2008) [13]. Cognitive self‐consciousness was also lower in patients than in normal individuals. In their research, Bowman and Major [25] emphasize patients’ concerns with disease-related issues. According to his study, patients with hypochondriasis are more prone to worry about disease-related issues than general issues. Deficiency in cognitive self‐consciousness and attention to specific content (concern about physical symptoms) exacerbates anxiety and disturbs anxiety.
Overall, these studies indicated stable correlations between metacognitive beliefs and Covid self-morbidity disorder. These correlations have been reported for positive and negative metacognitions. Beliefs about uncontrollability and the danger of thoughts are fundamental.
Therefore, due to the comprehensive and profound negative impact that this disorder has on the individual and the health system, and according to the successful results of research on metacognitive therapy of hypochondriasis patients and recognizing dysfunctional metacognitive beliefs of these patients, metacognitive therapy can be an effective treatment for this disorder.

Ethical Considerations
Compliance with ethical guidelines
The present study was registered with the code IR.IAU.ARAK.REC.1399.036 in the ethics committee of Islamic Azad University, Arak branch and was defended in the form of a master's thesis in clinical psychology in September 2016. Prior to the study, informed consent was obtained and the subjects could leave the study at any stage of the study if they wished.

Funding
The authors declared no conflict of interest.

Authors' contributions
Supervisor: Hamidreza Jamilian; Conceptualization, methodology, data collection, data analysis and financing, and resources: Mansoureh Nourizadeh; Review, original draft, review and editing: All authors.

Conflicts of interest
The authors declared no conflicts of interest. 

Acknowledgements
The researchers express their gratitude and appreciation for the sincere cooperation of experts and specialists in the field of medicine, especially the medical staff of Imam Reza Clinic and Amirkabir Hospital in Arak.


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