The effects of safety behaviors on health anxiety: an experimental investigation

Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for fibromyalgia: Secondary analysis of a randomized controlled trial

Fibromyalgia is a chronic pain condition associated with substantial suffering and societal costs. Traditional cognitive behavior therapy (T-CBT) is the most evaluated psychological treatment, but exposure therapy (Exp-CBT) has shown promise with a pronounced focus on the reduction of pain-related avoidance behaviors. In a recent randomized controlled trial (N = 274), we found that Exp-CBT was not superior to T-CBT (d = -0.10) in reducing overall fibromyalgia severity. This study investigated pain-related avoidance behaviors, pain catastrophizing, hypervigilance, pacing, overdoing and physical activity as potential mediators of the treatment effect. Mediation analyses were based on parallel process growth models fitted on 11 weekly measurement points, and week-by-week time-lagged effects were tested using random intercepts cross-lagged panel models. Results indicated that a reduction in avoidance behaviors, pain catastrophizing, and hypervigilance were significant mediators of change in both treatments. An increase in pacing and a reduction in overdoing were significant mediators in T-CBT only. Physical activity was not a mediator. In the time-lagged analyses, an unequivocal effect on subsequent fibromyalgia severity was seen of avoidance and catastrophizing in Exp-CBT, and of overdoing in T-CBT. Exposure-based and traditional CBT for fibromyalgia appear to share common treatment mediators, namely pain-related avoidance behavior, catastrophizing and hypervigilance.

The anxiety response of patients with severe psychiatric disorders to the recent public health crisis

BACKGROUND

The devastating health, economic, and social consequences of COVID-19 may harm the already vulnerable groups, particularly people with severe psychiatric disorders (SPDs). The present study was conducted to investigate the anxiety response of patients with SPDs during the COVID-19 pandemic.

METHODS

A total of 351 patients with SPDs [Schizophrenia Spectrum (SSD), Bipolar (BD), Major Depressive (MDD), and Obsessive-Compulsive (OCD) Disorders] and healthy controls in Guilan province, Iran, throughout 2021-2022 were included in this cross-sectional analytical study. The anxiety response consisted of four concepts: COVID-19-related anxiety, general health anxiety, anxiety sensitivity, and safety behaviors. We conducted an unstructured interview and provided sociodemographic and clinical information. Also, the participants were asked to complete four self-report measures of the Corona Disease Anxiety Scale, the Anxiety Sensitivity Index-Revised, the Short Health Anxiety Inventory, and the Checklist of Safety Behaviors.

RESULTS

Analysis of variance showed a significant difference between the groups of patients with SPDs and the control group in COVID-19-related anxiety (F = 6.92, p = 0.0001), health anxiety (F = 6.21, p = 0.0001), and safety behaviors (F = 2.52, p = 0.41). No significant difference was observed between them in anxiety sensitivity (F = 1.77, p = 0.134). The Games-Howell test showed that the control group obtained a higher mean than the groups of people with BD (p < 0.0001), SSD (p = 0.033), and OCD (p = 0.003) disorders in COVID-19-related anxiety. The patients with MDD (p = 0.014) and OCD (p = 0.01) had a higher mean score than the control group in health anxiety. Tukey's test showed that the mean of safety behaviors of the control group was significantly higher than the OCD group (p = 0.21). No significant difference was found between the groups of patients with MDD, BD, SSD, and OCD in terms of COVID-19-related anxiety, health anxiety, and safety behaviors.

CONCLUSION

Anxiety response to health crisis is different in groups with SPDs and control group. The findings of this study suggest that although health anxiety is present in many of these patients during the pandemic, their anxiety response to the health crisis may be less than expected. There can be various explanations, such as pre-existing symptoms, low health literacy, and possible co-occurring cognitive impairment. The results of this study have many practical and policy implications in meeting the treatment needs of this group of patients during public health crises and indicate that their needs may not be compatible with the expectations and estimates that health professionals and policymakers already have.

Role of interoceptive fear and maladaptive attention and behaviors in the escalation of psychopathology-a network analysis

The complex interplay of fear, attention, and behavior toward bodily sensations with psychopathological symptoms and how they mutually influence and potentially reinforce one another remains to be fully elucidated. In this study, we used a network analytical approach to unravel these complex interactions. Specifically, we aimed to identify central symptoms and etiologically relevant factors that might be associated with anxiety and depressive core symptoms. To this end, the following clusters were assessed in 791 adults: interoceptive fear, interoceptive attention, maladaptive behaviors related to bodily sensations, and core symptoms of anxiety and depression. This network was modeled using a Gaussian Graphical Model. Central variables (nodes) were identified using centrality indices and bridge analysis. Self-examination and attention to bodily sensations emerged as central nodes. Moreover, time spent paying attention to bodily sensations, fear of anxiety-related sensations, and self-examination were identified as central bridge nodes, that is, central nodes connecting psychopathologically relevant symptom clusters. The present study indicates that fear of bodily sensations, the amount of attention and time spent focusing on somatic sensations, and self-examination are central factors. The findings suggest potential targets for future longitudinal studies on the impact of these factors for the escalation of anxiety and depressive symptoms.

Coping with COVID-19: a snapshot of college student mental health, coping, and expectancies during stay-at-home orders

OBJECTIVE

The COVID-19 pandemic has disrupted people's lives around the world, including college students. This cross-sectional study aimed to 1) describe psychological distress, coping, and expectancies of undergraduates during COVID-19 "stay-at-home" orders and 2) examine the associations among these variables.

PARTICIPANTS AND METHODS

Midwestern US undergraduates (N = 186) completed measures of psychological distress, coping behaviors, and expectancies in March-April 2020 during the initial round of "stay-at-home" orders.

RESULTS

Students engaged in approach coping and disease prevention behaviors and had low expectations for contracting COVID-19. Most students reported clinically significant depression or anxiety. Adherence to disease prevention behaviors was associated with less stress but more anxiety. Positive expectancies and approach coping were associated with less distress. Avoidance coping was associated with more distress.

CONCLUSIONS

This study describes the toll that COVID-19 has had on college students. Continued attention to the mental health of college students during the pandemic is imperative.

Coping, health anxiety, and stress among health professionals during Covid-19, Cape Coast, Ghana

The aim of this study is to investigate coping strategies, health anxiety and stress among healthcare professionals in selected hospitals in the Cape Coast Metropolis during the Covid 19 pandemic. This study adopted the Descriptive survey design. The Multistage sampling technique was used to select 322 health professionals. The health professionals included Medical Officers, Physician Assistants and Nurses. Data were gathered using the Health Anxiety Inventory (HAI-SF), Perceived Stress Scale (PSS), and the Brief-COPE Inventory. Analyses were conducted using mean and standard deviation, ANOVA as well as Independent Samples t-test. Results indicate that Health professionals adopted diverse coping strategies ranging from positive to negative coping style to overcome the negative impact of the COVID-19 pandemic. Results also indicate that coping strategies significantly influenced health anxiety levels of health professionals, and that Active Coping is a significant determinant of stress among health professionals. Male health professionals had significantly more health anxiety than females. However, gender was not a significant factor in the experiences of stress. Lastly, age of health professionals does not determine the type of coping strategy they adopted during the pandemic.

Stress and loneliness: exploring adolescents' use of social media as a coping strategy during COVID-19

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, adolescents used various coping strategies to manage stress and loneliness. One such strategy was to engage in active coping, social relations coping and humour coping via social media. Such coping strategies can be helpful but can also reinforce stress and loneliness.

AIM

To explore adolescents' use of social media to manage stress and loneliness at a time of restricted social contacts due to the COVID-19 pandemic, including potential differences between adolescents according to gender, age, area of residence and extent of social media use.

METHOD

A cross-sectional design and an online questionnaire were used to survey a convenience sample of adolescents aged between 12 and 18 years in Jordan. Three data collection tools were used - the modified Brief Coping Scale, the six-item Revised UCLA Loneliness Scale and the Perceived Stress Scale.

RESULTS

A total of 770 adolescents participated, half of whom were using social media more than before the pandemic. Increased use of active coping, social relations coping and humour coping was associated with decreases in stress and loneliness. Active coping contributed the most to reducing levels of stress while social relations coping contributed the most to reducing levels of loneliness. Younger participants made more use of active coping and humour coping than older participants.

CONCLUSION

Social media use can be a positive coping strategy for adolescents to manage stress and loneliness during a crisis such as the COVID-19 pandemic.

Is everything really okay?: Using ecological momentary assessment to evaluate daily co-fluctuations in anxiety and reassurance seeking

OBJECTIVE

Reassurance seeking, a behavior prominent in anxiety disorders and depression, is associated with poorer quality of interpersonal relationships and acts as a mechanism of stress generation. However, little research has elucidated momentary associations between state anxiety and reassurance seeking behaviors.

METHOD

In a sample of 104 university-affiliated young adults, we sought to replicate cross-sectional associations of reassurance seeking with trait anxiety (Aim 1) and intolerance of uncertainty (Aim 2). We then used ecological momentary assessment (EMA) to evaluate concurrent fluctuations in daily anxiety and reassurance seeking across 14 consecutive days (Aim 3). Hierarchical multi-level models for intensive longitudinal data were used to evaluate the relationship between state anxiety and daily reassurance seeking.

RESULTS

In baseline analyses, trait anxiety and intolerance of uncertainty were significantly associated with greater trait reassurance seeking, controlling for depression. Analyses of the EMA data showed that daily reassurance seeking behaviors fluctuated concurrently with daily anxiety during the 14 days, while controlling for trait anxiety and depression.

CONCLUSION

Given evidence of concurrent fluctuations between state anxiety and reassurance seeking, the behavior should be considered as a potential target in treatment for anxiety disorders.

Reducing safety behaviors to prevent anxious symptoms: a pre-registered prevention intervention study

The purpose of this pre-registered study was to test the efficacy of a simple, low-impact safety behavior prevention intervention for anxiety. The intervention was delivered online using a 4-week workbook format. Participants (n = 130) were a non-clinical sample of American college students; they were randomly assigned to one of two intervention conditions: safety-behavior reduction or active control condition (academic skills). Results showed that participants in the safety behavior workbook condition did not report fewer safety behaviors or lower levels of anxiety compared to the active control condition post-intervention. Exploratory analyses found that fidelity mattered; participants who completed all the workbook activities reported a significant decrease in the safety-behaviors relative to the control condition. However, those who reduced their use of safety behaviors reported greater levels of anxiety compared to participants in the control condition who reduced their safety behaviors. These results suggest that encouraging safety behavior reduction in non-clinical samples may have the unintended consequence of maintaining anxiety.

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.

Mind-Wandering and Its Relationship With Psychological Wellbeing and Obsessive-Compulsive Symptomatology in the Context of Covid-19

Mind-wandering (MW) as a research topic has received considerable attention over the last several decades. The recent differentiation between spontaneous and deliberate MW has suggested a particular effect of the former on psychopathology; in that increased spontaneous MW may precede mental illness. The present study sought to explore MW as a potential contributing factor to poor mental health in the context of the Covid-19 pandemic. More specifically, we sought to determine firstly, whether the effects of MW frequency, type and content on subjective psychological wellbeing was consistent with previous findings after controlling for the impacts of Covid-related stress. Secondly, previous research has demonstrated an effect of both Covid-stress and spontaneous MW on the experience of obsessive-compulsive symptomatology (OCS), and so the present study explored this relationship further by assessing whether Covid-stress mediated the relationship between spontaneous MW and OCS. Participants completed measures of MW, OCS and psychological wellbeing through an online questionnaire. The results indicated that increased spontaneous MW was indicative of both poorer subjective psychological wellbeing and OCS, with Covid-stress partially mediating the relationship between spontaneous MW and OCS. Our findings provide further support for the adverse effect of unintentional MW on psychological wellbeing, as well as for the differentiation between both forms of the cognitive phenomenon. Additionally, they provide an important insight into one of the factors that may have preceded poor mental health among the Irish population during Covid-19. Future research may build upon the present study by exploring similar relationships among clinical populations.

From Bad to Worse: Safety Behaviors Exacerbate Eating Disorder Fears

When evaluating ambiguous situations, humans sometimes use their behavior as a source of information (behavior-as-information effect) and interpret safety behaviors as evidence for danger. Accordingly, we hypothesized that eating disorder safety behaviors (restrictive eating, body checking, etc.) might aggravate fear and anxiety in individuals with an eating disorder. The present study tested to what extent eating disorder safety behaviors increase threat perception in individuals with and without an eating disorder. For this, 108 individuals with a self-reported eating disorder diagnosis and 82 healthy controls rated the dangerousness of several short situations. The situations systematically varied in the presence of eating disorder safety behaviors and danger information. As expected, all participants perceived situations in which the protagonist executed an eating disorder safety behavior as more threatening than situations without a safety behavior. This 'behavior-as-information' effect was equally strong in individuals with and without an eating disorder. Additionally, safety behaviors strengthened threat perception more in safe situations than in dangerous situations. To conclude, the presence of eating disorder safety behavior can increase threat perception regardless of whether individuals have an eating disorder or not. This makes eating disorder safety behaviors a potential risk factor for the development and maintenance of eating disorder fears.

Unwanted outcomes in cognitive behavior therapy for pathological health anxiety: a systematic review and a secondary original study of two randomized controlled trials

INTRODUCTION

Cognitive behavior therapy (CBT) is effective for pathological health anxiety, but little is known about unwanted outcomes.

AREAS COVERED

We investigated unwanted outcomes in the form of adverse events, overall symptom deterioration, and dropouts in CBT for pathological health anxiety based on a systematic review of 19 randomized controlled trials (PubMed, PsycInfo, and OATD; last updated 2 June 2023; pooled N = 2188), and then a secondary original study of two randomized controlled trials (pooled N = 336). In the systematic review, 10% of participants in CBT reported at least one adverse event and 17% dropped out. Heterogeneity was substantial. In the original investigation, 17% reported at least one adverse event, 0-10% met criteria for overall symptom deterioration, and 10-19% dropped out. In guided Internet-delivered CBT, dropouts were more common with lower education and lower credibility/expectancy ratings. Higher adherence was associated with a larger reduction in health anxiety.

EXPERT OPINION

Unwanted effects are routinely seen in CBT for pathological health anxiety, but, under typical circumstances, appear to be acceptable in light of the treatment's efficacy. There is a need for more consistent methods to improve our understanding adverse events, dropouts, and overall symptom deterioration, and how these outcomes can be prevented.

Acceptability, feasibility, and utility of a safety aid reduction treatment in underserved veterans: a pilot investigation

Access to mental health services, particularly for veterans residing in underserved communities, remain scarce. One approach to addressing availability barriers is through the use of group-based transdiagnostic or unified treatment protocols. One such protocol, Safety Aid Reduction Treatment (START), previously termed False Safety Behavior Elimination Treatment (FSET), has received increasing empirical support. However, prior research has only examined this treatment among civilians with a primary anxiety diagnosis. Thus, the purpose of the current study was to replicate and extend prior research by examining the acceptability, feasibility, and utility of START among veterans, particularly those living in underserved communities, and across a wider array of diagnoses. Veterans (n = 22) were assessed prior to, immediately after, and one month following the 8-week treatment. The majority of veterans found START useful and acceptable. Additionally, recruitment and retention rates suggest that the treatment was feasible. Notably, results revealed reductions in overall anxiety, depression, and safety aid usage, which were maintained throughout the brief follow-up period. These findings add to a growing body of literature highlighting the utility of transdiagnostic approaches in the amelioration of various anxiety and related disorders. Limitations include the small sample size and uncontrolled design.

The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic

BACKGROUND

The Perceived Vulnerability to Disease Questionnaire (PVDQ) measures beliefs associated with personal susceptibility to infectious diseases and behaviors or perceptions in the presence of potential risk of pathogen transmission. Given the onset of the Severe Acute Respiratory Syndrome Coronavirus 2 global pandemic, otherwise known as the COVID-19 pandemic, the construct being measured may function differently based on affective, behavioral, and cognitive changes along with the need to change norms and lifestyles in a global context. The present study aims to test the psychometric properties and the gender invariance of the Italian adaptation of the PVDQ to confirm that the scale can be used with Italian-speaking people, and that it functions effectively during a pandemic.

METHODS

A total of 509 participants filled out an online questionnaire including the Italian version of the I-PVDQ (I-PVDQ) and several measures of psychological constructs. Reliability and factor analyses (single and multigroup) were conducted. Bayesian correlation tests and Bayesian independent sample t-tests were used to assess the validity of I-PVDQ.

RESULTS

Exploratory factor analysis supported the two-factor structure of the I-PVDQ, and factor loadings loaded appropriately onto perceived infectability (PI) and germ aversion (GA). In terms of invariance, the scale showed configural, metric, scalar, and strict invariance across genders. Decisive evidence in favor of correlation with the measure of COVID-19 related fears for both PI and GA was found. There was strong evidence for observed correlations with COVID-19 related constructs such as intolerance to uncertainty, psychological inflexibility, resilience, stress, and anxiety. Women showed higher GA than men, while there were no gender differences in PI.

CONCLUSIONS

Taken together, these results suggest that the I-PVDQ confirms the psychometric properties of the original version and that can be used to detect PVD when it is affected by environmental circumstances since its functioning is preserved during a pandemic.

The 14-item short health anxiety inventory (SHAI-14) used as a screening tool: appropriate interpretation and diagnostic accuracy of the Swedish version

BACKGROUND

The 14-item Short Health Anxiety Inventory (SHAI-14) is a common measure of health anxiety but its screening properties have not been studied. The aims of this study were to evaluate the SHAI-14 as a screening instrument, identify cut-offs for clinically significant health anxiety and investigate which scores correspond to different severity levels.

METHOD

The study included 1729 psychiatric patients and 85 healthy controls. Participants completed the SHAI-14 and underwent a diagnostic interview. Cut-off scores were evaluated in three scenarios to approximate screening 1) in a psychiatric clinic, 2) in a low prevalence setting and, 3) of healthy volunteers (cut-off for remission). Receiver operating characteristics were used. Classification of severity was based on the distribution of SHAI-14 scores reported by patients with clinically significant health anxiety.

RESULTS

The area under the curve (AUC) values were high in all scenarios (above 0.95). The optimal cut-off scores on the SHAI-14 were 22 in the psychiatric context, 29 in a setting with low prevalence of psychiatric disorders and 18 versus healthy controls. SHAI-14 scores of 0-27 represented no or mild health anxiety, 28-32 moderate health anxiety and 33-42 substantial health anxiety.

CONCLUSION

Brief self-report measures used as screening instruments are a simple way of gathering information about the presence of specific symptoms and thus a way to detect the likelihood of a diagnosis. The SHAI-14 shows evidence of good diagnostic utility in both clinical and non-clinical settings. However, which cut-off score is to be used, depends on the intended purpose and the setting where the cut-off is used.

Worry and fear during the COVID-19 epidemic normalization: Analyzing prevalence and risk factors among 182,991 high school students in China

It is worth paying attention to the level of worry and fear of students during the normalization of the epidemic. We conducted the cross-sectional study that included 182,991 high school students using an online survey to assess worry and fear levels and its influencing factors in three cities in Henan Province, China, from May 21 to May 27, 2021. Worry and fear levels were measured using a five-item Likert-type scale. Multinomial logistic regression was used to analyze the risk factors. Approximately 65.42% of students reported being high worry about the coronavirus disease 2019 (COVID-19) epidemic, and about 41.44% of students reported being high fear about the COVID-19 epidemic. In addition, compared with female, male had lower odds of suffering from a high worry, and compared with senior high school students, junior high school students were more likely to suffer from a high worry. Students lived in rural had highest odds increased likelihood of high worry. Similar results in fear levels. During the normalization period of the COVID-19 epidemic, many students have high levels of worry and fear. This study has implications for potential influencers of worry and fear levels in follow-up work.

Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder

Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD.

Social Support Mediates the Association between Health Anxiety and Quality of Life: Findings from a Cross-Sectional Study

This study aimed to test if perceived social support and cyberchondria mediate the association between health anxiety and quality of life (QoL) in a nonclinical sample. Cross-sectional research involved adult internet users (n = 538) between 16 May 2020 and 29 December 2020 in Poland who completed self-report questionnaires, including the cyberchondria severity scale (CSS-PL), the short health anxiety inventory (SHAI), the multidimensional scale of perceived social support (MSPSS) and the quality of life scale (QOLS). A mediation analysis was performed to examine the direct effects of health anxiety on cyberchondria, perceived social support and quality of life. Likewise, the effects of cyberchondria and perceived social support on QoL were analyzed. Hence, indirect effects of health anxiety on QoL through cyberchondria and perceived social support were explored. Health anxiety significantly impaired QoL both directly and indirectly through low-perceived social support. Perceived social support partly mediated the association between health anxiety and QoL. Cyberchondria did not have a significant direct effect on the latter. Thus, cyberchondria did not mediate the relationship between health anxiety and QoL. Boosting-perceived social support may mitigate the detrimental effect of health anxiety on QoL. Cyberchondria was not found to have a significant effect on QoL in contrast to health anxiety alone.

Predictors of interest in predictive testing for rheumatoid arthritis among first degree relatives of rheumatoid arthritis patients

OBJECTIVES

There is increasing interest in prediction and prevention of RA. It is important to understand the views of those at risk to inform the development of effective approaches. First-degree relatives (FDRs) of RA patients are at increased risk of RA. This study assessed predictors of their interest in predictive testing for RA.

METHODS

Questionnaires were completed by RA patients (provided with their questionnaire by a healthcare professional) and their FDRs (provided with their questionnaire by their RA proband). FDR surveys assessed interest in taking a predictive test, demographic variables, perceived RA risk, attitudes about predictive testing, autonomy preferences, illness perceptions, avoidance coping and health anxiety. Patient surveys included demographic variables, disease impact, RA duration and treatment. Ordinal logistic regression examined the association between FDRs' characteristics and their interest in predictive testing. Generalized estimating equations assessed associations between patient characteristics and FDRs' interest in predictive testing.

RESULTS

Three hundred and ninety-six FDRs responded. Paired data from the RA proband were available for 292. The proportion of FDRs interested in predictive testing was 91.3%. Information-seeking preferences, beliefs that predictive testing can increase empowerment over health and positive attitudes about risk knowledge were associated with increased interest. Beliefs that predictive testing could cause psychological harm predicted lower interest. Patient characteristics of the proband were not associated with FDRs' interest.

CONCLUSIONS

FDRs' interest in predictive testing for RA was high, and factors associated with interest were identified. These findings will inform the development of predictive strategies and informational resources for those at risk.

Fear and death anxiety in the shadow of COVID-19 among the Lebanese population: A cross-sectional study

Background

The COVID-19 pandemic was one of the most devastating health crises the world has seen. One of its mental health consequences includes fear of being infected, which could lead to anxiety. This study aimed to assess the fear related to the COVID-19 pandemic and its associated factors among the adult population in Lebanon.

Methods

A cross-sectional study was conducted in Lebanon between February 26^th and April 29^th, 2021. Data was collected through an online survey among adults aged 18 years and older. Information on sociodemographic and clinical characteristics of the participants, fear and death anxiety related to the COVID-19 pandemic, depression, and anxiety were collected. Multivariable linear regression analyses were carried out to identify the predictors of fear related to the COVID-19 pandemic.

Results

A total of 1840 participants were included in the analysis of which 62.9% were females and 62.2% were single. The age of the participants ranged from 18 to 70 years with a mean of 26.6 ±8.8 years. Of the total participants, 41.9% felt uncomfortable thinking about the novel Coronavirus and 35.4% of candidates became nervous/anxious when watching the news about COVID-19 on social media. About one-third of the participants (33.7%) were afraid of COVID-19 and 23.8% were afraid of losing their life because of the disease. Concerning somatic symptoms of fear, 7.9% reported increased heart races or palpitations whenever they thought about getting infected with COVID-19, 3.7% complained about sleep disturbances while 2.5% developed tremors or sweating in their hands when they thought about Coronavirus. In addition, Death anxiety related to the COVID-19 pandemic was one of the most fear-related factors (B = 0.191, 95% CI (0.172 to 0.211), P-value < 0.0001).

Conclusion

This study provides insights on the impact of COVID-19 on individuals at the level of fear in Lebanon. Death anxiety was identified as the most significant predictor of fear related to the COVID-19 pandemic. Considering the negative psychological effects of fear, it is necessary to educate the adults on how to deal with death anxiety and implement psychological interventions and counseling programs to relieve fear and improve the mental health of Lebanese adults.

A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder: single-group prospective feasibility trial

BACKGROUND

Exposure-based psychological treatment appears to have beneficial effects for several patient groups that commonly report distress related to persistent somatic symptoms. Yet exposure-based treatment is rarely offered in routine care. This may be because existing treatment protocols have been developed for specific symptom clusters or specific unwanted responses to somatic symptoms, and many clinics do not have the resources to offer all these specialised treatments in parallel. In preparation for a randomised controlled trial, we investigated the feasibility of a new and unified Internet-delivered exposure treatment (OSF.io: cnbwj) for somatic symptom disorder regardless of somatic symptom domain (e.g. cardiopulmonary, fatigue, gastrointestinal, pain), combination of unwanted emotions (e.g. anger, anxiety, fear, shame) and whether somatic symptoms are medically explained or not. We hypothesised that a wide spectrum of subgroups would show interest, that the treatment would be rated as credible, that adherence would be adequate, that the measurement strategy would be acceptable and that there would be no serious adverse events.

METHODS

Single-group prospective cohort study where 33 self-referred adults with undifferentiated DSM-5 somatic symptom disorder took part in 8 weeks of unified Internet-delivered exposure treatment delivered via a web platform hosted by a medical university. Self-report questionnaires were administered online before treatment, each week during treatment, post treatment and 3 months after treatment.

RESULTS

Participants reported a broad spectrum of symptoms. The Credibility/Expectancy mean score was 34.5 (SD = 7.0, range: 18-47). Participants completed 91% (150/165) of all modules and 97% of the participants (32/33) completed at least two exposure exercises. The average participant rated the adequacy of the rationale as 8.4 (SD = 1.5) on a scale from 0 to 10. The post-treatment assessment was completed by 97% (32/33), and 84% (27/32) rated the measurement strategy as acceptable. The Client Satisfaction Questionnaire mean score was 25.3 (SD = 4.7, range: 17-32) and no serious adverse events were reported. Reductions in subjective somatic symptom burden (the Patient Health Questionnaire 15; d = 0.90) and symptom preoccupation (the somatic symptom disorder 12; d = 1.17) were large and sustained.

CONCLUSIONS

Delivering a unified Internet-delivered exposure-based treatment protocol for individuals with undifferentiated somatic symptom disorder appears to be feasible.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04511286 . Registered on August 13, 2020.

Safety behaviors toward innocuous stimuli can maintain or increase threat beliefs

Safety behaviors can prevent or minimize a feared outcome. However, in relatively safe situations, they may be less adaptive, presumably because people will misattribute safety to these behaviors. This research aimed to investigate whether safety behaviors in safe situations can lead to increased threat beliefs. In Study 1, we aimed to replicate a fear conditioning study (N = 68 students) in which the experimental, but not the control group, received the opportunity to perform safety behavior to an innocuous stimulus. From before to after the availability of the safety behavior, threat beliefs persisted in the experimental group, while they decreased in the control group. In Study 2, we examined whether threat beliefs had actually increased for some individuals in the experimental group, using a multi-dataset latent class analysis on data from Study 1 and two earlier studies (N = 213). Results showed that about a quarter of individuals who performed safety behavior toward the innocuous stimulus showed increased threat expectancy to this cue, while virtually nobody in the control group exhibited an increase. Taken together, safety behavior in relatively safe situations may have maladaptive effects as it generally maintains and sometimes even increases threat beliefs.

Health Anxiety and Its Relationship to Thyroid-Hormone-Suppression Therapy in Patients with Differentiated Thyroid Cancer

Differentiated thyroid cancer (DTC) has a good prognosis; however, patients often need lifelong follow up, and they face potential side effects. The aim of this study was to investigate health anxiety among DTC patients and its relationship to TSH suppression. In 2020, patients from a previous cohort who were from Stockholm completed the 14-item Short Health Anxiety Inventory (SHAI-14; 0−42; 18 being the threshold for clinical significance) and a study-specific questionnaire. Clinical information was also retrieved from medical records. Linear regression was used to investigate the relationship between the TSH levels and the SHAI-14, while adjusting for potential confounders. In total, 146 (73%) patients were included. A total of 24 respondents (16%) scored 18 or more on the SHAI-14, and the mean score was 11.3. Patients with TSH levels of 0.1−0.5 (mE/L) scored, on average, 3.28 points more (p-value 0.01) on the SHAI-14 compared to patients with TSH levels > 0.5. There was no statistically significant difference between patients with TSH levels < 0.1 and TSH levels > 0.5. Thus, we found no linear relationship between the TSH values and health anxiety. Clinically significant levels of health anxiety are slightly higher than those in the general population, but do not appear to be a major psychiatric comorbidity among patients with DTC.

Psychological well-being, risk factors, and coping strategies with social isolation and new challenges in times of adversity caused by the COVID-19 pandemic

Objective

COVID-19 triggers anxiety and fear due to several reasons, and thus, dealing with it requires prolonged coping mechanisms. When the number of infections soared, to slow the spread, many governments decided to close universities and dormitories and move teaching to online platforms. The majority of the university students decided to move back home to their parents changing their social lives. Here, we aimed to point to risk, as well as protective factors, and understand the influence of these factors on both physical and psychological indicators of well-being. Further, to discover how university students cope with maintaining their social lives during the COVID-19 pandemic.

Method

We collected online survey data from multiple university sources. Participants (N = 605) completed measures of emotion regulation strategies, knowledge on the disease, contamination fear, perceived social support, worrying and intolerance of uncertainty, quality of sleep, well-being, emotional stability, anxiety, and depression.

Results

Our results showed that the most prominent risk and protective factors that were most strongly associated with the indicators of well-being were rumination, catastrophizing, positive refocusing, and social support from family; respectively.

Conclusion

These results have implications for professionals working with and helping (e.g., as counselors) people during the challenges of an emergency.

Longitudinal relationships between COVID-19 preventative behaviors and perceived vulnerability to disease

Engagement in infection-preventing behaviors (e.g., mask wearing) has become crucial in the context of the COVID-19 pandemic, and health-related anxiety may be an important determinant of individual compliance with recommended guidelines. However, little is known about transactional associations between health anxiety and preventative behaviors, particularly with respect to COVID-19. The present study aimed to longitudinally examine the links between preventative behaviors and both emotion-driven (Germ Aversion) and belief-based (Perceived Infectability) aspects of health anxiety during the COVID-19 pandemic. We hypothesized that greater health anxiety at Time 1 (early in the pandemic) would predict future compliance with preventative behaviors six months later. Two hundred and ninety-six adults (M/SD_age= 30.9/10.9 years, 42.2% female) completed two online assessments during the COVID-19 pandemic (Time 1 =June 2020; Time 2 =December 2020). Longitudinal cross-lagged analyses revealed that initial Germ Aversion predicted greater engagement in preventative behaviors at follow-up (β = 0.16; p = <.001), over and above initial engagement in such behaviors. Similarly, initial engagement in preventative behaviors predicted increases in Germ Aversion at follow-up (β = .23; p = <.001), over and above initial Germ Aversion. The present findings indicate that affect-driven aspects of health anxiety have a complex transactional relationship with engagement in behaviors aimed at curbing the spread of the COVID-19 pandemic. Clinical and public health implications are discussed.

A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study (Preprint)

Background

An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies.

Objective

The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic.

Methods

Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed.

Results

The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis.

Conclusions

Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety.

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.

The association of cultural and contextual factors with social contact avoidance during the COVID-19 pandemic

As a first line of defense to the COVID-19 pandemic in 2020, people reduced social contacts to avoid pathogen exposure. Using a panel of countries, this research suggests that this was amplified in societies characterized by high social support and future orientation. People reacted more strongly in dense environments; government orders had more effect in high power distance societies. Conversely, a focus on accomplishments was associated with lower changes. Understanding people’s actual behaviors in response to health threats across societies is of great importance for epidemiology, public health, international business, and for the functioning of humanity as a whole.

The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic

BACKGROUND

Internet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic.

METHODS

THIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP's iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019-11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10).

RESULTS

From March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%.

CONCLUSIONS

iCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.

Early and Later Perceptions and Reactions to the COVID-19 Pandemic in Germany: On Predictors of Behavioral Responses and Guideline Adherence During the Restrictions

In March 2020, the German government enacted measures on movement restrictions and social distancing due to the COVID-19 pandemic. As this situation was previously unknown, it raised numerous questions about people's perceptions of and behavioral responses to these new policies. In this context, we were specifically interested in people's trust in official information, predictors for self-prepping behavior and health behavior to protect oneself and others, and determinants for adherence to social distancing guidelines. To explore these questions, we conducted three studies in which a total of 1,368 participants were surveyed (Study 1 N=377, March 2020; Study 2 N=461, April 2020; Study 3 N=530, April 2021) across Germany between March 2020 and April 2021. Results showed striking differences in the level of trust in official statistics (depending on the source). Furthermore, all three studies showed congruent findings regarding the influence of different factors on the respective behavioral responses. Trust in official statistics predicted behavioral responses in all three studies. However, it did not influence adherence to social distancing guidelines in 2020, but in 2021. Furthermore, adherence to social distancing guidelines was associated with higher acceptance rates of the measures and being older. Being female and less right-wing orientated were positively associated with guidelines adherence only in the studies from 2020. This year, political orientation moderated the association between acceptance of the measures and guideline adherence. This investigation is one of the first to examine perceptions and reactions during the COVID-19 pandemic in Germany across 1year and provides insights into important dimensions that need to be considered when communicating with the public.

Internet memes related to the COVID-19 pandemic as a potential coping mechanism for anxiety

This study examined whether significantly anxious individuals differed from non-anxious individuals in their perceptual ratings of internet memes related to the Covid-19 pandemic, whilst considering the mediating role of emotion regulation. Eighty individuals presenting clinically significant anxiety symptoms (indicating ≥ 15 on the GAD-7) and 80 non-anxious controls (indicating ≤ 4) rated the emotional valance, humour, relatability, shareability, and offensiveness of 45 Covid-19 internet memes. A measure of emotion regulation difficulties was also completed. The perception of humour, relatability, and shareability were all greater amongst anxious individuals relative to non-anxious controls. These differences were not mediated by emotion regulation deficits. Internet memes related to the current Covid-19 pandemic may tentatively serve as coping mechanism for individuals experiencing severe symptoms of anxiety.

Does Fear of the New Coronavirus Lead to Low-Carbon Behaviors: The Moderating Effect of Outcome Framing

PURPOSE

Air pollution has been found to aggravate the infection and mortality of COVID-19, leading to increasing attention on pro-environmental behaviors. Considering individuals' psychological distance from COVID-19, this research aims to examine the relationship between fear of COVID-19, air pollution concern, and low-carbon behaviors.

METHODS

Two survey-based studies were conducted in this research. Study 1 consisted of 323 participants and examined the relationships between psychological distance (PD) from COVID-19, fear of COVID-19, air pollution concern, and low-carbon behaviors. Study 2 identified the moderating effect of outcome framing using an intergroup experiment in which 304 participants were randomly assigned to two groups (gain framing vs loss framing).

RESULTS

The results of Study 1 showed that the closer the PD was, the higher the fear was. Fear of COVID-19 and low-carbon behaviors were positively associated. Additionally, air pollution concern acted as a mediator in their relationship. The results of the moderating effect test in Study 2 showed that fear and air pollution concern led to higher low-carbon behavioral intention within gain framing than within loss framing.

CONCLUSION

This research revealed that personal fear of public health emergencies will lead to environmental pollution concern and pro-environmental behaviors, and information from the outside plays a moderating role. The results provide implications for policy advocacy of the health and environmental sectors and for guiding people's low-carbon behaviors.

Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations.

METHOD

Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I² statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations.

RESULTS

Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong.

DISCUSSION

The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.

"Health Comes First": Action Tendencies to Health-Related Stimuli in People with Health-Anxiety as Revealed by an Emotional Go/No-Go Task

The processing of health-related stimuli can be biased by health anxiety and anxiety sensitivity but, at the moment, it is far from clear whether health-related stimuli can affect motor readiness or the ability to inhibit action. In this preliminary study, we assessed whether different levels of health anxiety and anxiety sensitivity affect disposition to action in response to positive and negative health-related stimuli in non-clinical individuals. An emotional go/no-go task was devised to test action disposition in response to positive (wellness-related), and negative (disease-related) stimuli in non-clinical participants who also underwent well-validated self-report measures of health anxiety and anxiety sensitivity. The main results showed that both health anxiety and anxiety sensitivity biased participants' responses. Importantly, safety-seeking and avoidance behaviors differently affected action disposition in response to positive and negative stimuli. These preliminary results support the idea that health anxiety and anxiety sensitivity could determine a hypervigilance for health-related information with a different perturbation of response control depending on the valence of the stimuli. Health anxiety and health anxiety disorder do form a continuum; thus, capturing different action tendencies to health-related stimuli could represent a valuable complementary tool to detect processing biases in persons who might develop a clinical condition.

Psychological Determinants and Consequences of COVID-19 Anxiety: A Web-Based Study in Iran

Pandemic illnesses such as COVID-19 can provoke negative emotions, including anxiety and depression, in addition to compulsive behaviors. Clarifying the psychosocial antecedents and consequences of COVID-19 anxiety can inform successful psychological support and treatment. This study investigated psychological predictors and consequences of COVID-19 anxiety during the outbreak of COVID-19 in Iran. University students (N = 398) completed a web-based survey measuring COVID-19 anxiety, general health anxiety, uncertainty intolerance, interpersonal trust, depression, and COVID-19-related panic shopping. The participants also responded to two additional questions: "Do you personally know of anyone who was suspected of having been infected with COVID-19?" and "Did you get sick in the past year?" Exploratory factor analysis, confirmatory factor analysis, Pearson correlation, multiple regression analysis, multivariate regression analysis, and 2 × 2 factorial ANOVA were used to analyze data. Health anxiety, uncertainty intolerance, and interpersonal trust were significantly associated with COVID-19 anxiety. COVID-19 anxiety was a significant predictor of depression and panic shopping. Participants who knew someone with COVID-19 and those who reported being sick in the past year experienced more COVID-19 anxiety. COVID-19 anxiety appears to be more severe among people with a low tolerance for uncertainty and low interpersonal trust. Understanding these risk factors can inform individualized therapeutic approaches to address the maladaptive outcomes of depression and false safety behaviors, such as panic buying.

Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown

It is critical to gain an understanding of the impact of the COVID 19 pandemic and the associated lockdown restrictions on the psychological, social and behavioural functioning of the general public, in order to inform public health promotion and future health service resource allocation. This cross-sectional study, completed during week 1 of lockdown in India, reports on data from 234 participants using an online survey. Data regarding health anxiety, coping mechanisms and locus of control was collected. Structural equation modelling was used to assess the relationship between locus of control, coping mechanisms, health anxiety and age. Age related differences in both locus of control and coping strategies were found. Younger people experienced more health-related anxiety and were more likely to engage with social media as a coping mechanism. Mindfulness-based strategies may reduce health anxiety by increasing tolerance of uncertainty experienced during the COVID 19 pandemic.

Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

Objective: Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice.

Inclusion Criteria: We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs.

Methods and Analysis: The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings.

Findings: After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty.

Conclusion: While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.

Fear of COVID-19 for Individuals and Family Members: Indications from the National Cross-Sectional Study of the EPICOVID19 Web-Based Survey

The study analyzed the association of the fear of contagion for oneself and for family members (FMs) during the first wave of the COVID-19 pandemic, with demographic and socioeconomic status (SES) and health factors. The study was performed within the EPICOVID19 web-based Italian survey, involving adults from April-June 2020. Out of 207,341 respondents, 95.9% completed the questionnaire (60% women with an average age of 47.3 vs. 48.9 years among men). The association between fear and demographic and SES characteristics, contacts with COVID-19 cases, nasopharyngeal swab, self-perceived health, flu vaccination, chronic diseases and specific symptoms was analyzed by logistic regression model; odds ratios adjusted for sex, age, education and occupation were calculated (aORs). Fear for FMs prevailed over fear for oneself and was higher among women than men. Fear for oneself decreased with higher levels of education and in those who perceived good health. Among those vaccinated for the flu, 40.8% responded they had feelings of fear for themselves vs. 34.2% of the not vaccinated. Fear increased when diseases were declared and it was higher when associated with symptoms such as chest pain, olfactory/taste disorders, heart palpitations (aORs > 1.5), lung or kidney diseases, hypertension, depression and/or anxiety. Trends in fear by region showed the highest percentage of positive responses in the southern regions. The knowledge gained from these results should be used to produce tailored messages and shared public health decisions.

Relationships Between the Life Satisfaction, Meaning in Life, Hope and COVID-19 Fear for Turkish Adults During the COVID-19 Outbreak

The current study investigated whether there are significant relationships between life satisfaction and meaning in life, hope and COVID-19 fear and the extent to which life satisfaction is predicted by these variables. The study group of this research consists of 1,186 adults with the mean age of 41.04. Study group participants are consists of different cities of different regions of Turkey. As the data collection tools, the life satisfaction scale, the meaning in life scale, the dispositional hope scale and the COVID-19 fear scale were used. The results of the analyses have revealed that meaning in life, hope (actuating thinking and alternative ways thinking) are significant predictors of life satisfaction as positively. Besides, it is seen COVID-19 fear, age, gender and the presence of people infected with COVID-19 around aren't significant predictors of life satisfaction in adults.

An explanatory sequential investigation of the working alliance as a change process in videoconferencing psychotherapy

OBJECTIVES AND DESIGN

Debate exists as to patient experience, and the importance, of the working alliance (WA) in videoconferencing psychotherapy (VCP). This study used a two-phase explanatory sequential design to investigate the WA as a change process in VCP.

METHODS

Phase I: sessional VCP outcome and WA data were analysed using multilevel modelling (n = 46). Phase II: participants (n = 12) from Phase I were recruited to semi-structured interviews, analysed using thematic framework analysis.

RESULTS AND CONCLUSIONS

Results demonstrate: (1) a significant correlation between WA and outcome (F(1, 15.19) = 25.01, p < 0.001), (2) previous session WA significantly predicted outcome in the next session (F(1, 355.61) = 4.47, p < 0.05), and (3) previous session outcome significantly predicted next session WA (F(1, 55.3) = 15.19, p < 0.001), with three core themes explaining patient experience (engaging with the medium, connection with the therapist, and working via the medium). Results are discussed and future research recommended.

Compliance with governmental restrictions during the coronavirus pandemic: A matter of personal self-protection or solidarity with people in risk groups?

During the coronavirus pandemic, governments across the globe ordered physical-distancing and hygiene restrictions to slow down the spread of COVID-19. The present work was conducted during the peak of restrictions in Germany (April/May 2020). In a convenient (N = 218) and representative sample (N = 715), we examined people's motivations to comply with these restrictions during the lockdown: Were they motivated by personal self-protection, or rather by solidarity with people in risk groups? Specifically, we investigated predictors of personal self-protection (compliance to protect the self against infection) and group-protection behaviours (compliance for reasons of solidarity in protecting people in risk groups). Results indicate that self- and group-protection result from different psychological processes: Whereas personal self-protection seems to be a form of coping with personal anxieties (epistemic and existential needs, personal threat), group protection is an intergroup phenomenon that is enabled by identification with a collective goal (common identity), the perception that society is capable of dealing with the virus (group efficacy), and concern for people in risk groups. We discuss potential implications for behavioural change in pandemics.

Anxiety and safety behavior usage during the COVID-19 pandemic: The prospective role of contamination fear

The coronavirus (COVID-19) pandemic has broadly increased anxiety and changed individual behavior. However, there is limited research examining predictors of pandemic-related changes, and the majority of existing research is cross-sectional in nature, which limits causal inference. Given functional links with disease avoidance processes, individual differences in contamination fear may be especially relevant in predicting responses to COVID-19. Accordingly, the present study prospectively examines contamination fear and obsessive-compulsive washing symptoms as predictors of anxiety and safety behaviors in response to COVID-19 in a student sample (N = 108). To examine specificity, anxiety and safety behaviors in response to seasonal influenza are also examined. In the early stages of the pandemic (March 2020), coronavirus-related anxiety was higher than flu-related anxiety (d = 1.38). Obsessive-compulsive washing symptoms also increased from before the pandemic (d = 0.4). Although baseline contamination fear and obsessive-compulsive washing symptoms did not significantly predict coronavirus-related anxiety, contamination fear did significantly predict safety behavior usage in response to both COVID-19 and influenza. The specificity of the prospective association between contamination fear and the use of safety behaviors are discussed in the context of the global COVID-19 pandemic and the broader literature on the role of safety behaviors in anxiety.

How to Assess Perceived Risks and Safety Behaviors Related to Pandemics: Developing the Pandemic Risk and Reaction Scale during the Covid-19 Outbreak

Objective: The aim of the present study was to develop a self-report questionnaire to assess the level of perceived risks and safety behaviors during pandemics. Method : We went through recommended phases and their corresponding steps to create a valid and reliable scale: (a) item development (including 1. domain identification and item generation, 2. content validity), (b) scale development (including 1. pretesting questions, 2. sampling and survey administration, 3. item reduction, and 4. extraction of factors), and (c) scale evaluation (including 1. tests of dimensionality, 2. tests of reliability, and 3. tests of validity). Results: We found four factors with eigenvalues greater than 1 that were accounted for 0.63 of the total variance. The 4-factor solution showed all items had factor loading greater than 0.4 and each belonged to one factor. The fit indices indicated the 4-factor solution model was fitted to our data. Conclusion: In sum, the Pandemic Risk and Reaction Scale (PRRS) is a valid and reliable self-reported scale to assess the level of perceived risk and safety behaviors during pandemics.

Fear of COVID-19 Scale for Hospital Staff in Regional Hospitals in Mexico: a Brief Report

The presence of COVID-19 has had psychological consequences among health personnel; these include fear, anxiety, and depression. In the current study, we used the Fear of COVID-19 Scale (FCV-19S) to assess the response to fear within health staff in Mexico. This was a cross-sectional survey study in which we administered the Spanish version of the FCV-19S to hospital staff. The FCV-19S is a seven-item questionnaire that assesses the severity of fear caused by COVID-19. A total of 2860 participants—1641 female and 1218 male personnel from three hospitals—were included in the study. The internal reliability of the scale was good, with Cronbach’s alpha of .902. A confirmatory factor analysis (CFA) was conducted on the seven items of the FCV-19S, showing good model fit (χ² (7) = 29.40, p < .001; CFI = .99; TLI = .99; RMSEA = .03; SRMR = .010; AIC = 71.40). We found a global FCV-19S mean score of 19.3 ± 6.9, with a significant difference in scores between women and men. Our survey shows a significantly higher level of fear in nursing and administrative personnel, which may be explained by the nursing staff being in close contact with infected patients and the administrative staff lacking understanding of the possible implications of the infection, compared with nonclinical hospital personnel. Our results are consistent with those of other researchers. We must remember that fear is a reaction and that we must be courageous enough to trust validated infection prevention practices to provide the highest standard of care, in the safest environment that we can, for as long as we can.

Psychological Predictors of Anxious Responses to the COVID-19 Pandemic: Evidence from Pakistan

OBJECTIVE

COVID-19 epidemic can be associated with a variety of anxious responses and safety behaviors. The present research explored the psychological implications associated with COVID-19 during the outbreak in 2020 to date. Pakistani media has given particular attention to this outbreak in the region.

METHODS

Three hundred and forty-seven undergraduate university students from Pakistan completed a battery of questionnaires focusing fear of COVID-19, associated safety behaviors, factual knowledge of COVID-19, and other psychological pointers hypothesized to be as predictors of anxious responses to COVID-19 threat and associated safety behaviors.

RESULTS

The sample appeared to be fearful of COVID-19 and this fear was related to disgust sensitivity, anxiety sensitivity-related physical concerns, body vigilance, contamination cognitions, and general distress. Results suggested that the tendency of overestimating the severity of contamination and anxiety sensitivity towards physical concerns are significant predictors of COVID-19 related fear and consequent safety behaviors.

CONCLUSION

It is suggested that people with a greater concern of contamination are likely to respond fearfully to COVID-19 and that people with higher fear of COVID-19 are likely to feel contamination concerns.

Psychological and Behavioral Responses to the COVID-19 Pandemic in Greece

OBJECTIVE

Fear of COVID-19 was associated with more severe depressive and anxiety symptoms. This study aimed to explore COVID-19-related fear, depressive and anxiety symptoms, social responsibility, and behavioral responses during the COVID-19 pandemic in Greece.

METHOD

A cross-sectional study was conducted from April 10 to April 13, 2020. Members of the Greek general population completed anonymously an online survey, distributed through the social media. Among the 3,700 adult respondents, 3,029 fulfilled inclusion criteria. The survey included sociodemographic questions, questions exploring potential risk factors for increased fear of COVID-19, questions about the employment of safety and checking behaviors, and questions about compliance with public health guidelines. In addition, four psychometric scales were used, the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), and Steele's Social Responsibility Motivation scale. Multivariate General Linear Models (GLM) were used to depict significant differences among dependent variables (FCV-19S, PHQ-9, GAD-7) and independent variables (potential risk factors, safety and checking behaviors, compliance with guidelines). The relationship between the FCV-19S total score and influencing factors was quantified by linear regression analysis.

RESULTS

Several participants reported high levels of COVID-19-related fear (35.7%) and moderate to severe depressive symptoms (22.8%), while a significant proportion reported moderate to severe anxiety symptoms (77.4%). Women scored altogether significantly higher than men. Respondents under the age of 30 reported less fear and depressive symptoms and showed the least social responsibility. Based on GLM, a significant other's COVID-19 illness, being on psychiatric medication, employment of safety and checking behaviors, and compliance with guidelines were associated with higher COVID-19-related fear. Linear regression analysis revealed that gender, age, depressive, and anxiety symptoms modified levels of COVID-19-related fear.

CONCLUSIONS

Greater behavioral responses to the pandemic, that is, excessive employment of safety/checking behaviors and greater compliance with guidelines, were shown to amplify fear, potentially due to increased contamination awareness. In addition, female gender, older age, and more severe anxiety symptoms were related with higher COVID-19-related fear. Describing and weighing carefully the psychosocial and behavioral impact of the pandemic will enable the implementation of both supportive and preventive interventions.