Fear of the unknown: One fear to rule them all?

Uncertainty Makes Me Emotional: Uncertainty as an Elicitor and Modulator of Emotional States

Uncertainty and emotion are an inevitable part of everyday life and play a vital role in mental health. Yet, our understanding of how uncertainty and emotion interact is limited. Here, an online survey was conducted (n = 231) to examine whether uncertainty evokes and modulates a range of negative and positive emotions. The data show that uncertainty is predominantly associated with negative emotional states such as fear/anxiety. However, uncertainty was also found to modulate a variety of other negative (i.e., sadness/upset, anger/frustration, and confusion) and positive (i.e., surprise/interest and excited/enthusiastic) emotional states, depending on the valence of an anticipated outcome (i.e., negative and positive) and the sub parameter of uncertainty (i.e., risk and ambiguity). Uncertainty increased the intensity of negative emotional states and decreased the intensity of positive emotional states. These findings support prior research suggesting that uncertainty is aversive and associated with negative emotional states such as fear and anxiety. However, the findings also revealed that uncertainty is involved in eliciting and modulating a wide array of emotional phenomena beyond fear and anxiety. This study highlights an opportunity for further study of how uncertainty and emotion interactions are conceptualised generally and in relation to mental health.

An integrative review of the use of the concept of reassurance in clinical practice

Aim

To synthesize evidence on the concept of reassurance in nursing practice.

Design

Integrative review.

Review Method

PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962).

Results

Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.

Factors Associated With Experiences of Fear, Anxiety, Depression, and Changes in Sleep Pattern During the COVID-19 Pandemic Among Adults in Nigeria: A Cross-Sectional Study

Background

Multiple facets of the pandemic can be a source of fear, depression, anxiety and can cause changes in sleep patterns. The aim of this study was to identify health profiles and the COVID-19 pandemic related factors associated with fear, depression, anxiety and changes in sleep pattern in adults in Nigeria.

Methods

The data for this analysis was extracted from a cross-sectional online survey that collected information about mental health and well-ness from a convenience sample of adults 18 years and above resident in Nigeria from July to December 2020. Study participants were asked to complete an anonymous, closed-ended online questionnaire that solicited information on sociodemographic profile, health profiles (high, moderate and low COVID-19 infection risk profile) including HIV status, COVID-19 status, and self-reported experiences of fear, anxiety, depression and changes in sleep patterns.

Results

In total, 4,439 participants with mean age of 38.3 (±11.6) years responded to the survey. Factors associated with higher odds of having COVID-19 related fear were health risk (p < 0.05); living with HIV (AOR: 3.88; 95% CI: 3.22-4.69); having COVID-19 symptoms but not tested (AOR: 1.61; 95% CI: 1.30-1.99); having a friend who tested positive to COVID-19 (AOR: 1.28; 95% CI: 1.07-1.53) and knowing someone who died from COVID-19 (AOR: 1.43; 95% CI: 1.24-1.65). The odds of feeling anxious was significantly higher for those with moderate or low health risk profile (p < 0.05); living with HIV (AOR: 1.64; 95% CI: 1.32-2.04); had a friend who tested positive for COVID-19 (AOR: 1.35; 95% CI: 1.08-1.68) or knew someone who died from COVID-19 (AOR: 1.53; 95% CI: 1.28-1.84). The odds of feeling depressed was significantly higher for those with health risk profile (p < 0.05); living with HIV (AOR: 2.49; 95% CI: 1.89-3.28); and respondents who had COVID-19 symptoms but had not taken a test (AOR: 1.41; 95% CI: 1.02-1.94). Factors associated with higher odds of having sleep pattern changes were having moderate and low health risk profiles (p < 0.05).

Conclusion

The study findings suggest that the pandemic may cause fear, anxiety, depression and changes in sleep patterns differently for people with different health profile, HIV status and COVID-19 status.

Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample

Intolerance of uncertainty (IU) has been conceptualized as a transdiagnostic vulnerability for emotional psychopathology, but few studies have tested whether it prospectively predicts emotional psychopathology, and none have utilized transdiagnostic and clinician-rated outcomes. To fill this gap, the present study tested whether IU prospectively predicted the clinician-rated severity of transdiagnostic emotional psychopathology six months later in a treatment-seeking Veteran sample. Participants completed the Intolerance of Uncertainty 12-item scale (IUS-12) and the Structured Clinical Interview for the DSM-5 (SCID-5) at Time 1 and again six-months later (Time 2); assessed emotional disorders included both anxiety-related disorders (i.e., post-traumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, specific phobia) and depressive conditions (i.e., major depressive disorder and persistent depressive disorder). Linear regression analyses revealed a bidirectional prospective relation between IU and emotional psychopathology, wherein higher Time 1 IUS-12 predicted greater Time 2 emotional disorder severity and greater Time 1 emotional disorder severity predicted higher Time 2 IUS-12. Follow-up analyses revealed that IU prospectively predicted the maintenance (but not the development) of anxiety-related issues, whereas prediction of Time 2 depression was nullified when controlling for Time 1 anxiety pathology. These findings implicate IU as a transdiagnostic vulnerability for emotional psychopathology and suggest the construct can be particularly useful as a treatment target and prognostic indicator for anxiety-related conditions.

Intolerance of uncertainty moderates the relationship between catastrophizing, anxiety, and perceived pain in people with chronic nononcological pain

OBJECTIVE

Substantial empirical evidence has shown that intolerance of uncertainty is a central transdiagnostic feature in psychopathology and it has been suggested to be a pain-related psychological factor contributing to the experience of chronic pain. However, research in this area is virtually nonexistent. The objective of this study was to investigate associations between pain severity, catastrophizing, and anxiety in people with chronic nononcological pain, while assuming that intolerance of uncertainty moderates these relationships.

METHODS

A convenience sample of 188 individuals with nononcological chronic pain (157 women and 32 men) participated in the study. We investigated the moderated mediation of intolerance of uncertainty between anxiety and catastrophizing and between catastrophizing and pain intensity.

RESULTS

The full moderated mediation model accounted for significant variance in pain intensity (R2 = .148, P< .001). Intolerance of uncertainty significantly moderated the interaction between anxiety and catastrophizing (B = 0.039, SE = 0.012, CI [0.015, 0.063]) and between catastrophizing and pain intensity (B = -0.034, SE = 0.010, CI [-0.054, -0.014]). Anxiety and intolerance of uncertainty did not interact in predicting catastrophizing, although an interaction effect was found between intolerance of uncertainty and catastrophizing in predicting pain intensity.

CONCLUSION

This study is the first to address the interrelationship of intolerance of uncertainty, catastrophizing, and anxiety in relation to perceived pain intensity. The current findings support intolerance of uncertainty as a relevant psychological variable that is distinct from other relevant constructs in the setting of pain research and treatment.

A Predictive Study Between Anxiety and Fear of COVID-19 With Psychological Behavior Response: The Mediation Role of Perceived Stress

OBJECTIVE

Despite the abundance of studies linking fear and anxiety to COVID-19, there are limited studies that examine how these elements impact psychological behavioral responses, especially in Iran. The aim of this study was to investigate the relationship between anxiety and fear of COVID-19 with psychological behavior response, whether this relationship is mediated by role of perceived stress among Iranian population during the COVID-19 pandemic.

METHODS

A predictive cross-sectional study was used to investigate the relationships between COVID-19 anxiety syndrome, fear of COVID-19 with psychological behavioral responses due to the pandemic, and the mediating role of the COVID-19 perceived stress in these relationships.

RESULTS

The current study revealed that during the COVID-19 pandemic, fear and anxiety of COVID-19 can influence the psychological behavioral responses of individuals; however, this can be explained through perceived stress.

CONCLUSION

As such, the current study points out that the individuals who perceived high stress due to COVID-19 were more likely to comply with guidelines, which has given new insight into this field. The current study findings are applicable for health policymakers in order to help them in understanding human behavior for developing health promotion programs and also for fostering resilience among the general population.

Ethnic differences in behavioral and physiological indicators of sensitivity to threat

The clinical presentation of anxiety may differ between Hispanics/Latinx (H/L) and non-H/L, although findings on ethnic differences in self-reported anxiety symptoms have been mixed. Fewer studies have focused on ethnic differences in quick and relatively automatic laboratory-assessed indicators of anxiety symptoms, which have the potential to be more objective indicators than self-report. Therefore, the present study examined ethnic differences in two laboratory-assessed indicators of threat sensitivity (an important transdiagnostic mechanism of anxiety): attentional bias to threat and electromyography startle reactivity to threat. White H/L (n = 117) and White non-H/L (n = 168) adults who were matched on demographics and lifetime psychopathology (including anxiety) completed a dot-probe task to assess attentional bias to threat and the No-Predictable-Unpredictable threat (NPU) task to assess startle reactivity to threat. Results indicated that H/L displayed less Slow OrientationRB (β = -0.27, p = 0.032, R2β∗ = 0.02), and increased Slow DisengagementRB (β = 0.31, p = 0.016, R2β∗ = 0.02) compared to non-H/L. H/L exhibited blunted overall startle compared to non-H/L (β = -0.30, p = 0.014, R2β∗ = 0.02), but groups did not differ in startle reactivity to either predictable or unpredictable threat. In summary, H/L and non-H/L may differ in their experience and presentation of anxiety symptoms and such differences may vary across indicators of sensitivity to threat.

Coping through the unknown: School staff wellbeing during the COVID-19 pandemic

Approximately one quarter of all teachers experience feelings of stress throughout their careers, for many this leads to emotional exhaustion and burnout. In this article we present a case study that explores the wellbeing of three teaching staff from an Australian Primary School, during the COVID-19 pandemic. The Transactional Model of Stress and Coping devised by Lazarus and Folkman was used as the framework to interpret this group of experiences. The findings indicated that the additional stress induced by fear of the 'unknown' imposed by the pandemic further intensified the emotional toll experienced by participants. These emotional responses included feelings of guilt about their providing the best education for students, anxiety about the unknown implications on schooling and frustration at the lack of communication and inconsistent decision making by people holding leadership positions. Despite this, these teaching staff shared many positive strategies for coping and grow through the experience.

The Serbian COVID-19 Stress Scale (Serbian-CSS) and vaccine acceptance: Is there a place for COVID-19-related distress in explaining attitudes towards vaccination?

Objectives

Previous research has shown that the COVID-19 Stress Scale (CSS), a measure assessing various dimensions of distress related to the COVID-19 pandemic, is associated with self-protective behaviours; however, it remains unknown whether this distress can be used to predict attitudes towards vaccination. The purpose of this study was to validate the Serbian CSS (Serbian-CSS) and to explore its predictive power over and above certain sociodemographic characteristics, individual difference variables (attitudes and personality) and general distress in relation to COVID-19 vaccine acceptance.

Study design

An online cross-sectional study was conducted that targeted users of different social network groups at the beginning of the public COVID-19 vaccination programme in Serbia.

Methods

A large, online study sample (N = 3129) provided self-reported data on COVID-19-related distress, health and sociodemographic indicators, individual difference variables and attitudes towards vaccination.

Results

The Serbian-CSS is a valid and reliable instrument that assesses six dimensions of COVID-19 distress. The strongest predictors of vaccine acceptance were attitudes towards immigrants (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] 0.31, 0.41), followed by education (AOR = 1.51, 95% CI 1.27, 1.88) and prepandemic mental health issues (AOR = 1.61, 95% CI 1.30, 2.01).

Conclusions

The level of distress measured by the CSS had a non-substantial contribution to vaccine acceptance, which is probably because of the mild level of distress that was observed at the time of assessment. Public health messaging that relies on the distribution of information is not sufficient to address strongly held beliefs against vaccination. The study provides a benchmark for future cross-cultural research regarding negative affective states associated with the COVID-19 pandemic.

How deep is your thought? The relations between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa

BACKGROUND

Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations.

METHODS

In a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested.

RESULTS

A total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation.

CONCLUSIONS

These results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa. Adolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.

Split-Second Unlearning: Developing a Theory of Psychophysiological Dis-ease

Psychophysiological “stress” underpins many conditions including anxiety, depression, phobias, chronic fatigue syndrome and non-specific musculoskeletal pain such as fibromyalgia. In this article we develop an understanding of chronic psychophysiological stress from a psychological educational perspective, by drawing on supporting evidence that significant emotional events in early life (traumatic and benign) can influence health and well-being later in life. We suggest that traumatic events instigate psychophysiological “stress” responses and the formation of emotional memory images (EMIs) within very short time frames, i.e., “split-second learning.” Once formed these emotional memories are triggered in daily living “re-playing” psychophysiological stress responses, resulting in chronic psychophysiological “dis-ease.” We describe a novel therapeutic approach to scan clients for mannerisms signifying a subconscious “freeze-like” stress response that involves the client as a curious observer within their own experience, feeding back the non-verbal cues as they arrive in the moment. By breaking down the observable fragments of their split-second Pavlovian response to the trigger, clients can detach their EMI from the psychophysiology stress response, i.e., “split-second unlearning.” Our split-second unlearning model recognizes the EMI as a barrier to moving forward and needs to be unlearned before the client can become naturally adaptive again. We argue that this approach places the client at the center of the work without the need of getting bogged down in a life-long narrative.

Intolerance of Uncertainty and Tendency to Worry as Mediators Between Trust in Institutions and Social Support and Fear of Coronavirus and Consequences of the Pandemic

The aim of this article is to formulate and test a model integrating cognitive behavioral therapy (CBT) findings regarding the importance of intolerance of uncertainty (IU) and tendency to worry with findings regarding the importance of trust in institutions, other people, and social support. We assumed that trust in institutions, other people, and social support reduce fear of the coronavirus and of the consequences of the pandemic in a direct way, but also indirectly by enhancing one’s sense of control and diminishing the tendency to worry which, further, attenuates fear of the coronavirus and fear of the consequences of the pandemic. An online survey was conducted among the Serbian general population (N = 1409, 78.1% female, M = 38.82, SD = 9.24) at the end of April 2020, which included questionnaires on fear of SARS-CoV-2, fear of consequences of the pandemic, social support, trust in other people and trust in political and health institutions. The model has been validated by data from our study suggesting that it represents one possible pattern of interrelationships between social and intrapsychic variables in the pandemic situation. Results also showed that the COVID-19 related fears are related more strongly to intrapsychic variables – IU and tendency to worry – than to variables operationalizing social context relevant for coping with pandemic at the social and individual level.

COVID-19 Pandemic Impacts on the Mental Health of Professional Soccer: Comparison of Anxiety Between Genders

This study verifies associated factors with trait and state anxiety in professional soccer teams during the COVID-19 pandemic. The sample was composed of 315 athletes, coaches, and physical trainers of professional soccer teams during the COVID-19 pandemic. From this amount, 214 were classified with trait anxiety, and 315 were classified with state anxiety using the State-Trait Anxiety Inventory (STAI). This study is an epidemiological and cross-sectional study. We applied an observational method, and we performed a remote measurement. The measurement was made via online questionnaires in male and female individuals working on soccer teams (soccer professionals or athletes) who could be affected by anxiety during social isolation in the COVID-19 pandemic. Each questionnaire was composed of sociodemographic questions, self-perceived performance, and STAI. The main results indicated a significant difference between female vs. male soccer professionals in state anxiety (54.97 ± 9.43 vs. 57.65 ± 9.48 index) and trait anxiety (54.21 ± 5.74 vs. 55.76 ± 6.41 index) with higher results in men. Sociodemographic variables impacted significant differences between female and male athletes and professionals of soccer clubs, and anxiety during the pandemic COVID-19 period impacted self-perceived performance analysis. The present results highlight the importance of cognitive behavior therapy for professional soccer teams.

Attentional Control Moderates the Relations between Intolerance of Uncertainty and Generalized Anxiety Disorder and Symptoms

BACKGROUND

Intolerance of uncertainty (IU), perceived attentional control (AC), and poor cognitive control abilities are risk factors for anxiety; however, few studies have examined their interactive effects in relation to anxiety. A more complete understanding of interplay between IU, perceived AC, and cognitive control could inform intervention efforts.

METHODS

The current study examined the direct and interactive effects of IU and AC on anxiety in a sample of 280 community outpatients (M age = 36.01 years, SD = 16.17). Perceived AC was measured using self-report and cognitive control abilities were measured using a Go/No-Go task.

RESULTS

Findings indicated a significant IU by perceived AC interaction predicting worry and GAD diagnoses. There was a positive relation between IU and worry/GAD diagnoses that was strongest among those with high perceived AC. Perceived AC was unrelated to cognitive control abilities, and cognitive control abilities did not interact significantly with IU. Cognitive control abilities were related to worry symptoms but not to GAD diagnoses.

CONCLUSIONS

These results indicate that at high levels of perceived AC, individuals with elevated IU report higher levels of worry, potentially due to the conscious use of worry as an emotion regulation strategy. Clinical implications and future directions are discussed.

To fear the unknown: Covid-19 confinement, fear, and food choice

The coronavirus outbreak in December 2019 completely changed the dynamic of consumption in different sectors of industry. The food and beverage industries have been profoundly affected, from production, to modifications in consumers' choices. Among the different reasons behind those modifications is confinement, which forces consumers to stay at home for an extended period and just go out to perform essential tasks, such as going to the supermarket. We hypothesized that this new dynamic of consumption could create a situation of fear that changes food choice. To test this hypothesis, two studies were conducted in three countries with a different degree of confinement: Mexico (flexible), Spain (strict), and Peru (hard). Study one consisted of a free association task with 60 participants in each country with the inductor word "coronavirus and food". The different associations served as the basis to build a structured questionnaire, which was used in the second study focused on fear and food choice. The second study was applied to 450 participants in the same three countries. Results showed that fear can be separated into nine dimensions: social, emotional, food supply, government, basic needs, food-delivery, overeating, immunity, and family conflicts. The participants could also be clustered into four different groups that differ in their country of origin and sex, but also in their food choice. Overall, the results showed that fear influenced consumer's food choices during a confinement period.

Intolerance of uncertainty and physiological responses during instructed uncertain threat: A multi-lab investigation

Individuals with high self-reported Intolerance of uncertainty (IU) tend to interpret uncertainty negatively. Recent research has been inconclusive on evidence of an association between IU and physiological responses during instructed uncertain threat. To address this gap, we conducted secondary analyses of IU and physiology data recorded during instructed uncertain threat tasks from two lab sites (Wisconsin-Madison; n = 128; Yale, n = 95). No IU-related effects were observed for orbicularis oculi activity (auditory startle-reflex). Higher IU was associated with: (1) greater corrugator supercilii activity to predictable and unpredictable threat of shock, compared to the safety from shock, and (2) poorer discriminatory skin conductance response between the unpredictable threat of shock, relative to the safety from shock. These findings suggest that IU-related biases may be captured differently depending on the physiological measure during instructed uncertain threat. Implications of these findings for neurobiological models of uncertainty and anticipation in anxiety are discussed.

The Relationship Between Intolerance of Uncertainty and Employment Anxiety of Graduates During COVID-19: The Moderating Role of Career Planning

COVID-19, which is characterized by uncertainty, makes the employment anxiety of college graduates in the period of career change more and more intense. How to deal with this challenge is particularly important. The present study took career planning as a moderating variable to explore the relationship between intolerance of uncertainty (IU) and employment anxiety, as well as the role of career planning. In this quantitative study, the data of 563 college graduates from different schools were collected by using the Intolerance of Uncertainty Scale-12, Vocational Selection Anxiety Questionnaire of University Graduate, and Career Planning Scale. The final effective sample size was 550 (the overall recovery rate was 97.7%). The results of correlation analysis showed that there was a significant positive correlation between IU and employment anxiety, while there was a significant negative correlation between career planning and IU, as well as the relationship between career planning and employment anxiety. The results of hierarchical regression analysis showed that IU significantly positively predicted the employment anxiety of graduates, and career planning moderated the relationship between IU and employment anxiety. These findings suggested that maintaining a sense of career planning can help college graduates get through smoothly in the face of uncertainty of COVID-19.

Intolerance of uncertainty and novelty facilitated extinction: The impact of reinforcement schedule

Individuals who score high in intolerance of uncertainty (IU) display reduced threat extinction. Recently, it was shown that replacing threat associations with novel associations during extinction learning (i.e., presenting a novel tone 100% of the time) can promote threat extinction retention in individuals with high IU. This novelty facilitated extinction (NFE) effect could be driven by the tone's novelty or reliability. Here, we sought to address this question by adjusting the reliability of the novel tone (i.e., the reinforcement rate) during NFE. We measured skin conductance response during an associative learning task in which participants (n = 92) were assigned to one of three experimental groups: standard extinction, NFE 100% reinforcement, or NFE 50% reinforcement. For standard extinction, compared to NFE 100% and 50% reinforcement groups, we observed a trend for greater recovery of the conditioned response during extinction retention. Individuals with high IU relative to low IU in the standard extinction group demonstrated a larger recovery of the conditioned response during extinction retention. These findings tentatively suggest that NFE effects are driven by the novelty rather than the reliability of the new stimulus. The implications of these findings for translational and clinical research in anxiety disorder pathology are discussed.

Fear of the unknown as a mechanism of the inverse relation between life meaning and psychological distress

BACKGROUND AND OBJECTIVES

Although there is accumulating evidence for an inverse relation between life meaning and psychological distress, little is known about the mechanisms of this relation. Using cross-sectional, observational methods, this research examined fear of uncertainty as one potential mechanism.

DESIGN AND METHODS

Study 1 (N = 141) was completed with a convenience sample, a unidimensional measure of life meaning, and general measures of anxiety and depression. Study 2 (N = 152) was completed with a sample prescreened for anxiety, a multidimensional measure of life meaning, and clinical measures of anxiety and depression.

RESULTS

The results from both studies generally showed an inverse relation between life meaning and psychological distress. Study 2 further indicated that these relations were stronger for the meaning subscale of perceiving life as coherent/comprehensible than the subscales assessing whether participants' lives are perceived as purposeful or significant. Mediation analyses in both studies showed indirect effects of life meaning on psychological distress through fear of uncertainty.

CONCLUSIONS

These findings support and extend previous research by showing that (i) meaning-as-comprehension may be particularly important in regards to psychological distress, and (ii) fear of uncertainty may mediate the inverse relation between meaning and measures of anxiety and depression.

Frequency of Anxiety, Depression, and Irritability Symptoms in Children During the COVID-19 Outbreak and Potential Risk Factors Associated With These Symptoms

ABSTRACT

The aim of this study was to determine the frequency of anxiety, depression, and irritability symptoms in children during the COVID-19 outbreak and to investigate the associated factors of these symptoms. This study was conducted with 1071 children aged 6 to 17. Results showed that 49.9% of the participants had anxiety symptoms, 29.5% had depression symptoms, and 51.4% had irritability symptoms. Low age was a potential risk factor for anxiety symptoms. Female sex was a potential risk factor for anxiety and depression symptoms. A COVID-19 death in the family or environment was a potential risk factor for depression and irritability symptoms. Exposure to COVID-19 information on television and on the internet was a potential risk factor for anxiety, depression, and irritability symptoms. In conclusion, this study revealed that the COVID-19 outbreak may have serious effects on the mental health of children, and the study highlighted potential risk factors.

Neurotransmitters and Electrophysiological Changes Might Work as Biomarkers for Diagnosing Affective Disorders

Affective disorders are the leading causes of human disability worldwide; however, the diagnosis is still hard to define, because emotion is the least study subjects in psychology. Recent emotional studies suggest that human emotions are developed from basic emotions, which are evolved for fundamental human lives. Even though most psychologists agree upon the idea that there are some basic emotions, there is little agreement on how many emotions are basic, which emotions are basic, and why they are basic. In our previous papers, we suggested that there are three basic emotions: joy, fear, and disgust. These basic emotions depend on the peptides and monoamines: dopamine-joy (peptides-reward), norepinephrine-fear (anger), and serotonin-disgust (sadness). Further tests with event-related potentials (ERP) found that joy, fear, and disgust showed the fastest response compared with other emotions, suggesting that they are fast automatic responses, which confirmed that these three emotions are prototypical emotions. Other basic emotions, anger and sadness, are due to object induced behaviors instead of sensation of object, so they developed secondary to prototypical emotions. Thus, we concluded that only joy, fear, and disgust are prototypical emotions, which can mix into other emotions, like the primary colors. In all, the neural substrates for all emotions, including the affections, are possibly monoamine neuromodulators: joy-dopamine (peptides), fear (anger)-norepinephrine, and disgust-serotonin. We hope these basic emotional studies will offer some neural mechanisms for emotional processing and shed lights on the diagnosis of affective disorders.

Consideration of equality, diversity, and inclusivity as a higher function

Equality, inclusivity, and diversity remain pertinent topics in healthcare not only for the benefit of patients but also for the workforce. Schemes have existed for many years, but in spite of the progress being made, it remains necessary to reiterate the importance of these terms and to make a conscious effort to enforce them. This paper describes prejudices and stereotypes as a function of the Bayesian brain, beyond human control, and suggests that a higher function is needed to recognise and over-ride these innate thought processes.

I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training

Background

Intolerance of uncertainty (IU), the tendency to find uncertainty distressing, is an important transdiagnostic dimension in mental health disorders. Higher self-reported IU has been linked to poorer threat extinction training (i.e., the updating of threat to safe associations), a key process that is targeted in exposure-based therapies. However, it remains to be seen whether IU-related effects during threat extinction training are reliably and specifically driven by the IU construct or a particular subcomponent of the IU construct over other self-reported measures of anxiety.

Methods

A meta-analysis of studies from different laboratories (18 experiments; sample N = 1006) was conducted on associations between different variants of self-reported IU (i.e., 27-item, 12-item, inhibitory, and prospective subscales), trait anxiety, and threat extinction training via skin conductance response. The specificity of IU and threat extinction training was assessed against measures of trait anxiety.

Results

All the self-reported variants of IU, but not trait anxiety, were associated with threat extinction training via skin conductance response (i.e., continued responding to the old threat cue). Specificity was observed for the majority of self-reported variants of IU over trait anxiety.

Conclusions

The findings suggest that the IU construct broadly accounts for difficulties in threat extinction training and is specific over other measures of self-reported anxiety. These findings demonstrate the robustness and specificity of IU-related effects during threat extinction training and highlight potential opportunities for translational work to target uncertainty in therapies that rely on threat extinction principles such as exposure therapy.

Development of a behavioural measure of Intolerance of Uncertainty in preadolescent children: Adaptation of the beads task

BACKGROUND AND OBJECTIVES

Intolerance of Uncertainty (IU) may be important for the development and maintenance of anxiety disorders but research with preadolescent children has relied entirely on questionnaire measures to assess IU. Here we aimed to develop a behavioural measure of IU that was appropriate for preadolescent children by adapting the beads task (Jacoby, Abramowitz, Buck, & Fabricant, 2014).

METHODS

Participants were 51 typically developing children (26 female; 7-11 years). We examined first whether preadolescent participants could understand and complete the task, then how participants responded to varying levels of uncertainty. We also conducted exploratory analyses regarding associations between task measures and questionnaire measures of IU, anxiety and worry.

RESULTS

Overall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. At least some of these reactions are related to questionnaire measures of IU and anxiety. Implications and areas for future research are discussed to provide insights into how behavioural tasks examining responses to uncertainty can improve our understanding of IU.

LIMITATIONS

The sample size was relatively small. There was no control task or condition without uncertainty.

CONCLUSIONS

Overall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. This type of behavioural task would be appropriate for use in future research that aims to improve our understanding of IU in children.

Post-Lockdown Effects on Students' Mental Health in Romania: Perceived Stress, Missing Daily Social Interactions, and Boredom Proneness

The rapid spread of COVID-19 worldwide was accompanied by intense fears, confusion, worries, anger, and stress threatening people's mental health. Unprecedented measures to slow down and prevent the transmission of COVID-19 have had various impacts on the population's health behaviour and mental health. The main purpose of the present study is to investigate the lockdown's effects on university students' mental health in Romania. Based on a cross-sectional design, the survey data were collected from a sample of 722 participants (247 males; M = 21.1 years; SD ± 1.73). A path analysis was performed to verify the hypothesised direct and indirect effects included in the multiple mediation model. The findings showed a positive association between stress and boredom proneness, missing daily social interactions, spending more time on phone conversations, and the increasing interest in following news about the pandemic. The path analysis revealed an excellent fit between the proposed multiple mediation model and the sample data. Boredom proneness and missing daily social interactions both affected stress, directly and indirectly, through more time spent on phone conversations. In addition, it was found that the increased interest in following news about the pandemic mediated the relationship between boredom proneness and perceived stress. In terms of gender differences, our findings revealed that female students experienced significantly higher stress levels than male students, perceived to a greater extent the lack of daily social interactions, and spent more time on phone conversations. Overall, the findings further extend the empirical evidence on university students' mental health in the context of the COVID-19 pandemic. Therefore, universities need to organise support programmes focused on developing university students' coping strategies to maintain their mental health even in adverse contexts.

Being future-conscious during a global crisis: The protective effect of heightened Futures Consciousness in the COVID-19 pandemic

Futures Consciousness (FC) refers to the capacity that a person has for understanding, anticipating, and preparing for the future. In many respects, the COVID-19 pandemic has been a challenge for future thinking, implying delay discounting, uncertainty, low sense of control, and self-sacrifice for the benefit of the community at large. FC might hence have an important role in explaining people's perceptions of and reactions to the pandemic. The results of a longitudinal study over the course of the summer 2020 found that UK participants (N = 298) who reported higher scores of FC at the first time of measure were more likely to express greater satisfaction and engagement with the COVID-19 government restrictions at the second time of measure. They also reported higher compassion for others, stronger sense of neighbourliness, and greater engagement in different forms of collective action. This positive engagement translated in benefit for the self: greater perceived wellbeing, lesser emotional blunting, and greater feelings of hope about the future. Remarkably, the same participants also reported greater concern about societal issues. It hence seems that FC triggers an active and aware engagement with the future. We discuss implications for future-thinking research and interventions aiming to improve Futures Consciousness.

Intolerance of uncertainty is associated with heightened responding in the prefrontal cortex during cue-signalled uncertainty of threat

Heightened responding to uncertain threat is considered a hallmark of anxiety disorder pathology. We sought to determine whether individual differences in self-reported intolerance of uncertainty (IU), a key transdiagnostic dimension in anxiety-related pathology, underlies differential recruitment of neural circuitry during cue-signalled uncertainty of threat (n = 42). In an instructed threat of shock task, cues signalled uncertain threat of shock (50%) or certain safety from shock. Ratings of arousal and valence, skin conductance response (SCR), and functional magnetic resonance imaging were acquired. Overall, participants displayed greater ratings of arousal and negative valence, SCR, and amygdala activation to uncertain threat versus safe cues. IU was not associated with greater arousal ratings, SCR, or amygdala activation to uncertain threat versus safe cues. However, we found that high IU was associated with greater ratings of negative valence and greater activity in the medial prefrontal cortex and dorsomedial rostral prefrontal cortex to uncertain threat versus safe cues. These findings suggest that during cue-signalled uncertainty of threat, individuals high in IU rate uncertain threat as aversive and engage prefrontal cortical regions known to be involved in safety-signalling and conscious threat appraisal. Taken together, these findings highlight the potential of IU in modulating safety-signalling and conscious appraisal mechanisms in situations with cue-signalled uncertainty of threat, which may be relevant to models of anxiety-related pathology.

Dealing with uncertainty: A high-density EEG investigation on how intolerance of uncertainty affects emotional predictions

Intolerance of uncertainty (IU) can influence emotional predictions, constructed by the brain (generation stage) to prearrange action (implementation stage), and update internal models according to incoming stimuli (updating stage). However, neurocomputational mechanisms by which IU affects emotional predictions are unclear. This high-density EEG study investigated if IU predicted event-related potentials (ERPs) and brain sources activity developing along the stages of emotional predictions, as a function of contextual uncertainty. Thirty-six undergraduates underwent a S1-S2 paradigm, with emotional faces and pictures as S1s and S2s, respectively. Contextual uncertainty was manipulated across three blocks, each with 100%, 75%, or 50% S1-S2 emotional congruency. ERPs, brain sources and their relationship with IU scores were analyzed for each stage. IU did not affect prediction generation. During prediction implementation, higher IU predicted larger Contingent Negative Variation in the 75% block, and lower left anterior cingulate cortex and supplementary motor area activations. During prediction updating, as IU increased P2 to positive S2s decreased, along with P2 and Late Positive Potential in the 75% block, and right orbito-frontal cortex activity to emotional S2s. IU was therefore associated with altered uncertainty assessment and heightened attention deployment during implementation, and to uncertainty avoidance, reduced attention to safety cues and disrupted access to emotion regulation strategies during prediction updating.

Predicting personal protective equipment use, trauma symptoms, and physical symptoms in the USA during the early weeks of the COVID-19 lockdown (April 9-18, 2020)

The COVID-19 pandemic created a complex psychological environment for Americans. In this study, 450 MTurk workers completed measures of sociodemographic characteristics, perceived risk for COVID-19, general perceived vulnerability to disease, intolerance of uncertainty, and psychological flexibility. These variables were used to predict COVID-19 preventive health behaviors (PPE use), psychological distress, and physical symptoms. The surveys were completed between April 9, 2020 and April 18, 2020 which is a period that corresponded to the first 2-3 weeks of lockdown for most participants. A demographically diverse sample of participants was recruited. A substantial number of participants reported a reduction employment status and 69% were in self-isolation. Participants reported a high degree of perceived vulnerability to COVID-19. PPE mask wearing was variable: 16% "not at all," 20% "some of the time," 42% "a good part of the time," and 26 "most of the time." Using clinical cutoff on the post-trauma scale, 70% of the sample would be considered to have symptoms consistent with PTSD. Physical symptom reporting was also high. Intolerance of uncertainty and psychological inflexibility were significant predictors of psychological distress and physical symptoms. Psychological flexibility moderated the relationship between intolerance of uncertainty and psychological distress/physical symptoms. The relationship between intolerance of uncertainty and psychological distress/physical symptoms was stronger among participants with lower levels of psychological flexibility. These findings indicate psychological flexibility can reduce distress associated with COVID-19. Additionally, these results support the workability of the Unified Flexibility and Mindfulness Model as a framework for studying health behavior.

Lived experiences of Overseas Filipino Worker (OFW) nurses working in COVID-19 intensive care units

Background

Limited studies focus on the effects of the pandemic on the nurses' overall risks and wellbeing. At present, no single study has been published on Filipino nurses' experiences outside the country during the COVID-19 pandemic.

Objective

This descriptive phenomenological study explored the Overseas Filipino Worker (OFW) nurses' experiences working in COVID-19 intensive care units.

Methods

The study was conducted in Dubai, United Arab Emirates, where there is a high number of COVID-19 cases. This study utilized a qualitative Husserlian phenomenological approach to describe and explore the lived experiences of the OFW nurses' caring for COVID-19 critically ill patients. The research key interview informants were eight ICU nurses who cared for COVID-19 patients in Dubai hospitals. Data saturation was reached. Data collection was done in 2020, and Collaizi's method of data analysis was utilized.

Results

A total of 135 significant statements were extracted from the interview transcripts. There were 36 formulated meanings generated, and four themes emerged from this study. The first theme is Challenges During the Pandemic with the following subthemes: Away from Home, Caring for the COVID-19 Patients, and Fear of the Unknown. The second theme is Patient Care during COVID-19 with the following subthemes: COVID-19 ICU Patient Care and The Nursing Profession. Third, Adapting to Change with the subthemes: Living the New Normal and Protecting One's Self from COVID-19. Lastly, Resilience Amidst the Pandemic with the following subthemes: Being with Others and Seeing Oneself.

Conclusion

Despite the existing challenges like cultural differences and homesickness faced by these OFW nurses and the new challenges they are faced with the pandemic today, they were still able to continue living and do what is expected of them. From the hassle of wearing the PPEs, shortage of PPE, and being transferred from one unit in the hospital to another, the OFW nurses were able to adapt to these changes. The nurses already got used to the routine, but the fear of getting infected by the virus is still there.

Super-natural fears

Supernatural fears, although common, are not as well-understood as natural fears and phobias (e.g., social, blood, and animal phobias) which are prepared by evolution, such that they are easily acquired through direct experience and relatively immune to cognitive mediation. In contrast, supernatural fears do not involve direct experience but seem to be related to sensory or cognitive biases in the interpretation of stimuli as well as culturally driven cognitions and beliefs. In this multidisciplinary synthesis and collaborative review, we claim that supernatural beliefs are "super natural." That is, they occur spontaneously and are easy to acquire, possibly because such beliefs rest on intuitive concepts such as mind-body dualism and animism, and may inspire fear in believers as well as non-believers. As suggested by psychological and neuroscientific evidence, they tap into an evolutionarily prepared fear of potential impending dangers or unknown objects and have their roots in "prepared fears" as well as "cognitively prepared beliefs," making fear of supernatural agents a fruitful research avenue for social, anthropological, and psychological inquires.

Anxiety Sensitivity Mediates Relations Between Mental Distress Symptoms and Medical Care Utilization During COVID-19 Pandemic

Anxiety and uncertainty are common during pandemics. The present study extended previous pandemic research by investigating the role of two transdiagnostic risk factors — anxiety sensitivity (AS: fear of physiological anxiety or “fear of fear”; Reiss & McNally, 1985) and intolerance of uncertainty (IU; Buhr & Dugas, 2009) — in explaining relations between mental distress symptoms and behavioural responding during the COVID-19 pandemic. Student and community-based participants (N=457; 87.6% female) were recruited between May and July 2020 to complete measures of anxiety (health, panic, general), depression, and stress. Anxiety and related symptoms were found to be higher than in previous studies. Parallel mediation analyses showed that clinically meaningful levels of mental distress symptoms directly influenced safety behaviours and medical care utilization but also indirectly influenced the latter (vs. former) through AS-physical concerns (vs. IU). CBT interventions, targeting AS-physical concerns, may reduce mental distress symptoms during pandemic and prevent overuse of healthcare.

Changes in intolerance of uncertainty over the course of treatment predict posttraumatic stress disorder symptoms in an inpatient sample

Intolerance of uncertainty (IU) is the inability to tolerate distress that arises in response to the absence of important information. The level of IU has been investigated across various psychological disorders; however, few studies have examined IU in trauma‐affected samples. We aimed to investigate the relationship between IU and posttraumatic stress disorder (PTSD) across the course of treatment. Participants (n = 106) had a diagnosis of PTSD and were from first responder, military, and occupational injury backgrounds. Participants completed self‐report questionnaires pre‐ and post‐engagement in an inpatient group trauma‐informed psychoeducation and skills (TIPS) intervention. Regression analyses indicated that decreases in overall and inhibitory IU were associated with decreases in PTSD severity overall and at the symptom cluster level. However, prospective IU was only associated with changes in the re‐experiencing, avoidance, and arousal PTSD symptom clusters. Our findings are congruent with the nascent literature indicating that IU may be a maintaining factor for PTSD, suggesting clinical relevance for attendance to IU within the course of treatment.

The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research

Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.

Social Anxiety and Depression in Romantic Relationships: A Three-Sample Exploration

Introduction: Social anxiety contributes to a variety of interpersonal difficulties and dysfunctions. Socially anxious adults are less likely to marry and more likely to divorce than are non-anxious adults. The present pre-registered study investigated incremental variance accounted for by social anxiety in relationship satisfaction, commitment, trust, and social support. Methods: Three independent samples of adults (N = 888; 53.7% female; Mage = 35.09 years) involved in a romantic relationship completed online self-report questionnaires. Both social anxiety and depression were significantly correlated with relationship satisfaction, commitment, dyadic trust, and social support. Hierarchical regression analyses were conducted with each sample to investigate the incremental variance accounted for by each of social anxiety and depression in relationship satisfaction, commitment, dyadic trust, and social support. Subsequent meta-analyses were run to determine the strength and replicability of the hierarchical models. Results: Results suggest that social anxiety is a robust predictor of unique variance in both perceived social support and commitment. Depression was a robust predictor of unique variance in relationship satisfaction, dyadic trust, social support, and commitment. Discussion: These results help to further understanding of social anxiety in romantic relationships and provide direction for future research and clinical intervention.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients

OBJECTIVE

To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients.

METHODS

Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21).

RESULTS

The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression (r = .256, P = .008) and IUS-12 scores (r = .214, P = .024). SDM correlated negatively with DASS-21 Depression (r = -.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression (B = 0.674, P = .048).

CONCLUSION

Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.

Effect of a Brief Supportive and Educational Intervention on the Psychological Well-Being of Mothers with Babies in Neonatal Wards of a Tertiary Hospital in Ibadan, Nigeria

OBJECTIVE

To assess the effect of a supportive educational intervention on the psychological wellbeing of mothers whose babies were admitted to Neonatal Care Unit (NCU) in Nigeria.

METHODS

Controlled trial involving 41 mothers whose babies were consecutively admitted into two NCUs (21 in the intervention group and 19 controls). The intervention group received two group-based sessions which included psychological coping strategies, and familiarity with NCU environment, equipment, personnel and procedures. The control group received usual care. Outcome measures were depressive symptoms (Edinburg Postnatal Depression Scale-EPDS), stress-related to NCU (Parental Stressor Scale: Neonatal Intensive Care Unit-PSS: NICU) and post-traumatic symptoms (Impact Event Scale-Revised-IES-R).

RESULTS

Difference-in-Differences (DiD) analysis showed a difference of -4.70 in PSS: NICU score in favour of the intervention group which was statistically significant [F(3, 75) = 9.47, p < 0.0001, R2 = 0.28]. The differences in EPDS (0.91) and IES-R (2.55) were not statistically significant [F(3, 75) = 10.10, p = 0.74] and [F(3, 75) = 10.13, p = 0.73], respectively. All the mothers in the treatment group expressed satisfaction with the intervention.

CONCLUSION

This brief group-based supportive educational intervention for mothers with babies in NCU was feasible, acceptable and helpful in reducing stress related to NCU. Larger controlled trials are recommended to establish the generalizability of these findings in this region.

LAY SUMMARY

Babies born too early and or with complications require admission to special hospital called Neonatal Care Unit (NCU) to help them to survive. However, parents whose babies are admitted to NCU can find the experience frightening. We examined how to reduce the fear and stress mothers in Nigeria experience when their babies are admitted to NCU.We had two groups of mothers. The first group made up of 21 mothers was taught how to cope with the stress of having a baby in NCU. They were also shown how the various equipment in the NCU work, what the staff in NCU do and what types of things need to be done to help their babies. The second group of 19 mothers received usual care but did not have the extra teaching the first group received. After 2 weeks, we checked the level of depression and stress the mothers in both groups had compared with the level before the first group received the extra teaching.We found that mothers in the first group who received the extra teaching were less stressed about having their babies in the NCU compared with the mothers that did not receive the teaching.

Evolving public behavior and attitudes towards COVID-19 and face masks in Taiwan: A social media study

Facing the COVID-19 pandemic, Taiwan demonstrated resilience at the initial stage of epidemic prevention, and effectively slowed down its spread. This study aims to document public epidemic awareness of COVID-19 in Taiwan through collecting social media- and Internet-based data, and provide valuable experience of Taiwan’s response to COVID-19, involving citizens, news media, and the government, to aid the public in overcoming COVID-19, or infectious diseases that may emerge in the future. The volume of Google searches related to COVID-19 and face masks was regarded as an indicator of public epidemic awareness in the study. A time-series analysis was used to explore the relationships among public epidemic awareness and other COVID-19 relevant variables, which were collected based on big data analysis. Additionally, the content analysis was adopted to analyze the transmission of different types of fear information related to COVID-19 and their effects on the public. Our results indicate that public epidemic awareness was significantly correlated with the number of confirmed cases in Taiwan and the number of news reports on COVID-19 (correlation coefficient: .33–.56). Additionally, the findings from the content analysis suggested that the fear of the loss of control best explains why panic behavior occurs among the public. When confronting the highly infectious COVID-19, public epidemic awareness is vital. While fear is an inevitable result when an emerging infectious disease occurs, the government can convert resistance into assistance by understanding why fear arises and which fear factors cause excessive public panic. Moreover, in the digitalization era, online and social media activities could reflect public epidemic awareness that can e harnessed for epidemic control.

Intolerance of uncertainty and reactions to the COVID-19 pandemic

The COVID-19 pandemic has presented a threat to mental health worldwide. The current study aims to investigate the role of intolerance of uncertainty in cognitive, emotional and behavioral reactions to this pandemic and propose a path model of these reactions. In the first two months of the COVID-19 pandemic in Slovakia, participants in a general sample (n = 1,011) as well as an older adult sample (n = 655) completed measures regarding intolerance of uncertainty, mental health (anxiety, well-being, perceived stress) and adherence to preventive measures. Two rounds of data collection were carried out in the first sample. Intolerance of uncertainty was found to be related to mental health indicators and the structural equation model showed a direct and indirect effect on them as well as on the adherence to preventive measures. However, the comparison of data from different time points has brought inconsistent results. The findings highlight the role of intolerance of uncertainty in reaction to threat and indicate the potential of uncertainty reduction e.g., getting clear messages from authorities, as a way of decreasing mental health problems.

A longitudinal examination of the interpersonal fear avoidance model of pain: the role of intolerance of uncertainty

Youth with chronic pain and their parents face uncertainty regarding their diagnosis, treatment, and prognosis. Given the uncertain nature of chronic pain and high comorbidity of anxiety among youth, intolerance of uncertainty (IU) may be critical to the experience of pediatric chronic pain. This study longitudinally examined major tenets of the Interpersonal Fear Avoidance Model of Pain and included parent and youth IU as key factors in the model. Participants included 152 youth with chronic pain (Mage = 14.23 years; 72% female) and their parents (93% female). At baseline, parents and youth reported on their IU and catastrophic thinking about youth pain; youth reported on their fear of pain, pain intensity, and pain interference; and parents reported on their protective responses to child pain. Youth reported on their pain interference 3 months later. Cross-lagged panel models, controlling for baseline pain interference, showed that greater parent IU predicted greater parent pain catastrophizing, which, in turn, predicted greater parent protectiveness, greater youth fear of pain, and subsequently greater youth 3-month pain interference. Youth IU had a significant indirect effect on 3-month pain interference through youth pain catastrophizing and fear of pain. The results suggest that parent and youth IU contribute to increases in youth pain interference over time through increased pain catastrophizing, parent protectiveness, and youth fear of pain. Thus, parent and youth IU play important roles as risk factors in the maintenance of pediatric chronic pain over time and may be important targets for intervention.

A Perfect Storm? Health Anxiety, Contamination Fears, and COVID-19: Lessons Learned from Past Pandemics and Current Challenges

The novel coronavirus disease 2019 (COVID-19) rapidly spread, becoming a global pandemic with significant health, economic, and social impacts. COVID-19 has caused widespread anxiety, which at healthy levels leads to adaptive, protective behavioral changes. For some individuals, a pandemic outbreak can lead to excessive, maladaptive levels of anxiety, particularly among those with obsessive-compulsive disorder (OCD) and health anxiety. In the present paper, we review past research studies that examined anxiety in response to other disease outbreaks (including Swine Flu, Zika, and Ebola) to serve as a guide for expectable responses to COVID-19. Our review focused on the role of belief-based cognitive variables (obsessive beliefs, contamination cognitions), transdiagnostic processes (disgust sensitivity, anxiety sensitivity, an intolerance of uncertainty), social factors, and environmental/situational variables as contributing factors to excessive concerns about past pandemics. These factors in combination with unique characteristics of the virus (disease, behavioral, social and economic factors) and media consumption might enhance vulnerability to excessive anxiety about COVID-19, in line with a diathesis-stress model. COVID-19 is also unique from past pandemics due to its severity, easy transmissibility, and the nature of prescribed behavioral responses (i.e., hand washing and social distancing). We therefore discuss the ways in which COVID-19 may disproportionately affect individuals with OCD and health anxiety. We conclude with important topics for clinical and research attention to help mental health professionals respond in this time of crisis.

Altered immunoemotional regulatory system in COVID-19: From the origins to opportunities

The emergence of the novel coronavirus (SARS-CoV-2) and the worldwide spread of the coronavirus disease (COVID-19) have led to social regulations that caused substantial changes in manners of daily life. The subsequent loneliness and concerns of the pandemic during social distancing, quarantine, and lockdown are psychosocial stressors that negatively affect the immune system. These effects occur through mechanisms controlled by the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenocortical (HPA) axis that alter immune regulation, namely the conserved transcriptional response to adversity (CTRA), which promotes inflammation and diminishes antiviral responses, leading to inadequate protection against viral disease. Unhealthy eating habits, physical inactivity, sleep disturbances, and mental health consequences of COVID-19 add on to the pathological effects of loneliness, making immunity against this ferocious virus an even tougher fight. Therefore, social isolation, with its unintended consequences, has inherently paradoxical effects on immunity in relation to viral disease. Though this paradox can present a challenge, its acknowledgment can serve as an opportunity to address the associated issues and find ways to mitigate the adverse effects. In this review, we aim to explore, in detail, the pathological effects of the new social norms on immunity and present suggested methods to improve our physical, psychological, and healthcare abilities to fight viral infection in the context of the COVID-19 pandemic.