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Knowles KA, Tolin DF. Reductions in Anxiety are Associated with Decreased Expressive Suppression and Increased Cognitive Reappraisal After Cognitive-Behavioral Treatment: A Naturalistic Study in Youth. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01684-4. [PMID: 38530590 DOI: 10.1007/s10578-024-01684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Broad deficits in emotion regulation skills have been observed in children with anxiety-related disorders. These deficits typically improve during cognitive-behavioral therapy (CBT), but few studies have examined changes in expressive suppression and cognitive reappraisal in youth with anxiety disorders and/or obsessive-compulsive disorder (OCD) during CBT, especially in real-world settings. In a naturalistic treatment-seeking sample, 123 youth completed measures of anxiety, depression, and emotion regulation strategy use before and after 15 sessions of CBT. For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD. Thus, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction; improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT.
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Affiliation(s)
- Kelly A Knowles
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
- Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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2
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Bock RC, Baker LD, Kalantar EA, Berghoff CR, Stroman JC, Gratz KL, Tull MT. Clarifying relations of emotion regulation, emotional avoidance and anxiety symptoms in a community-based treatment-seeking sample. Psychol Psychother 2024. [PMID: 38411316 DOI: 10.1111/papt.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/13/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Anxiety is a global problem that is readily treatable with psychosocial interventions, though many individuals do not benefit following participation in extant treatment protocols. Accordingly, clarification of process-related variables that may be leveraged to enhance outcomes appears warranted. Emotion regulation (ER) is a robust correlate of anxiety symptoms and is often targeted in behavioural treatments applied to anxiety-related problems. Yet, some evidence suggests ER difficulties may be a proxy variable for emotional avoidance (EA). Clarifying the relative influence of ER and EA on anxiety symptom severity may improve specificity in targeting behavioural processes within psychosocial treatments designed to alleviate anxiety-related suffering. Accordingly, we examined relations of ER and EA to anxiety symptom severity after accounting for anxiety sensitivity and anxiolytic medication use in a community-based treatment-seeking sample. DESIGN A four-step hierarchical linear regression analysis of cross-sectional data provided by a community-based treatment-seeking sample. METHODS Totally, 120 participants (Mage = 39.18; Female = 58.3%) completed a questionnaire packet upon intake to an anxiety disorders clinic. RESULTS EA and ER were strongly correlated, and each accounted for significant variance over and above model covariates. EA was a dominant risk factor for anxiety symptom severity, as ER was not a significant predictor (p = .073) following the inclusion of EA in the model (p = .006). CONCLUSIONS EA appears to be a dominant risk factor, and ER a proxy risk factor, for anxiety symptom severity. EA may be an avenue for greater treatment specificity for those with anxiety symptoms.
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Affiliation(s)
- Rachel C Bock
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Lucas D Baker
- George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Emily A Kalantar
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | | | - Joel C Stroman
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Kim L Gratz
- Lyra Health, Burlingame, California, USA
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Lyra Health, Burlingame, California, USA
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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3
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Metts AV, Roy-Byrne P, Stein MB, Sherbourne CD, Bystritsky A, Craske MG. Reciprocal and Indirect Effects Among Intervention, Perceived Social Support, and Anxiety Sensitivity Within a Randomized Controlled Trial for Anxiety Disorders. Behav Ther 2024; 55:80-92. [PMID: 38216239 DOI: 10.1016/j.beth.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Social support may facilitate adaptive reappraisal of stressors, including somatic symptoms. Anxiety sensitivity refers to negative beliefs about somatic symptoms of anxiety, which may influence one's perception of social support. Evidence-based treatment may impact these associations. The current longitudinal study evaluated reciprocal relationships between perceived social support and anxiety sensitivity, and explored indirect intervention effects, in a randomized controlled trial for anxiety disorders that compared cognitive behavioral therapy with or without medications (CALM) to usual care. Data collected over 18 months from 940 primary care patients were examined in random intercept cross-lagged panel models. There were significant reciprocal associations between perceived social support increases and anxiety sensitivity decreases over time. There were significant indirect effects from intervention to perceived social support increases through anxiety sensitivity decreases and from intervention to anxiety sensitivity decreases through perceived social support increases. These data suggest that, relative to usual care, CALM predicted changes in one construct, which predicted subsequent changes in the other. Secondary analyses revealed an influence of anxiety and depressive symptoms on reciprocal associations and indirect effects. Findings suggest that future treatments could specifically address perceived social support to enhance reappraisal of somatic symptoms, and vice versa.
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Boehm LM, Bird CM, Warren AM, Danesh V, Hosey MM, McPeake J, Potter KM, Su H, Eaton TL, Powers MB. Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery. Am J Crit Care 2023; 32:449-457. [PMID: 37907373 DOI: 10.4037/ajcc2023975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.
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Affiliation(s)
- Leanne M Boehm
- Leanne M. Boehm is an assistant professor, Vanderbilt University School of Nursing, Nashville, Tennessee; and an investigator, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claire M Bird
- Claire M. Bird is a postdoctoral fellow, Baylor University Medical Center, Dallas, Texas
| | - Ann Marie Warren
- Ann Marie Warren is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
| | - Valerie Danesh
- Valerie Danesh is a research investigator, Center for Applied Health Research, Baylor Scott & White Research Institute; and an assistant professor, Baylor College of Medicine, Temple, Texas
| | - Megan M Hosey
- Megan M. Hosey is an assistant professor, Division of Pulmonary and Critical Care Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanne McPeake
- Joanne McPeake is a research fellow, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Kelly M Potter
- Kelly M. Potter is a research assistant professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Han Su
- Han Su is an assistant professor, Vanderbilt University School of Nursing; and an investigator, CIBS Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is an associate investigator, VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Mark B Powers
- Mark B. Powers is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
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Breen LJ, Greene D, Rees CS, Black A, Cawthorne M, Egan SJ. A co-designed systematic review and meta-analysis of the efficacy of grief interventions for anxiety and depression in young people. J Affect Disord 2023; 335:289-297. [PMID: 37196936 DOI: 10.1016/j.jad.2023.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Grief in young people is common and associated with symptoms of anxiety and depression, yet grief interventions for this age group are under-researched. METHOD We conducted a systematic review and meta-analysis to examine the efficacy of grief interventions in young people. The process was co-designed with young people and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PsycINFO, Medline, and Web of Science databases were searched in July 2021 (updated December 2022). RESULTS We extracted results from 28 studies of grief interventions with young people (14-24 years) that measured anxiety and/or depression (N = 2803 participants, 60 % girls/women). Cognitive behavior therapy (CBT) for grief demonstrated a large effect for anxiety and medium effect for depression. Meta-regression indicated that CBT for grief that included a higher degree of CBT strategies, was not trauma focused, had >10 sessions, offered on an individual basis, and did not involve parents, was associated with larger effect sizes for anxiety. Supportive therapy had a moderate effect for anxiety and a small-moderate effect for depression. Writing interventions were not effective for anxiety or depression. LIMITATIONS Studies are limited in number and there were few randomized controlled studies. CONCLUSIONS Findings indicate that CBT for grief is an effective intervention for reducing symptoms of anxiety and depression in young people experiencing grief. CBT for grief should be offered as the first line treatment for grieving young people experiencing anxiety and depression. PROTOCOL REGISTRATION PROSPERO (registration number CRD42021264856).
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Affiliation(s)
- Lauren J Breen
- enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth 6845, Australia; Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia.
| | - Danyelle Greene
- Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
| | - Clare S Rees
- Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
| | - Amy Black
- Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
| | | | - Sarah J Egan
- enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth 6845, Australia; Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
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Zvolensky MJ, Shepherd JM, Clausen BK, Kauffman BY, Heggeness L, Garey L. Anxiety Sensitivity Among Non-Hispanic Black Adults: Relations to Mental Health and Psychosomatic States. J Racial Ethn Health Disparities 2023; 10:751-760. [PMID: 35182371 PMCID: PMC10062188 DOI: 10.1007/s40615-022-01263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
Abstract
The non-Hispanic Black adult population has notable disparities in mental and physical health compared to several other racial/ethnic groups. Yet, there is a lack of scientific knowledge about psychologically based individual difference factors that may be associated with an exacerbation of common mental and physical health symptoms among non-Hispanic Black persons. The present investigation sought to build on the limited knowledge about anxiety sensitivity among non-Hispanic Black adults by exploring whether this construct was uniquely associated with a range of prevalent mental health and psychosomatic symptoms commonly tied to disparities among this population. Participants included non-Hispanic Black adults (N = 205; Mage = 21.67 years; SDage = 5.39; age range: 18-60 years; 82.0% female). Results indicated that anxiety sensitivity was positively related to anxious arousal, general depression, insomnia, fatigue severity, and somatic symptom severity; effects were evident above and beyond the variance explained by a range of covariates, including age, sex, education, subjective social status, and neuroticism. Overall, the present findings uniquely build from past research on anxiety sensitivity and non-Hispanic Black adults by demonstrating that individual differences in this construct are consistently and relatively robustly associated with a wide range of mental health and psychosomatic symptoms. Future research that builds from this work may benefit from consideration of intervention programming targeting anxiety sensitivity reduction to offset mental and physical health impairments among the non-Hispanic Black population.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Justin M Shepherd
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Luke Heggeness
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
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The Role of Emotion Regulation and Executive Functioning in the Intervention Outcome of Children with Emotional and Behavioural Problems. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010139. [PMID: 36670689 PMCID: PMC9857297 DOI: 10.3390/children10010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/08/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Emotional and behavioural problems are closely associated with impairments in regulating emotions and in executive functions (EF). To examine this further, the aim of the present study was to determine whether EF and emotion regulation at baseline would predict emotional and behavioural problem scores post-intervention, and further explore the extent to which emotion regulation mediates these outcomes. Participants were 41 primary school children who exhibited emotional and/or behavioural problems, aged 8 to 11 years. All the children completed measures of emotional and behavioural problems, cognitive emotion regulation, anxiety symptoms, and performed two experimental tasks to measure working memory and response inhibition before and after participating in a transdiagnostic Cognitive Behaviour Therapy-based programme, "Super Skills for Life" (SSL), and at 3-months follow-up. Results revealed significant reduction in the use of maladaptive emotion regulation strategy catastrophising and other blame following the intervention. Additionally, EF and emotion regulation was associated with outcomes for emotional problems and conduct problems. More specifically maladaptive emotion regulation strategy such as catastrophising and other blame was closely related with self-reports of emotional problems, likewise other blame, was also linked with scores of conduct problems. This study provides preliminary empirical support for EF and emotion regulation in predicting outcomes of emotional and behavioural problems in children following intervention.
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Brinkman HR, Smith JE, Leyro TM, Zvolensky MJ, Farris SG. Effect of Emotion Regulation Difficulties on Acute Smoking Urges Following a 35% Carbon Dioxide Challenge. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Danhauer SC, Miller ME, Divers J, Anderson A, Hargis G, Brenes GA. Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults. Am J Geriatr Psychiatry 2022; 30:979-990. [PMID: 35260292 DOI: 10.1016/j.jagp.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cognitive-behavioral therapy (CBT) and yoga decrease worry and anxiety. There are no long-term data comparing CBT and yoga for worry, anxiety, and sleep in older adults. The impact of preference and selection on these outcomes is unknown. In this secondary data analysis, we compared long-term effects of CBT by telephone and yoga on worry, anxiety, sleep, depressive symptoms, fatigue, physical function, social participation, and pain; and examined preference and selection effects. DESIGN In this randomized preference trial, participants (N = 500) were randomized to a: 1) randomized controlled trial (RCT) of CBT or yoga (n = 250); or 2) preference trial (selected CBT or yoga; n = 250). Outcomes were measured at baseline and Week 37. SETTING Community. PARTICIPANTS Community-dwelling older adults (age 60+ years). INTERVENTIONS CBT (by telephone) and yoga (in-person group classes). MEASUREMENTS Penn State Worry Questionnaire - Abbreviated (worry);1,2 Insomnia Severity Index (sleep);3 PROMIS Anxiety Short Form v1.0 (anxiety);4,5 Generalized Anxiety Disorder Screener (generalized anxiety);6,7 and PROMIS-29 (depression, fatigue, physical function, social participation, pain).8,9 RESULTS: Six months after intervention completion, CBT and yoga RCT participants reported sustained improvements from baseline in worry, anxiety, sleep, depressive symptoms, fatigue, and social participation (no significant between-group differences). Using data combined from the randomized and preference trials, there were no significant preference or selection effects. Long-term intervention effects were observed at clinically meaningful levels for most of the study outcomes. CONCLUSIONS CBT and yoga both demonstrated maintained improvements from baseline on multiple outcomes six months after intervention completion in a large sample of older adults. TRIAL REGISTRATION www. CLINICALTRIALS gov Identifier NCT02968238.
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Affiliation(s)
- Suzanne C Danhauer
- Department of Social Sciences and Health Policy (SCD), Wake Forest School of Medicine, Winston Salem, NC.
| | - Michael E Miller
- Department of Biostatistics and Data Science (MEM), Wake Forest School of Medicine, Winston Salem, NC
| | - Jasmin Divers
- Division of Health Services Research (JD), NYU Long Island School of Medicine, New York, NY
| | - Andrea Anderson
- Department of Biostatistics and Data Science (AA), Wake Forest School of Medicine, Winston Salem, NC
| | - Gena Hargis
- Department of Internal Medicine (GH), Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Gretchen A Brenes
- Department of Internal Medicine (GAB), Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
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Ngombe N, Kessler K, Shaw DJ. Take my advice: Physiological measures reveal that intrinsic emotion regulation is more effective under external guidance. Int J Psychophysiol 2022; 180:49-59. [PMID: 35914547 DOI: 10.1016/j.ijpsycho.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 06/13/2022] [Accepted: 07/23/2022] [Indexed: 01/10/2023]
Abstract
Research into emotion regulation (ER) has focused primarily on the intra-personal process through which we regulate our own emotions intrinsically. More recently, however, studies have begun to explore the inter-personal nature of intrinsic ER - that is, how we regulate our emotions under the guidance of others. Preliminary evidence suggests that ER might be more effective when implemented in an inter- compared with an intra-personal manner, but these findings are based almost exclusively on self-reported ratings that capture only the subjective experience of emotions. The current study therefore investigated whether this apparent superiority of inter-personal intrinsic ER could be replicated and extended to physiological measures of affective reactions - namely, various metrics of electrodermal activity. In a within-subjects design, a sufficiently powered sample (N = 146) were required to down-regulate their emotional reactions to negatively valenced images using an ER strategy they had chosen themselves intra-personally or one that had been recommended to them inter-personally. Physiological responses converged to demonstrate the greater effectiveness of inter- over intra-personal ER in decreasing negative affective reactions, despite subjective ratings suggesting that participants perceived the opposite to be true. The superiority of inter- over intra-personal ER in physiological recordings was unrelated to individuals' perceptions of their ability to regulate their own emotions, however, and so it remains to be seen if and how such benefits extend to clinical populations.
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Affiliation(s)
- Nicola Ngombe
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Klaus Kessler
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK; Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Daniel Joel Shaw
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK.
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Ulaş S, Seçer İ. Developing a CBT-Based Intervention Program for Reducing School Burnout and Investigating Its Effectiveness With Mixed Methods Research. Front Psychol 2022; 13:884912. [PMID: 35923738 PMCID: PMC9342602 DOI: 10.3389/fpsyg.2022.884912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study sets out to develop a cognitive-behavioral therapy-based psychoeducation application to reduce the school burnout levels of secondary school students and to test its effectiveness with the mixed methods research design. For this purpose, qualitative data have been included in the process at three different steps, before, during, and after the experimental application involving an intervention application. The application of the intervention of the research has been carried out with an experimental design with pretest-posttest control group, which is one of the true experimental designs. Experimental and control groups have been determined with 30 students reached by nested sampling method, and the CBT-based psychoeducation practice developed during the research process has been carried out for 9 weeks in the experimental group. During the research, descriptive analysis and content analysis methods have been used in the analysis of qualitative data, normality analysis, and One-Way Analysis of Covariance have been used in the analysis of quantitative data. Findings obtained from the study show that CBT-based psychoeducation practice is an effective approach in reducing school burnout. It has also been determined that the findings obtained from the analysis of the documents obtained during the application and findings from the interview process done after the application coincided with the findings of quantitative methods, and the qualitative findings adequately explain the quantitative findings.
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Singh J, Chitranshi J. Impact on student behavior due to Covid-19 lockdown in India. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.207214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This paper aims to comprehend the change & impact on students’ behavior during the COVID-19 Lockdown in India. The research is conducted by surveying to assess the different behavioral changes due to the COVID-19 spread. Novel coronavirus pandemic started from Wuhan, China, on 31/12/19. It spread across the globe affecting 1,00 000 people within the span of two to three months. People across the globe were affected not just in terms of physical health but also mental & psychological health, resulting in major changes in their behavior. The digital questionnaire assessed the status of pupils’ mental and psychical nature while the COVID-19 lockdown was on. The questions were framed to answer how students felt about the pandemic and how it has affected their day-today life. The results of the survey revealed the measure of the anxiety level of the students. The survey results are analyzed on SPSS, and Pearson Coefficient is the method used for statistical analysis. The survey results revealed that 74.2% of the respondents favored cleaning their hands more often due to the COCID-19 pandemic. In the same way, an overwhelming number of student respondents have become aware that wearing masks is crucial to prevent the spread, and 95.9% of student respondents have favored wearing masks if they decide to step outside of their house. Student respondents are more worried about the possibility that their family members will catch the COVID-19 virus than the concern of themselves catching the virus. The student respondents showed clear signs of worry and unpredictability due to the COVID-19 spread. More than have 37.6% have responded that they are in a constant state of worry during the lockdown. The paper states varied responses from the students on the anxiety levels and that they have been experiencing high anxiety levels during the lockdown. The measurement and correlation between emotional & preventive behavior can provide viable options to reduce the outbreak and further control it.
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Hunt C, Campbell-Sills L, Chavira D, Craske M, Sherbourne C, Sullivan G, Roy-Byrne P, Stein MB, Bomyea J. Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: Evidence from the Coordinated Anxiety Learning management trial. Behav Res Ther 2022; 155:104119. [DOI: 10.1016/j.brat.2022.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/15/2022]
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Vujanovic AA, McGrew SJ, Walton JL, Raines AM. Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity. Addict Behav 2022; 126:107177. [PMID: 34801295 DOI: 10.1016/j.addbeh.2021.107177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/17/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.
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Affiliation(s)
| | - Shelby J McGrew
- University of Houston, USA; Southeast Louisiana Veterans Health Care System, USA
| | - Jessica L Walton
- Southeast Louisiana Veterans Health Care System, USA; South Central Mental Illness Research, Education and Clinical Center (MIRECC), USA; Department of Psychiatry and Behavioral Sciences, Tulane University, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, USA; South Central Mental Illness Research, Education and Clinical Center (MIRECC), USA; School of Medicine, Louisiana State University, USA.
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Meyerbröker K, Morina N, Kerkhof GA, Emmelkamp PMG. Potential Predictors of Virtual Reality Exposure Therapy for Fear of Flying: Anxiety Sensitivity, Self-efficacy and the Therapeutic Alliance. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fitzgerald HE, Hoyt DL, Kredlow MA, Smits JAJ, Schmidt NB, Edmondson D, Otto MW. Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021; 28:323-337. [PMID: 35300171 PMCID: PMC8923531 DOI: 10.1037/cps0000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.
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Affiliation(s)
- Hayley E Fitzgerald
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - Danielle L Hoyt
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - M Alexandra Kredlow
- Department of Psychology, Harvard University, 52 Oxford Street, Cambridge, MA 02140
| | - Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23 St., Austin, TX 78712
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | | | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
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17
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Linn BK, Zhao J, Bradizza CM, Lucke JF, Ruszczyk MU, Stasiewicz PR. Alexithymia disrupts emotion regulation processes and is associated with greater negative affect and alcohol problems. J Clin Psychol 2021; 77:2915-2928. [PMID: 34787929 DOI: 10.1002/jclp.23279] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/17/2021] [Accepted: 10/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Alexithymia is common among people who abuse alcohol, yet the mechanisms by which alexithymia exerts its influence remain unclear. This analysis tested a model whereby the three subscales of the Toronto Alexithymia Scale exert an indirect effect on alcohol problems through difficulties with emotion regulation and psychological distress. METHOD Men and women (n = 141) seeking alcohol use disorder (AUD) treatment completed the Toronto Alexithymia Scale, the Difficulties with Emotion Regulation Scale, the Brief Symptom Inventory, the Short Inventory of Problems, and the Alcohol Dependence Scale. RESULTS The Difficulty Identifying Feelings subscale of the Toronto Alexithymia Scale was positively associated with alcohol problems through emotion dysregulation and psychological distress. The other two subscales, Difficulty Describing Feelings and Externally oriented Thinking, were not associated with any other variables. CONCLUSION People with alexithymia may consume alcohol to help regulate undifferentiated states of emotional arousal. Given the prevalence of alexithymia among people who abuse alcohol, treatment supplements that enhance the identification of emotions are needed.
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Affiliation(s)
- Braden K Linn
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Junru Zhao
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Clara M Bradizza
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Joseph F Lucke
- Department of Psychiatry, University at Buffalo, Buffalo, New York, USA
| | | | - Paul R Stasiewicz
- School of Social Work, University at Buffalo, Buffalo, New York, USA
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18
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Agako A, Donegan E, McCabe RE, Frey BN, Streiner D, Green S. The role of emotion dysregulation in cognitive behavioural group therapy for perinatal anxiety: Results from a randomized controlled trial and routine clinical care. J Affect Disord 2021; 292:517-525. [PMID: 34147963 DOI: 10.1016/j.jad.2021.05.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotion dysregulation (ED) has been implicated in anxiety disorders and may play an important role in Cognitive Behavioural Therapy (CBT) treatment for perinatal anxiety outcomes although there is a dearth of research in this area. The current study investigated the role of ED in perinatal anxiety treatment outcome to determine whether it impacts CBT treatment outcomes and whether CBT reduces ED. METHODS Secondary analyses were run on a sample of N = 75 women participating in a CBT for perinatal anxiety randomized controlled trial (RCT), and N = 47 women who received the treatment as part of routine clinical care. Participants completed measures of anxiety, depression and ED at baseline, post-CBT/post-waitlist and 3-month follow-up (CBT-RCT group only). MANOVAs were conducted to determine if level of ED moderates treatment outcomes and whether CBT reduces ED. Reliable and clinically meaningful change was calculated. RESULTS Baseline level of ED did not moderate treatment outcomes. There were significant changes in some ED subscales over time in the CBT group compared to waitlist. Changes were reliable and clinically meaningful in 28.6% (RCT) and 16% (routine clinical care) of participants. Participants with high ED at baseline remained in the high range at post-treatment. LIMITATIONS Limitations include low sample size; homogeneity of sample, use of measures not validated in perinatal populations. CONCLUSIONS These findings suggest that ED during the perinatal period may be a stand-alone factor that will need to be separately addressed in psychological treatment.
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Affiliation(s)
- Arela Agako
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.
| | - Eleanor Donegan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - David Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Sheryl Green
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
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19
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Are Changes in Beliefs About Rumination and in Emotion Regulation Skills Mediators of the Effects of Internet-Delivered Cognitive-Behavioral Therapy for Depression and Anxiety? Results from a Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background
Internet-delivered cognitive behavior therapy (iCBT) is effective in treating anxiety and depression. Research on how these interventions operate is scarce. This study explored whether emotion regulation skills and positive beliefs about rumination were affected by iCBT and if these constructs mediated changes in depression and anxiety.
Methods
This is a secondary analysis of a pragmatic randomized waitlist-controlled trial testing the effectiveness of supported iCBT. Adults with at least mild symptoms of depression or anxiety were included. Depression (PHQ-9), anxiety (GAD-7), positive beliefs about rumination (PBRS-A) and two emotion regulation skills: cognitive reappraisal (ERQ-A) and expressive suppression (ERQ-S), were measured at baseline and 8-weeks post-treatment.
Results
The analyses included 358 participants, 71% were female. Median age was 29. Linear mixed models showed statistically significant differences along ERQ-A in favor of the iCBT group (b = 1.83, SE = 0.82, p = .026). Mediation analyses showed reductions in depression (b = 0.31, SE = 0.15, p = 0.043) and anxiety symptoms (b = 0.27, SE = 0.14, p = 0.057) were partially mediated by gains in ERQ-A. No effects were observed for PBRS-A and ERQ-S.
Conclusions
These results align with findings from face-to-face therapy and add to the scarce literature on mediators of effects of iCBT, contributing to the understanding of how these interventions operate. Since mediator and outcome variables were measured at the same time, partial mediation results should be interpreted with caution since the study design did not account for temporality and therefore causality effects cannot be confirmed.
Trial Registration
ISRCTN91967124.
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20
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Zheng R, Zhou Y, Fu Y, Xiang Q, Cheng F, Chen H, Xu H, Fu L, Wu X, Feng M, Ye L, Tian Y, Deng R, Liu S, Jiang Y, Yu C, Li J. Prevalence and associated factors of depression and anxiety among nurses during the outbreak of COVID-19 in China: A cross-sectional study. Int J Nurs Stud 2020; 114:103809. [PMID: 33207297 PMCID: PMC7583612 DOI: 10.1016/j.ijnurstu.2020.103809] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/20/2020] [Accepted: 10/17/2020] [Indexed: 02/05/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is a public health emergency of international concern and has caused traumatic experience for nurses worldwide. However, the prevalence of depression and anxiety symptoms in nurses, and how psychosocial factors influence nurses in this public crisis are unknown. Objectives To determine the effect of COVID-19 on the mental health of nurses and the prevalence of anxiety and depression symptoms among nurses in China during the outbreak. Design A cross-sectional study. Settings and participants A total of 3,228 nurses in Sichuan Province and Wuhan City were selected by convenience sampling. All participants were invited to complete the questionnaire through WeChat from January 27 to February 3, 2020. Methods A self-reported questionnaire combining depression and anxiety scale was used to collect data anonymously. Binary and multivariate logistic regression was applied to measure the odds of psychosocial factors of anxiety and depression and perceived health, respectively. Results The total incidence of depression (34.3%) and anxiety (18.1%) during the COVID-19 outbreak was lower than that during the SARS outbreak; however, the rate of depression in our study (47.1%) was high and similar in a recent study (50.4%) about the health care workers exposed to COVID-19 in China. The results indicated that COVID-19-related stress, relationship quality with family, and demographic characteristics were associated with depression, anxiety, and perceived health status. Furthermore, the prevalence of depression was similar between nurses working in low-risk COVID-19 wards was as high as working in high-risk COVID-19 wards (OR, 1.078; 95% CI, 0.784–1.481). Conclusions Our study revealed the high prevalence of depression and anxiety among nurses during the outbreak of COVID-19. COVID-19 factors and psychosocial factors were associated with mental health of nurses. The results suggest that hospitals should implement effective mental health promotion programs focused on occupational safety and family support to improve the well-being of nurses.
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Affiliation(s)
- Rujun Zheng
- West China School of Nursing, Sichuan University/ Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, China
| | - Yuhong Zhou
- West China School of Nursing, Sichuan University/ Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, China
| | - Yan Fu
- West China School of Nursing, Sichuan University/ Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, China
| | - Qiufen Xiang
- West China School of Nursing, Sichuan University/ Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, China
| | - Fang Cheng
- Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Huaying Chen
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Huiqiong Xu
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lan Fu
- Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoling Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mei Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Ye
- Emergency Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongming Tian
- Department of Intensive Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rong Deng
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shanshan Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yan Jiang
- Department of Nursing/Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Chunhua Yu
- West China School of Nursing, Sichuan University/ Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, China.
| | - Junying Li
- West China School of Nursing, Sichuan University/ Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province 610041, China.
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21
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Akdeniz G, Kavakci M, Gozugok M, Yalcinkaya S, Kucukay A, Sahutogullari B. A Survey of Attitudes, Anxiety Status, and Protective Behaviors of the University Students During the COVID-19 Outbreak in Turkey. Front Psychiatry 2020; 11:695. [PMID: 32760303 PMCID: PMC7373786 DOI: 10.3389/fpsyt.2020.00695] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
A new coronavirus disease began on 31 December 2019 in Wuhan/China and has caused a global outbreak in only a few months resulting in millions being infected. In conjunction with its' physical side effects, this outbreak also has a tremendous impact on psychology health. This study aims to assess the spread and frequency of protective behaviors, emotional and anxiety status among the Turkish population using a rapid survey during the COVID-19 outbreak. An online questionnaire was administered to 3,040 respondents between the ages of 18-30. This cross-sectional study was conducted from Apr 2 to Apr 8, 2020. While questions related to the outbreak were created by members of our neuroscience department, the Turkish version of the Abbreviated Beck Anxiety Inventory was included in our survey to measure anxiety status. Pearson correlation coefficient was used for statistical analysis. We found that 90% of respondents report washing hands more frequently since the outbreak while %50 wear protective gloves. Respondents were more fearful of their relatives catching the coronavirus disease than they were of themselves catching it. In response to the question, "What are your emotions about the coronavirus?", 38% responded with "worried". There was a significant correlation between anxiety status and consumption information from the media about COVID-19. Individual early protection behaviors might slow transmission of the outbreak. Our results showed that the behavior of the participants has changed in predictable ways during the COVID-19 outbreak. Understanding how emotional responses such as fear and anxiety status vary and the specific factors that mediate it may help with the design of outbreak control strategies.
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Affiliation(s)
- Gulsum Akdeniz
- Department of Neuroscience, Ankara Yildirim Beyazit University, Ankara, Turkey.,Electroneurophysiology Lab, Department of Biophysics, and Yenimahalle Training and Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mariam Kavakci
- Department of Neuroscience, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Muharrem Gozugok
- Department of Neuroscience, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Semiha Yalcinkaya
- Department of Translational Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Alper Kucukay
- Department of Neuroscience, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilal Sahutogullari
- Department of Neuroscience, Ankara Yildirim Beyazit University, Ankara, Turkey
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