Health anxiety, cognitive coping, and emotion regulation: a latent variable approach

Somatic Symptom Disorder and Health Anxiety: Assessment and Management

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Somatic Symptom Disorder (SSD) and Illness Anxiety Disorder (IAD) replaced the diagnostic entities of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) somatoform disorders and hypochondriasis. SSD turns away from specifying the presence or absence of a medical condition for presented symptoms and instead focuses on excessive symptom-related affects, cognitions, and behaviors. People with pathological health anxiety can be diagnosed with SSD or IAD, depending on the intensity of accompanying somatic symptoms. Cognitive-behavioral therapy shows the best empirical evidence for an effective treatment of SSD and IAD.

Phobia-specific patterns of cognitive emotion regulation strategies

Although fear plays a vital role in survival, an overly active threat detection system could be maladaptive due to its negative health consequences. Putatively maladaptive emotion regulation (ER) strategies are a core problem in phobias. In contrast, adaptive ER strategies could help downregulate the emotion elicited by a threatening stimulus and decrease anxiety. Yet, the number of studies directly examining the pattern of ER strategies linked to various phobias is still scarce. Thus, this study sought to map the patterns of adaptive and maladaptive ER strategies linked to the three most common phobias (social, animal, and blood-injection-injury [BII]). A total of 856 healthy participants filled out our survey including self-reported measures of social anxiety, snake-, spider-, BII phobia, and cognitive ER strategies. Structural equation modeling was used to test the effects between the variables. The results show that social anxiety and animal phobia were linked to both adaptive and maladaptive ER strategies, while BII was only associated with maladaptive ones. Further analyses showed that the most prominent ER strategies differed by subtype. This is in line with previous neuroimaging studies claiming that the neurocognitive mechanisms underlying phobias are also different. Theoretical as well as practical implications are discussed.

The role of emotional functioning in the relationship between health anxiety and cyberchondria

Access to health information can have positive effects in the form of increased health awareness. However, self-diagnosis based on information available on websites can be dangerous, causing distress as an increasing amount of time is spent on searching. The main aim of the study was to determine the role of emotional functioning in the relationship between health anxiety and cyberchondria. The study included N = 615 participants aged 18 to 83 years (M = 43.86, SD = 14.57). The authors used the Cyberchondria Severity Scale, the Short Health Anxiety Inventory, the Life Orientation Test, the Difficulties in Emotion Regulation Scale, and the Kessler 6 Psychological Distress Scale. The results demonstrate that health anxiety is significantly related to cyberchondria and that pessimism and difficulties in emotion regulation act as mediators in this relationship.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04126-3.

An fMRI study of cognitive regulation of reward processing in generalized anxiety disorder (GAD)

BACKGROUND

Cognitive regulation can affect the process of decision making. Generalized anxiety disorder (GAD) patients seem to have an impairment in cognitive regulation of reward processing concerning food stimuli. This study aims to explore the impact of GAD in cognitive regulation of food-related rewards.

METHODS

GAD patients (n=11) and healthy controls (n=15) performed a cognitive regulation craving task with food images while undergoing a functional magnetic resonance imaging (fMRI) acquisition. Between-group differences in functional connectivity were measured using dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) seeds during cognitive regulation.

RESULTS

During cognitive regulation, there was a significant interaction for functional connectivity between the right dlPFC and bilateral vmPFC with the thalamus. GAD patients had lower functional connectivity for cognitive regulation conditions (distance and indulge) than for the non-regulated condition in these clusters, while control participants presented the opposite pattern. GAD group presented fixed food valuation scores after cognitive regulation.

CONCLUSIONS

GAD participants showed inflexibility while valuating food images, that could be produced by cognitive regulation deficits underpinned by functional connectivity alterations between prefrontal regions and the thalamus. These results show cognitive inflexibility and difficulty in the modulation of cognitive responses during decision making in GAD patients.

The bidirectional effects of obsessive-compulsive symptoms and difficulties in emotion regulation in Chinese adults during the COVID-19 pandemic-a dynamic structural equation model

Background

With the accumulation of negative emotions brought by COVID-19-related dysfunctional beliefs, individuals adopted obsessive–compulsive (OC) symptoms (e.g., over-checking the wearing of masks) and formed difficulties in emotion regulation (DER). This study focused on the temporal dynamics of the bidirectional relation between OC symptoms and DER, which had a devastating effect on the individual's mental health. As an extension, we further explored whether OC and DER and their relationship affect sleep problems.

Methods

In February 2020, a 14-day (twice a day, of 28 measurement intervals) online questionnaire survey was conducted on 122 Chinese adults (aged 18–55 years; 63 females). Subsequently, this research applied a dynamic structural equation model with a cross-lagged relationship and a time series. Health anxiety, anxiety, and depression were controlled as covariates.

Results

Both OC symptoms and DER had a significant autoregressive and cross-lagged effect. Comparatively speaking, DER was a stronger predictor of OC symptoms than OC’s prediction of DER. Moreover, both higher levels of OC symptoms and DER were related to the severity of sleep problems.

Conclusions

More guidance on intervening in OC symptoms and identifying emotion regulation should be added to reduce the negative impact of the COVID-19 pandemic on public mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00841-5.

Influencing Factors of International Students’ Anxiety Under Online Learning During the COVID-19 Pandemic: A Cross-Sectional Study of 1,090 Chinese International Students

Objective

We conducted the following cross-sectional study to comprehensively assess the anxiety among Chinese international students who studied online during the COVID-19 pandemic and its influencing factors.

Methods

Questionnaires were distributed through “Sojump,” and a total of 1,090 valid questionnaires were collected. The questionnaire was divided into two parts: general situation and anxiety assessment of students. The former used a self-made questionnaire, and the international general GAD-7 scale was used to measure anxiety. Chi-square test was used to analyze the differences between groups, and logistic regression analysis was performed for the factors with differences.

Results

Anxiety was found in 707 (64.9%) of 1,090 international students. Chi-square test and multivariate Logistic regression analysis showed that the incidence of anxiety was higher in the group under 22 years of age than in the group over 22 years of age (68% vs. 61%, p = 0.015; OR = 1.186, 95% CI 1.045–1.347, p = 0.008); International students living in big cities had a higher incidence of anxiety than those living in rural areas (67% vs. 60%, p = 0.022; OR = 1.419, 95%CI 1.038–1.859, p = 0.011); international students who socialized 3 times or less monthly had a higher incidence of anxiety than those who socialized more than 3 times per month (68% vs. 58%, p = 0.003; OR = 1.52, 95%CI 1.160–1.992, p = 0.002); international students who expected purely online teaching had a higher incidence of anxiety than those who expected purely offline teaching or dual-track teaching (72% vs. 64%, p = 0.037; OR = 1.525, 95%CI 1.069–2.177, p = 0.02); international students with a subjective score of online learning experience of 6 or less had a higher incidence of anxiety than those with subjective scores of more than 6 (70% vs. 60%, p = 0.001, OR = 1.25, 95%CI 1.099–1.422, p = 0.001). However, gender, emotional status, BMI, major of study, vaccination status, and degree type had no significant difference in the incidence of anxiety among international students who studied online during the COVID-19 pandemic.

Conclusion

During COVID-19, international students who were younger, came from big cities, had low social frequency, expected purely online teaching, and had poor experience of online classes were risk factors for anxiety during online classes.

Psychological well-being and coping strategies of elderly people during the COVID-19 pandemic in Hungary

OBJECTIVE

During COVID-19 lockdown the enforced social isolation and other pandemic-related changes highly increased the risk of mental health problems. We aimed to discover how elderly people coped with the psychological burdens of pandemic and the social isolation in Hungary.

METHODS

This study included 589 (441 females) Hungarian individuals, aged 60-83 (M = 68.1, SD = 4.46). We collected online survey data to reach a wide population of elderly. Results of hierarchical linear modelling and structural equation modelling (SEM) analyses established how the current life-changing circumstances, the intolerance of uncertainty, loneliness and social support influence the mental health (e.g. depression, anxiety, well-being) of the elderly. The model was used to explore how adaptive and maladaptive emotion regulation strategies mediated the effects.

RESULTS

Findings showed that perceived change in mood, social connectedness, and quality of life was negatively affected by catastrophizing and loneliness; whereas positive refocusing and contamination fear had a positive effect. According to the SEM analysis, intolerance of uncertainty and loneliness directly affected mental health. Further, maladaptive emotion regulation strategies mediated the connection between intolerance of uncertainty, contamination fear, loneliness and mental health. Whereas adaptive emotion regulation strategy mediated the connection between social support from friends, contamination fear, loneliness and mental health.

CONCLUSION

Overall, our research might help the understanding of how external and internal factors contributed to the well-being of elderly people during the COVID-19. The model can also be translated into professional interventions to develop coping strategies among elderly for the challenges of COVID-19 pandemic in their lives.

Emotional distress and coping strategies in COVID-19 anxiety

The present study aims to identify psychological factors affected by the COVID-19 pandemic given the information we have about reactions during previous pandemics, which documented features of anxiety, depression and post-traumatic stress disorder. We investigated the relationship between health anxiety, symptoms of depression, anxiety and stress, and coping mechanisms in the general population and among students. The study was conducted on Romanian population (n = 759), aged between 18-70 years old (M = 33.24), general population (n = 485), and students (n = 274). The results showed that the general population is more anxious when confronted with the new virus compared to students (t (757) = 1.902, p < .05, p = .029). Following the analysis of the hierarchical regression, the results revealed that when controlling the health anxiety variable, a high level of anxiety symptoms and stress, and a low level of depression symptoms could predict anxiety for COVID-19 (R 2  = .070, F change (3, 754) = 16.759, p ˂ .001). Also, we found that maladaptive strategies are the ones which explain the relationship between health anxiety and COVID-19-related anxiety (95% CI = .011 - .057). The results of this study bring extra knowledge and shed new light on the psychological aspects of the current sanitary crisis and contribute to the understanding of the way people relate to this disease.

The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation

INTRODUCTION

Cyberchondria is excessive seeking for online health-related information related to increasing health anxiety and distress levels. The current study investigated the mediating role of health-related metacognition, cognitive bias, and emotion dysregulation in the relationship between personality traits and cyberchondria.

METHODS

Participants were 703 individuals 18+ years old who had access to the internet (males = 43.8%, mean age = 33.82 ± 10.09 years and females = 56.2%, mean age = 34.37 ± 11.16 years). They voluntarily completed a questionnaire package that included the Cyberchondria Severity Scale (CSS), the revised NEO Personality Inventory (NEO-PI-R), the Difficulties in Emotion Regulation Scale (DERS), the Meta-Cognitions about Health Questionnaire (MCQ-HA), and the Health Cognitions Questionnaire (HCQ).

RESULTS

The initial evaluation of the model demonstrated that the personality traits of openness to experience, agreeableness, and conscientiousness had no significant relationship with other variables in the structural model, and the effects of neuroticism and extroversion were the only significant results. Rerunning the model with the removal of non-significant variables revealed a full mediation of health-related metacognition, cognitive bias, and emotion dysregulation in the relation between personality traits (neuroticism and extraversion) and cyberchondria. Fit indices demonstrated the acceptable fit of the model with the collected data (χ² = 979.24, p <.001; NFI = 0.92, CFI = 0.93, GFI = 0.90, IFI = 0.93, RMSEA = 0.071, and SRMR = 0.063). The results indicated that the present model could explain R ² = 54% of cyberchondria variance.

DISCUSSION

These findings suggest that health-related metacognition, cognitive bias, and emotion dysregulation could demonstrate a full mediating role in the correlation between personality traits and cyberchondria.

How health anxiety affected obsessive-compulsive symptoms during the COVID-19 pandemic in China: The mediation of difficulties in emotion regulation and the moderation of pathological personality traits

Health anxiety (HA) was/is a common negative emotional problem during the COVID-19 pandemic. According to the cognitive model of HA, individuals with HA continued to adopt a series of maladaptive and repetitive behaviors which were associated with obsessive-compulsive symptoms (OCS; including over-washing, over-checking, obsessing, and metal neutralizing). The priority of the present study was to explore how HA specifically affected OCS and whether difficulties in emotion regulation (DER) and pathological personality traits (PPT) affected the relationship between the HA and OCS. We distributed an online survey from February 1 to February 17 in 2020 (N = 1546, with average age of 25.8, and 32.7% of males) from 219 cities in China. Results showed that only four dimensions (i.e., Nonacceptance, Impulse, Non-clarity and Non-awareness) of the DER scale mediated in the predictive path of HA on OCS, which constituted a multiple mediating model. The other moderated mediation model further showed that, with higher PPT, the more significant the impact of HA was on DER, revealing PPT's moderator role between HA and OCS.

The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation

The current study aimed to investigate the mediating role of metacognitions, intolerance of uncertainty and emotion regulation in the relationship between fear of COVID-19 (FC-19) and health anxiety, among families with COVID-19 infected. Participants were 541 individuals from family members of patients with COVID-19 (F = 52.3%, mean age = 41.3 ± 13.2 years). Data were collected with a packet including sociodemographic and risk factors, the Fear of COVID-19 Scale, the Short Health Anxiety Inventory, the Metacognitions Questionnaire 30, the Intolerance of Uncertainty Scale-12 and the Emotion Regulation Questionnaire. Structural equation modelling analyses revealed a full mediation of metacognitions (i.e., positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence and beliefs about the need to control thoughts), intolerance of uncertainty and expressive suppression in the relation between FC-19 and health anxiety. Moreover, the strongest indirect links were found between FC-19 and health anxiety through negative beliefs about thoughts concerning uncontrollability and danger and intolerance of uncertainty. These associations were independent of gender and risk status. The final model accounted for 71% of the variance of health anxiety. These findings suggest that particularly metacognitions, intolerance of uncertainty and expressive suppression play a full mediational role in the relation between FC-19 and health anxiety.

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study

BACKGROUND

The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic.

OBJECTIVE

This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic.

METHODS

From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants' levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety.

RESULTS

This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety.

CONCLUSIONS

This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety.

Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19

Background

In the case of people who carry an increased number of anxiety traits and maladaptive coping strategies, psychosocial stressors may further increase the level of perceived stress they experience. In our research study, we aimed to examine the levels of perceived stress and health anxiety as well as coping styles among university students amid the COVID-19 pandemic.

Methods

A cross-sectional study was conducted using an online-based survey at the University of Debrecen during the official lockdown in Hungary when dormitories were closed, and teaching was conducted remotely. Our questionnaire solicited data using three assessment tools, namely, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WCQ), and the Short Health Anxiety Inventory (SHAI).

Results

A total of 1320 students have participated in our study and 31 non-eligible responses were excluded. Among the remaining 1289 participants, 948 (73.5%) and 341 (26.5%) were Hungarian and international students, respectively. Female students predominated the overall sample with 920 participants (71.4%). In general, there was a statistically significant positive relationship between perceived stress and health anxiety. Health anxiety and perceived stress levels were significantly higher among international students compared to domestic ones. Regarding coping, wishful thinking was associated with higher levels of stress and anxiety among international students, while being a goal-oriented person acted the opposite way. Among the domestic students, cognitive restructuring as a coping strategy was associated with lower levels of stress and anxiety. Concerning health anxiety, female students (domestic and international) had significantly higher levels of health anxiety compared to males. Moreover, female students had significantly higher levels of perceived stress compared to males in the international group, however, there was no significant difference in perceived stress between males and females in the domestic group.

Conclusion

The elevated perceived stress levels during major life events can be further deepened by disengagement from home (being away/abroad from country or family) and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping methods, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety could be mitigated.

Anxiety, depression and cognitive emotion regulation strategies in Chinese nurses during the COVID-19 outbreak

AIMS

To explore the association between cognitive emotion regulation strategies and anxiety and depression among nurses during the COVID-19 outbreak.

BACKGROUND

Nurses play a vital role in responding to the COVID-19 outbreak, but many of them suffer from psychological problems due to the excessive workload and stress. Understanding the correlation between cognitive emotion regulation strategies and anxiety and depression will promote targeted psychosocial interventions for these affected nurses.

METHODS

This cross-sectional study of 586 nurses was conducted in Eastern China. Participants completed online questionnaires that investigated anxiety, depression and cognitive emotion regulation strategies.

RESULTS

The prevalence of nurses' anxiety and depression was 27.6% and 32.8%, respectively. Lower self-blame, rumination and catastrophizing, as well as greater acceptance and positive refocusing, were related to fewer symptoms of anxiety or depression.

CONCLUSION

The cognitive emotion regulation strategies of acceptance and positive refocusing contribute to reducing anxiety or depression. These strategies should be considered when implementing psychotherapeutic interventions to improve nurses' adverse emotional symptoms.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the need to assess cognitive emotion regulation strategies use in screening for anxiety and depression. Nurse managers should develop psychosocial interventions including appropriate strategies to help nurses with adverse emotions during a pandemic.

Health anxiety during the early phases of COVID-19 pandemic in Turkey and its relationship with postpandemic attitudes, hopelessness, and psychological resilience

PURPOSE

To investigate health anxiety-related factors in the early stages of pandemic in Turkey.

DESIGN AND METHODS

This study included 1046 participants who responded to the online survey anonymously between 28 March and 04 April 2020.

FINDINGS

Demographic data, postpandemic attitudes towards the elderly and precaution-taking behaviors were health anxiety-related factors. The main predictors of the health anxiety were the level of hopelessness, perception of self, time spent on social media, and following COVID-19 pandemic-related news.

PRACTICE IMPLICATIONS

The results of this study are important in terms of understanding the health anxiety during the pandemic and providing data support for the proper interventions.

Krankheitsängste und Hypochondrische Störung

Fears of getting a severe disease (health anxiety) are widespread and their pathological manifestation as Hypochondriacal disorder (ICD-10) is cost-intensive for the health care system. In recent years advances in the research on and development of effective psychotherapeutic treatments have been made. Cognitive-behavioral therapy concepts currently are treatments of choice for Hypochondriacal disorder.

The Relationship Between Ruminating the Catastrophic Consequences of Bodily Changes and Positive Reappraisal and Practical Problem-Solving Strategies in Individuals With Illness Anxiety Disorder

Introduction:

Cognitive emotion regulation is suggested to contribute to Illness Anxiety Disorder (IAD). Reappraisal and suppression are essential ER strategies with controversial data about their roles in IAD. Relevant studies are mostly limited to exploring these two strategies in individuals without such disorder. Therefore, we aimed to study the role of emotion regulation in the psychopathology of IAD by evaluating other ER strategies in illness-anxious individuals. Furthermore, we investigated the relationship between IAD and emotion regulation by targeting the role of interpretation bias for health-related information.

Methods:

The study participants were 60 university students. They underwent a semi-structured clinical interview to assess the presence or absence of IAD symptoms (n=30/group). They completed a battery of questionnaires measuring IAD, emotion regulation, and interpretation bias.

Results:

The illness-anxious group applied significantly less reappraisal and refocus on planning and more rumination, catastrophizing, and acceptance strategies, compared to the controls. Besides, interpretation bias was positively correlated with rumination and catastrophizing; while its association with reappraisal and planning was negative.

Conclusion:

Both functional (e.g. reappraisal & planning) and dysfunctional strategies (e.g. rumination & catastrophizing) contributed to the psychopathology of IAD. The biased interpretation of bodily information could make individuals prone to ruminate about the catastrophic consequences of bodily changes; such conditions interrupt fostering more positive reappraisal or practical problem-solving strategies.

Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?

According to cognitive-behavioral models, traits, triggering events, cognitions, and adverse behaviors play a pivotal role in the development and maintenance of health anxiety. During virus outbreaks, anxiety is widespread. However, the role of trait health anxiety, cyberchondria, and coping in the context of virus anxiety during the current COVID-19 pandemic has not yet been studied. An online survey was conducted in the German general population (N = 1615, 79.8 % female, Mage = 33.36 years, SD = 13.18) in mid-March 2020, which included questionnaires on anxiety associated with SARS-CoV-2, trait health anxiety, cyberchondriaPandemic (i.e. excessive online information search), and emotion regulation. The participants reported a significantly increasing virus anxiety in recent months (previous months recorded retrospectively), especially among individuals with heightened trait health anxiety. CyberchondriaPandemic showed positive correlations with current virus anxiety (r = .09-.48), and this relationship was additionally moderated by trait health anxiety. A negative correlation was found between the perception of being informed about the pandemic and the current virus anxiety (r=-.18), with adaptive emotion regulation being a significant moderator for this relationship. The findings suggest that trait health anxiety and cyberchondria serve as risk factors, whereas information about the pandemic and adaptive emotion regulation might represent buffering factors for anxiety during a virus pandemic.

Emotional responses to illness imagery in young adults: Effects of attention to somatic sensations and levels of illness anxiety

This study investigated the effect of interoceptive attention on emotional responses during illness imagery, and the moderating role of illness anxiety. 101 students (81 female; 18-35 years old) with low, moderate and high levels of illness anxiety had to imagine personally relevant illness scenarios and standardized fearful, joyful and neutral scenarios, after undergoing an attention manipulation to direct their attention towards interoceptive or exteroceptive stimuli. Emotional responses assessed included self-reports of arousal, valence and somatic sensations, and psychophysiological measures of heart rate reactivity and variability, skin conductance level, and facial electromyography. Findings showed increased reports of emotional arousal, negative affect and somatic symptoms, accompanied by negative emotion expressions, but a hypo-arousal physiological response pattern (i.e. low heart rate reactivity) during illness imagery after interoceptive attention, irrespective of illness anxiety levels. Under directed attention, the observed emotional response to illness imagery may increase the risk for developing and perpetuating illness anxiety.

Encoding and retrieval biases for health-related scenes in patients with severe health anxiety

Severe health anxiety is a disorder characterised by excessive worries about harbouring or having a serious illness. The present study examines cognitive biases in evaluation and memory for health-related scenes in severe health anxiety in order to provide insights into the effect of these biases and the formation of illness intrusions in severe health anxiety. Twenty patients with severe health anxiety and 20 healthy participants completed a computerised task consisting of encoding, involuntary retrieval, voluntary retrieval and recognition of health-related, negative and neutral scenes. The results demonstrated that patients with severe health anxiety reported more negative emotional valence and greater physiological arousal to health-related scenes, both during encoding (ps < .031, ηp2  > .09) and retrieval (ps < .044, ds > 0.18). Furthermore, in contrast to the comparison group, patients with severe health anxiety did not show shorter retrieval time for health-related scenes during involuntary compared with voluntary retrieval (p = .789, d = 0.08), possibly due to greater demands on emotion regulation during involuntary retrieval. The results suggest an important role for negative emotional valence and physiological arousal to health-related stimuli in severe health anxiety, and highlight how cognitive biases in evaluation and memory might be at play in this disorder.

The impact of health anxiety on perceptions of personal and children's health in parents with Lynch syndrome

This study examined the differences in perceptions of one's health and one's child's health between parents with Lynch syndrome (LS) characterized with high versus low health anxiety. Twenty-one parents completed semistructured telephone interviews about their perceptions of their own health and the health of their children. Qualitative content analysis using a template coding approach examined the differences between parents with high and low health anxiety. Findings revealed that the most prevalent difference emerged on perceptions of personal health, showing individuals with high health anxiety reported more extreme worries, were more hypervigilant about physical symptoms, experienced the emotional and psychological consequences of LS as more negative and severe, and engaged in more dysfunctional coping strategies than those with low health anxiety. Unexpectedly, with regards to perceptions of their children, parents in the high and low health anxiety groups exhibited similar worries. However, high health anxiety parents reported using dysfunctional coping about their children's health more frequently than those with low health anxiety. The findings suggest that health anxiety is of clinical significance for individuals with LS. Accurately identifying and treating health anxiety among this population may be one avenue to reduce the distress experienced by LS carriers.

How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model

According to the cognitive-behavioral model, illness anxiety is developed and maintained through biased processing of health-threatening information and maladaptive responses to such information.

OBJECTIVE

This study is a systematic review of research that attempted to validate central tenets of the cognitive-behavioral model regarding etiological and maintenance mechanisms in illness anxiety.

METHODS

Sixty-two studies, including correlational and experimental designs, were identified through a systematic search of databases and were evaluated for their quality.

RESULTS

Outcomes were synthesized following a qualitative thematic approach under categories of theoretically driven mechanisms derived from the cognitive-behavioral model: attention, memory and interpretation biases, perceived awareness and inaccuracy in perception of somatic sensations, negativity bias, emotion dysregulation, and behavioral avoidance.

CONCLUSIONS

Findings partly support the cognitive-behavioral model, but several of its hypothetical mechanisms only receive weak support due to the scarcity of relevant studies. Directions for future research are suggested based on identified gaps in the existing literature.

Emotion dysregulation in hypochondriasis and depression

BACKGROUND

The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa.

METHODS

Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis.

RESULTS

Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores.

CONCLUSIONS

Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits.

KEY PRACTITIONER MESSAGE

Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions.

Strategies for coping with family members of patients with mental disorders

Objective:

to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables.

Method:

this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies.

Results:

the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined.

Conclusion:

despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.

Understanding Dysregulated Behaviors and Compulsions: An Extension of the Emotional Cascade Model and the Mediating Role of Intrusive Thoughts

Objective: The Emotional Cascade Model (ECM) by Selby et al. (2008) proposes that people often engage in dysregulated behaviors to end extreme, aversive emotional states triggered by a self-perpetuating vicious cycle of (excessive) rumination, negative affect, and attempts to suppress negative thoughts.

Method: Besides replicating the ECM, we introduced intrusions as a mediator between rumination and behavioral dysregulation and tested this extended ECM for compulsions as part of obsessive–compulsive disorders. A structural equation modeling approach was used to test this in a sample of N = 414, randomly recruited from the general population.

Results: Intrusions were found to fully mediate the effect of rumination on a broad array of dysregulated behaviors and compulsions. This mediation endured when controlling for symptoms of depression.

Conclusion: These findings support the idea that rumination fuels intrusions, which in turn foster dysregulated behaviors. Therefore, addressing rumination as well as intrusions may improve psychotherapeutic interventions for mental disorders characterized by dysregulated behaviors and/or extreme aversive emotional states.

Experiences of Uncertainty in Men With an Elevated PSA

A significant proportion of men, ages 50 to 70 years, have, and continue to receive prostate specific antigen (PSA) tests to screen for prostate cancer (PCa). Approximately 70% of men with an elevated PSA level will not subsequently be diagnosed with PCa. Semistructured interviews were conducted with 13 men with an elevated PSA level who had not been diagnosed with PCa. Uncertainty was prominent in men's reactions to the PSA results, stemming from unanswered questions about the PSA test, PCa risk, and confusion about their management plan. Uncertainty was exacerbated or reduced depending on whether health care providers communicated in lay and empathetic ways, and provided opportunities for question asking. To manage uncertainty, men engaged in information and health care seeking, self-monitoring, and defensive cognition. Results inform strategies for meeting informational needs of men with an elevated PSA and confirm the primary importance of physician communication behavior for open information exchange and uncertainty reduction.

Coping styles in substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD)

BACKGROUND

Patients with a substance use disorder (SUD) and co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) often start using substances in an attempt to cope with the stress related to their ADHD or ASD. To improve treatment for these patient groups, it is important to identify and compare the various coping styles between SUD patients with and without ADHD or ASD and with subjects from a general population sample.

METHODS

Cross-sectional study using the Utrecht Coping List (UCL) in 50 SUD patients, 41 SUD + ADHD patients, 31 SUD + ASD patients and 1,200 railway employees.

RESULTS

Compared with the reference group, all three SUD groups showed a significant higher mean on the Palliative reaction, Avoidance, and Passive reaction subscales of the UCL. The scores for all UCL subscales of the SUD and the SUD + ADHD groups were very similar. However, the SUD + ASD group scored higher on Passive reaction and lower on Reassuring thoughts than the SUD and the SUD + ADHD groups and lower on Expression of emotions subscale in comparison with the SUD + ADHD group.

CONCLUSIONS

Regardless of the presence of a co-occurring disorder, SUD patients reported more palliative, avoidant and passive coping when confronted than people in the general population. In addition, SUD patients with co-occurring ASD were different from other SUD patients in their coping and professionals should take this into account when working on more adaptive coping strategies with these patients.

Estratégias de enfrentamento dos enfermeiros em serviço hospitalar de emergência

Resumo Objetivo: Identificar as estratégias de enfrentamento dos enfermeiros em serviço hospitalar de emergência e relacioná-las às variáveis sociodemográficas e profissionais. Métodos: Estudo transversal com 89 enfermeiros. Os instrumentos de pesquisa foram: formulário para caracterização dos sujeitos e o Inventário de Estratégias de Enfrentamento de Folkman e Lazarus. Resultados: As estratégias de enfrentamento mais utilizadas foram: resolução de problemas e reavaliação positiva; a menos utilizada, foi o confronto. As estratégias confronto, reavaliação positiva, e fuga e esquiva foram associadas ao sexo masculino, não ter um companheiro e trabalhar em período noturno, respectivamente. Conclusão: As estratégias de enfrentamento podem ser auxiliadas por acompanhamento escuta, programas educacionais e um espaço para discussão das dificuldades relacionadas ao trabalho.

The stability of coping strategies in older adults with osteoarthritis and the ability of these strategies to predict changes in depression, disability, and pain

OBJECTIVES

Given the chronically painful, incurable nature of osteoarthritis, effective cognitive and behavioral coping strategies may be critical for older adults with the disease. Little is known about how and why coping changes over time, nor about stability of coping strategies in persons with osteoarthritis. The aims of this work were to examine the structure of coping in older adults with osteoarthritis, the association of coping strategies with well-being, the stability of coping over time, and its association with changes in well-being over the same period.

METHOD

In a cross-sectional study, 199 older adults with osteoarthritis of the knee were assessed at baseline and two-years' follow-up. Items from two coping scales were factor analyzed, and Pearson's correlations and paired-samples t-tests assessed relative and absolute stability of the resultant coping strategies. CFA assessed the stability of the factor structure itself. Ordinary least-squares regression analyses examined the impact of change in coping on well-being.

RESULTS

A five-factor coping solution emerged: stoicism, refocusing, problem-solving, wishful-thinking, and emotion-focused coping. The factor structure showed stability over the two-year period. Absolute stability of strategies varied, indicating that change in coping styles was possible.

CONCLUSION

Changes in coping style predicts future well-being; however, coping remains malleable with age and maladaptive strategies can be effectively targeted. Greater knowledge of the utility or maladaptive nature of a given strategy may help guide decisions about interventions for patients with osteoarthritis and encourage more adaptive coping styles.

An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies

Given the potential transdiagnostic importance of emotion dysregulation, as well as a lack of research examining emotion dysregulation in relation to health anxiety, the present study sought to examine associations among specific emotion regulation strategies (cognitive reappraisal and expressive suppression), emotion regulation difficulties, and health anxiety in a physically healthy sample of adults (N=482). As hypothesized, results of a series of hierarchical multiple regression analyses showed that emotion regulation difficulties provided a significant incremental contribution, beyond the specific emotion regulation strategies, in predicting each of the three health anxiety variables. Among the six dimensions of emotion regulation difficulties, the dimension representing perceived access to effective emotion regulation strategies was the only emotion regulation difficulty dimension that predicted all three health anxiety variables beyond the effects of the specific emotion regulation strategies. Results indicate that emotion regulation difficulties, and particularly one's subjective appraisal of his/her ability to effectively regulate emotions, may be of importance to health anxiety. Clinical implications are discussed.