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Traditional Bullying Victimization and Cyberbullying Perpetration The Role of Anger Rumination and Self-Control

This study explores the relationship between traditional bullying victimization and cyberbullying perpetration among adolescents, focusing on the roles of anger rumination and self-control. Findings indicate that anger rumination mediates the link between traditional bullying victimization and cyberbullying, while self-control moderates this relationship, with lower self-control leading to a stronger association. The research highlights the importance of understanding these mechanisms to develop effective interventions in the context of Asian schools.
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0% found this document useful (0 votes)
23 views11 pages

Traditional Bullying Victimization and Cyberbullying Perpetration The Role of Anger Rumination and Self-Control

This study explores the relationship between traditional bullying victimization and cyberbullying perpetration among adolescents, focusing on the roles of anger rumination and self-control. Findings indicate that anger rumination mediates the link between traditional bullying victimization and cyberbullying, while self-control moderates this relationship, with lower self-control leading to a stronger association. The research highlights the importance of understanding these mechanisms to develop effective interventions in the context of Asian schools.
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Psychology Research and Behavior Management

ISSN: 1179-1578 (Online) Journal homepage: www.tandfonline.com/journals/dprb20

Traditional Bullying Victimization and


Cyberbullying Perpetration: the Role of Anger
Rumination and Self-Control

Huaibin Jiang, Yinchuan Jin & Qun Yang

To cite this article: Huaibin Jiang, Yinchuan Jin & Qun Yang (2025) Traditional Bullying
Victimization and Cyberbullying Perpetration: the Role of Anger Rumination and Self-Control,
Psychology Research and Behavior Management, , 877-886, DOI: 10.2147/PRBM.S507510

To link to this article: https://doi.org/10.2147/PRBM.S507510

© 2025 Jiang et al.

Published online: 08 Apr 2025.

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Psychology Research and Behavior Management

Open Access Full Text Article


ORIGINAL RESEARCH

Traditional Bullying Victimization and


Cyberbullying Perpetration: the Role of Anger
Rumination and Self-Control
Huaibin Jiang 1 , Yinchuan Jin 2,3 , Qun Yang 2
1
School of Education, Fujian Polytechnic Normal University, Fuzhou, People’s Republic of China; 2Department of Clinical Psychology, Fourth Military
Medical University, Xi’an, People’s Republic of China; 3Innovation Research Institute, Xijing Hospital, Air Force Medical University, Shaanxi, People’s
Republic of China

Correspondence: Yinchuan Jin; Qun Yang, Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, No. 169,
Changle West Road, Xincheng District, Xi’an, Shaanxi, 710032, People’s Republic of China, Email [email protected]; [email protected]

Background: The transition from being a victim of traditional bullying to engaging in cyberbullying is an emerging area of research.
However, not all adolescents who experience traditional bullying go on to perpetrate cyberbullying. Grounded in the General
Aggression Model, this study investigates the longitudinal association between traditional bullying victimization and cyberbullying
perpetration, focusing on the underlying mechanisms.
Methods: In a longitudinal design, 442 middle school students (49.80% female, Mage = 13.02, SD = 0.85) completed a survey
including the Victim Scale, Anger Rumination Scale, Self-Control Scale, and Cyberbullying Scale at baseline enrollment and at six-
month follow-up.
Results: Key findings include: (1) T1 Traditional bullying victimization did not directly predict later T2 cyberbullying perpetration;
(2) T2 Anger rumination mediated the relationship between T1 traditional bullying victimization and T2 cyberbullying perpetration;
(3) T1 Self-control moderated the link between T2 anger rumination and T2 cyberbullying perpetration, with stronger association
observed in adolescents with lower self-control.
Conclusion: These results highlight crucial pathways from traditional bullying victimization to cyberbullying perpetration in
adolescents.
Keywords: traditional bullying victimization, anger rumination, self-control, cyberbullying perpetration

Introduction
The advent of the digital age has profoundly impacted people’s lives, particularly those in middle school settings. As
digital natives, adolescents benefit from the convenience and wealth of information available on the Internet but are also
vulnerable to cyberbullying, which involves harmful behaviors enacted through digital platforms such as the Internet or
mobile phones.1 Adolescents are at a critical developmental stage characterized by unbalanced physical and mental
growth and limited cognitive abilities.2 The anonymity provided by cyberspace facilitates the perpetration of cyberbully­
ing and complicates efforts to address and mitigate its impact. Both perpetrators and victims of cyberbullying may suffer
from psychological and behavioral issues such as anxiety and social withdrawal, which can impede their mental health
and social interactions.3,4 Research has identified a relationship between being bullied and being a bully.5,6 While the
global prevalence of cyberbullying is well documented, traditional bullying victimization remains a significant issue,
particularly in school contexts. Traditional bullying, characterized by physical and verbal aggression, continues to affect
a large number of adolescents, and its consequences often extend to the digital realm, facilitating the onset of
cyberbullying behaviors. The association between traditional bullying victimization and subsequent cyberbullying
perpetration has been explored in several studies.7 However, much of the existing research in this area has been
conducted in Western contexts, where cultural, social, and educational dynamics may differ from those in Asian schools.

Psychology Research and Behavior Management 2025:18 877–886 877


Received: 20 November 2024 © 2025 Jiang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php
Accepted: 13 March 2025 and incorporate the Creative Commons Attribution – Non Commercial (unported, v4.0) License (http://creativecommons.org/licenses/by-nc/4.0/). By accessing the work
you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For
Published: 7 April 2025 permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Jiang et al

Recent studies indicate that the factors influencing bullying behaviors in Asian contexts, such as the influence of
collectivist values, teacher-student relationships, and family dynamics, may play a unique role in shaping bullying
experiences.8–10 These studies highlight the need for further investigation into how traditional bullying victimization in
Asian schools contributes to cyberbullying perpetration and the mechanisms that drive this process.
Given the distinct cultural and social dynamics within Asian school settings, it is essential to explore these issues in
more depth. Although the relationship between traditional bullying and cyberbullying has been established, there is a lack
of research that delves into the specific pathways linking traditional bullying victimization to cyberbullying, particularly
within the Asian context. Understanding these pathways is crucial for developing culturally appropriate and effective
prevention and intervention strategies. This study aims to fill this gap by examining how traditional bullying victimiza­
tion leads to cyberbullying perpetration, with a focus on the mediating role of anger rumination and the moderating role
of self-control. In doing so, it hopes to contribute both theoretically and practically to the reduction of cyberbullying
among adolescents in Asia.

Traditional Bullying Victimization and Cyberbullying Perpetration


Traditional bullying victimization involves ongoing aggressive behavior repeatedly targeted at an individual, often
accompanied by a power imbalance.11 The General Aggression Model (GAM), rooted in social learning and social
cognitive theories, suggests that situational experiences, such as being bullied, can impact aggression through cognitive
and emotional processes.12 Victims of traditional bullying might adopt aggressive behaviors after observing how they are
treated, potentially using bullying as a maladaptive response to conflict.13 While research has identified a clear link
between traditional bullying victimization and later bullying perpetration,5 growing evidence indicates that such victims
may be more inclined to engage in cyberbullying as an act of retaliation.14
The anonymity of cyberspace reduces the risk of retaliation in real life, which makes cyberbullying an attractive
avenue for traditional bullying victims. Chu et al emphasize that the connection between traditional bullying victimiza­
tion and cyberbullying perpetration may surpass the relationship between victimization and subsequent traditional
bullying.14 Other studies also report this positive association, where traditional bullying victims engage in cyberbullying
as a means to assert control or retaliate.7,15 However, some research suggests that not all victims resort to cyberbullying
perpetration,16 indicating potential boundary conditions that may influence the relationship between victimization and
perpetration. For example, individual differences in empathy, anger rumination, or environmental factors such as peer
influence may play a role in determining whether victims turn to cyberbullying.17

Anger Rumination as a Mediator


According to the General Aggression Model (GAM), traditional bullying victimization can drive cyberbullying perpe­
tration primarily through triggering aggression-related cognitions, sensations, and arousal. Anger rumination, defined as
the tendency to dwell on anger-provoking events and their implications unconsciously,18 is a cognitive mechanism
closely associated with anger but remains relatively distinct.19 Victims of traditional bullying often revisit their
experiences repeatedly in an effort to make sense of them, which can lead to anger rumination.20 Moreover, such
individuals may process information in ways that reinforce hostile thought patterns, further fostering anger rumination.21
This cognitive bias, characterized by a focus on hostility, can contribute to cyberbullying perpetration.22 Additionally,
continually reflecting on anger-inducing events may amplify emotional distress, thereby increasing the likelihood of
engaging in cyberbullying.23 Research suggests that anger rumination mediates the link between bullying victimization
and aggressive behavior and has been shown to play a mediating role between cyber victimization and cyberbullying
perpetration.21,24 However, its mediating between traditional bullying victimization and cyberbullying perpetration
remains to be fully explored.

Self-Control as a Moderator
The General Aggression Model (GAM) posits that individual characteristics (eg, self-control) and environmental
influences (eg, victimization from traditional bullying) shape adolescents’ cognitive processes (eg, anger rumination)
and behaviors (eg, engaging in cyberbullying).13 Self-control, defined as the capacity to manage or modify one’s

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Jiang et al

responses, is essential for achieving adaptive and socially acceptable outcomes.25 Strong self-control enhances the ability
to suppress anger-related rumination,26 allowing individuals to focus more effectively on goal-directed activities while
minimizing intrusive, ruminative thoughts. In contrast, those with poor self-control may struggle to regulate future-
oriented thoughts, leading to increased rumination.27,28 Research indicates that high self-control mitigates tendencies
toward anger and aggressive behavior, disrupting cycles of rumination and alleviating negative emotional states.29
Furthermore, self-control moderates the link between anger rumination and cyberbullying.30 Specifically, low self-control
exacerbates the connection between anger rumination and cyberbullying behavior, whereas high self-control individuals
are better equipped to regulate their temper and impulses, diminishing the influence of anger rumination on cyberbullying
tendencies.

The Present Study


Previous research has investigated the link between being a victim of traditional bullying and later engaging in
cyberbullying perpetration. However, much of this work relies on cross-sectional designs, which do not allow for
establishing a definitive causal relationship between traditional bullying victimization and cyberbullying perpetration.
Moreover, the roles of anger rumination and self-control in this process remain underexplored. While some findings
indicate that anger rumination may intensify victims’ negative perceptions of bullying, thereby increasing their propen­
sity to perpetrate cyberbullying,24 these studies often focus on isolated psychological factors without examining the
interplay between anger rumination and self-control. To address these gaps, this study adopts a longitudinal approach to
investigate the mechanisms linking traditional bullying victimization to cyberbullying perpetration, considering both
anger rumination and self-control.

Method
Participants and Procedure
The study sampled students from two middle schools in Fujian, China. Initially, a representative city in Fujian Province
was selected as the target community. Within this community, two middle schools with comparable characteristics in
terms of size, teaching quality, and student demographics were randomly chosen. In each school, four classes were
randomly selected, and two waves of surveys were conducted in April 2023 (T1) and October 2023 (T2). A stratified
random sampling method was employed to ensure the broad representativeness of the sample. The surveys were
administered by trained graduate students who obtained consent from the participants and their parents one week
prior. At T1, 486 valid questionnaires were collected, and at T2, 422 valid follow-up questionnaires were gathered.
The dropout rate was 13.17%, with 64 participants lost between T1 and T2. No significant differences were found in
bullying, anger rumination, self-control, or cyberbullying scores between those who dropped out and those who
completed both surveys. The participants were aged between 12 and 16 years (Mage = 13.02, SD = 0.85), with 210
females (49.80%). The data collection procedures received approval from the Ethics Committee of the first authors’
institution. Additionally, six months have been used as an appropriate longitudinal period in prior studies.31,32

Measures
Victim Scale
The Chinese adaptation of the Victim Questionnaire was employed to assess experiences of traditional bullying
victimization.11,33 This instrument includes six items, each rated on a 4-point Likert scale (1 = “never”, 4 = “more
than four times”). An example question is: “Have classmates ever kicked, pushed, or threatened you?” Higher aggregate
scores reflect greater victimization levels. The scale has been validated with adolescents, showing satisfactory reliability
and validity.7 In this research, Cronbach’s α was 0.76.

Anger Rumination Scale


Anger rumination was measured using the Anger Rumination Scale.18,34 This scale consists of 19 items, each rated on a
4-point scale (1 = “never”, 4 = “always”). One sample item reads: “I repeatedly think about situations that made me

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angry”. Higher total scores signify higher tendencies for anger rumination. Prior studies have confirmed its psychometric
soundness among adolescents.35 The Cronbach’s α coefficient in the present study was 0.94.

Self-Control Scale
The Self-Control Scale in its Chinese version was utilized to measure levels of self-control.36,37 It comprises 13 items,
scored on a 4-point scale (1 = “strongly disagree”, 4 = “strongly agree”). A sample statement is: “Others think I exhibit
strong self-discipline”. Items 8 and 10 are reverse-coded. Higher overall scores indicate better self-control. This scale has
demonstrated robust reliability and validity in prior research.38 In this study, Cronbach’s α was 0.72.

Cyberbullying Scale
Cyberbullying perpetration was assessed using the Cyberbullying Scale.39,40 The scale includes six items rated on a 4-
point scale (1 = “never”, 4 = “several times a week”). A representative item is: “I share others’ private information
online”. Higher total scores correspond to higher levels of cyberbullying perpetration. Previous studies have demon­
strated the reliability and validity of the scale.7 In this research, Cronbach’s α was 0.78.

Data Analyses
Descriptive statistics and Pearson’s correlation analysis were conducted using SPSS 25.0 to explore the fundamental
characteristics and interrelations among the variables. The mediation of anger rumination between traditional bullying
victimization and cyberbullying perpetration was examined using Model 4 from Hayes’ PROCESS macro.41
Additionally, the moderating role of self-control in the link between anger rumination and cyberbullying perpetration
was analyzed through Model 14. Gender was controlled for in the analysis to account for its potential influence on the
study variables.

Results
Preliminary Analyses
To address the issue of potential common method bias, which may arise from self-reported measures, diagnostic testing
was performed. Harman’s single-factor test was utilized to evaluate common method bias across all items related to the
four variables: traditional bullying victimization, anger rumination, self-control, and cyberbullying perpetration.
Consistent with the threshold of 40%,42 the analysis revealed ten factors with eigenvalues greater than 1. The first factor
accounted for 22.61% of the total variance, significantly below the critical 40% cutoff. These findings suggest that
common method bias is not a major concern in this study.
The descriptive statistics are presented in Table 1. Correlation results show that traditional bullying victimization at
T1 is positively associated with anger rumination at T2. Anger rumination at T2, in turn, is positively linked to
cyberbullying perpetration, while self-control at T1 is negatively associated with anger rumination at T2.

Mediation Analysis
Figure 1 presents the mediation analysis results. Traditional bullying victimization at T1 was found to significantly
predict anger rumination at T2, which, in turn, significantly predicted cyberbullying perpetration at T2. Bootstrap testing
with a 95% confidence interval revealed that anger rumination completely mediated the link between traditional bullying

Table 1 Descriptive Statistics


Variables M (SD) 1 2 3 4

1.Traditional bullying victimizationT1 8.50(3.15) 1


2.Anger ruminationT2 35.28(11.46) 0.31** 1
3.Self-controlT1 35.14(5.47) −0.19** −0.23** 1
4.Cyberbullying perpetrationT2 6.07(0.58) 0.08 0.18** −0.09 1
Note: **p<0.01.

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Figure 1 Mediation of Anger Rumination.


Note. ***p<0.001.

victimization and cyberbullying perpetration (ab = 0.06, SE = 0.05, 95% CI = [0.001, 0.180]). The mediation effect
accounted for 83.64% of the total effect.

Moderated Mediation Analysis


Figure 2 illustrates the moderation analysis findings. Traditional bullying victimization significantly associated with
anger rumination, which then significantly predicted cyberbullying perpetration. Additionally, the interaction between
self-control and anger rumination was a significant predictor of cyberbullying perpetration, suggesting that self-control
moderates this pathway.
A simple effects analysis further explored the moderating role of self-control, as shown in Figure 3. When self-control
was low (−1 SD), the link between anger rumination and cyberbullying perpetration was stronger (Bsimple = 0.30, t = 4.88,
p < 0.001). Conversely, at high levels of self-control (+1 SD), the link became negligible (Bsimple = −0.01, t = −0.06, p
> 0.05).

Discussion
To better understand the link between traditional bullying victimization and cyberbullying, this study explores their
longitudinal relationship, focusing on the mechanisms and conditions under which traditional bullying victimization
associated with cyberbullying perpetration. The findings partially validate the hypotheses, revealing that while traditional
bullying victimization does not directly lead to cyberbullying perpetration, it exerts an indirect link through anger
rumination. Additionally, self-control moderates the relationship between anger rumination and cyberbullying
perpetration.

Figure 2 Moderated Mediation of Self-control.


Note. **p<0.01, ***p<0.001.

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Figure 3 Simple slope analysis.

Traditional Bullying Victimization and Cyberbullying Perpetration


The results reveal no direct association between traditional bullying victimization and cyberbullying perpetration six
months later, contradicting Hypothesis 1. This finding aligns with studies such as Raskauskas and Stoltz,16 which suggest
that traditional bullying victims may not necessarily transition into cyberbullying roles. Traditional bullying is typified by
repeated victimization and power imbalances,11 and the psychological impact of such experiences, including learned
helplessness, may discourage victims from retaliating through cyberbullying. Learned helplessness, a state where
individuals perceive themselves as powerless to change their circumstances, might render traditional bullying victims
less likely to exploit the anonymity and perceived safety of cyberspace to perpetrate bullying behaviors. Contrastingly,
Juvonen and Gross observed that students frequently targeted at school are significantly more likely to experience online
bullying.43 This highlights the interconnectedness of offline and online environments, underscoring the role of cyber­
space as an extension of school-based dynamics rather than an isolated risk domain. In conclusion, the absence of a direct
link between traditional bullying victimization and cyberbullying perpetration may reflect the complex interplay of
psychological, social, and contextual factors that shape victim responses. While cyberspace serves as an extension of
school-based interactions, the transition from victimization to perpetration is not uniform and is likely contingent upon a
range of individual and environmental influences. Understanding these nuances is critical for developing targeted
interventions to break the cycle of bullying across contexts.

The Mediating Role of Anger Rumination


However, traditional bullying victimization can indirectly influence cyberbullying perpetration through anger rumination,
which supports Hypothesis 2. Bullying victimization, as a strong negative stimulus, can harm adolescents’ emotional
regulation. It can immerse them in negative experiences and anger, resulting in repetitive negative thinking.20,44 This
ongoing rumination on anger not only intensifies the severity and duration of negative emotions but can also, to some
extent, weaken the inhibitory effect of learned helplessness.45 Anger rumination keeps individuals focused on the
unfairness and anger related to their bullying experiences, increasing dissatisfaction and hostility toward perpetrators
and the environment, thereby reinforcing the sense of injustice about their victimization.20 Moreover, anger rumination
can lead to a biased processing of information, increasing anger. This impairs an individual’s assessment and decision-
making about experienced events and increases the risk of aggressive behavior.46 In this emotional state, victims may
develop a strong desire for revenge or emotional release, particularly in the online environment, where such desires are

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more easily activated. The anonymity and concealment of cyberspace make adolescents more prone to engage in
cyberbullying and cyber retaliation as a way to retaliate and vent.22,24
Therefore, anger rumination can be seen as a key mediating mechanism that not only intensifies victims’ negative
emotions but also weakens the inhibitory effect of learned helplessness on cyberbullying behavior, thereby indirectly
linking traditional bullying victimization to cyberbullying behavior.

The Moderating Role of Self-Control


This study confirms Hypothesis 3 by demonstrating that self-control moderates the link between anger rumination and
cyberbullying perpetration. From the perspective of self-control resources, self-control reflects an individual’s stable
resource capacity.47 Individuals with low self-control tend to have fewer baseline resources available for regulating their
emotions and impulses compared to those with high self-control.48,49 Consequently, when experiencing the same level of
anger rumination, individuals with lower self-control often lack the resources needed to manage their emotions and
suppress impulsive behaviors, making them more susceptible to engaging in cyberbullying. Conversely, individuals with
high self-control possess a greater reserve of resources. Even when experiencing resource depletion, their stronger self-
regulatory capacity allows them to better manage their behavior and resist engaging in cyberbullying.
From the perspective of behavioral responses, individuals with high self-control respond differently to resource
depletion compared to those with low self-control. High self-control individuals can shift their attention away from
stimuli that cause depletion, focusing instead on other matters.50 This ability means that during episodes of anger
rumination, individuals with high self-control are more likely to consider the consequences of their actions and adhere to
societal norms and ethical principles.51 They can effectively interrupt the rumination process, reducing the likelihood of
cyberbullying. In contrast, adolescents with low self-control often lack robust self-regulation standards and fail to
evaluate the appropriateness of their behavior consciously. The anonymity of the online environment provides them
with a sense of “security”, encouraging impulsive actions without considering the repercussions, thereby increasing their
likelihood of cyberbullying.52

Limitations
This study acknowledges several limitations. First, the use of a longitudinal design, while helpful in exploring trends over
time, does not provide strong evidence for causality.53 As such, future research would benefit from employing more
rigorous experimental designs to better understand the causal relationship between traditional bullying victimization and
cyberbullying perpetration. Second, unobserved individual-level factors (such as personality, mental health history, and
coping mechanisms) and family-level factors (such as parenting style, socioeconomic background, and family stressors)
may significantly influence traditional bullying victimization and subsequent behaviors, such as cyberbullying perpetra­
tion. Therefore, the results should be interpreted with caution. Future research should incorporate these factors and utilize
longitudinal or multilevel models to further explore their impact. Third, this study use different time points for measuring
self-control (T1) and anger rumination (T2). Although previous research has supported the use of T1 for moderating
variables and T2 for mediating variables, this design choice limits our ability to directly assess changes in these variables
over time. Future research could consider using more consistent time points to measure both self-control and anger
rumination, allowing for a more comprehensive exploration of their dynamic interactions. Forth, this study did not
include measures of traditional bullying perpetration or cyberbullying victimization. This omission may limit our
understanding of the interplay between these behaviors and the primary constructs investigated. Future research should
consider incorporating these measures to provide a more comprehensive analysis. Lastly, the sample in this study was
limited to adolescents from Fujian, China, meaning that the results may not be generalizable to other regions or cultural
contexts. To strengthen the external validity of the conclusions, future studies should include a broader and more diverse
sample, spanning different geographical locations and cultural backgrounds.

Implications
Despite its limitations, this study makes significant contributions to both theoretical understanding and practical
applications. Theoretically, it is the first to employ a longitudinal design to explore the relationship between traditional

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bullying victimization and cyberbullying perpetration, offering a fresh perspective on this complex issue. By integrating
the GAM, this research extends the existing literature by examining how traditional bullying victimization is linked with
cyberbullying perpetration, bridging the gap between traditional and online aggression frameworks. Unlike previous
studies that primarily focused on environmental or social factors, this study highlights the significant role of anger
rumination as a cognitive-emotional mechanism that could help explain the connection between victimization and
aggressive online behaviors.
Practically, these findings provide a foundation for developing targeted intervention strategies. By focusing on
enhancing adolescents’ self-control and promoting healthier emotional regulation, such interventions could effectively
mitigate the risk of cyberbullying perpetration. Moreover, the study offers insights for designing prevention programs
that address both the immediate emotional consequences of bullying victimization and the long-term cognitive patterns
that may perpetuate aggression in digital contexts. This integrated approach holds promise for reducing cyberbullying
behaviors and fostering safer online environments for adolescents.

Data Sharing Declaration


The datasets generated and analyzed during the current study are not publicly available but are available from the
corresponding author on reasonable request.

Ethical Statement
The study was approved by the Ethics Committee of Fujian Polytechnic Normal University (2022-003) and all methods
were complied with the Declaration of Helsinki. We have obtained the informed consent from the study participants and
the parents/legal guardians.

Acknowledgments
We extend our heartfelt gratitude to the schools, teachers, parents, and adolescents for their invaluable support in making
this research possible.

Funding
This research was supported by the Joint Founding Project of Innovation Research Institute of Xijing Hospital
(LHJJ24XL09) and Rapid Response Project of Air Force Medical University (2023KXKT057).

Disclosure
The authors declare that they have no conflict of interest.

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