Fears, Coping Styles, and Health Behaviors: A Comparison of Patients With Hypochondriasis, Panic Disorder, and Depression

The relationship between maladaptive health beliefs, pandemic-related stress, and health anxiety during the COVID-19 pandemic

BACKGROUND

Research has demonstrated that people experience specific distress and anxiety regarding COVID-19. This distress may consist of interconnected symptom categories corresponding to a COVID stress syndrome. Susceptibility to COVID stress syndrome may be related to one's maladaptive health beliefs; however, no research has investigated the association between maladaptive health beliefs and COVID stress. The present study explored the impact of health beliefs on COVID stress, health anxiety, and associated psychological constructs.

PARTICIPANTS AND PROCEDURE

This cross-sectional survey study included 221 adults (M age = 20.59, SD = 2.28). Participants completed an online survey including demographic questionnaires and self-report measures of health beliefs, COVID stress, health anxiety, and related psychological constructs.

RESULTS

Health anxiety, anxiety sensitivity, state/trait anxiety, intolerance of uncertainty, and depression accounted for significant variance in COVID stress (F(6, 214) = 11.18, R2 = .24, p < .001). Health beliefs (i.e., perceived likelihood of illness, medical service inadequacy, and difficulty coping) were associated with greater COVID stress, although health beliefs were not found to mediate the relationship between health anxiety and COVID stress.

CONCLUSIONS

Health beliefs were associated with greater COVID stress, although health beliefs did not mediate the relationship between health anxiety and COVID stress. The relationship between health anxiety and COVID stress may be better explained by other COVID-related cognitions (e.g., vaccine efficacy, dangerousness of COVID-19). The findings highlight the importance of peoples' health beliefs during the pandemic. Given anxiety's influence on peoples' behavioural responses to the pandemic, further research should identify COVID-specific cognitions for prevention of COVID stress and health anxiety.

Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping

BACKGROUND AND OBJECTIVES

Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, panic disorder is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. The objective of this article is to systematically identify and review the empirical literature on emotional management processes and strategies associated with panic disorder, with the aim of evaluating their role in the development and maintenance of panic disorder, in order to better understand the pathogenesis of the disorder and guide clinicians to improve their current treatments.

METHODS

Four databases were searched for studies which were based on self-reported questionnaires or a methodology based on an experimental procedure.

RESULTS

Of the 1719 articles identified, 61 referred to different aspects of emotional management. People living with PD are characterized by low emotional intelligence levels, excessive use of suppression, impaired cognitive reappraisal, high levels of alexithymia and maladaptive coping strategies.

LIMITATIONS

Most of the reviewed studies used measures of emotional management in cross-sectional models and were based on self-assessment reports.

CONCLUSIONS

Improving emotional intelligence levels is key to increasing emotion regulation flexibility for people living with PD. Automatic cognitive reappraisal impairment in these people indicates low importance of cognitive restructuring in psychotherapeutic treatment.

Determining the relationship between health anxiety and healthy lifestyle behaviors, and the factors that affect them: A cross-sectional study in Turkey

PURPOSE

This study was conducted to determine the relationship between health anxiety (HA) and healthy lifestyle behaviors (HLBs), and the factors that affect them.

DESIGN AND METHODS

This descriptive, cross-sectional, and relational study was conducted with 1007 voluntary participants between June 1 and September 30, 2020.

FINDINGS

The participants' mean age was 33.46 ± 15.42 years. A positive-significant relationship was found between the participants' total HA and HLBs scores (r = 0.06, p = 0.03). The simple linear regression analysis performed by the researchers indicated that the explanatory power of HA as a determinant of HLBs was statistically significant (R²  = 0.05).

PRACTICAL IMPLICATIONS

This study determined that health anxiety increased the tendency towards HLBs.

Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany

OBJECTIVE

Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce.

METHODS

In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses.

RESULTS

Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower than anxiety related to other severe diseases (d = -0.54, p < .001) and not significantly associated with anxiety related to other severe diseases or pre-COVID-19 health anxiety.

CONCLUSION

It therefore appears premature to assume that SARS-CoV-2 related anxiety and other health worries are necessarily strongly interrelated and comparably high in people with pathological health anxiety.

A 3-Month Naturalistic Follow-Up Treatment With Selective Serotonin Reuptake Inhibitors in Frequent Attenders of General Medical Practice: What Correlates With a Good Response?

ABSTRACT

Frequent attenders (FAs), defined as patients repeatedly attending general practitioners, frequently exhibit underdiagnosed psychiatric comorbidities, leading to the hypothesis that frequent attendance may be related to an undetected psychiatric burden. This study explores the role of psychiatric comorbidities and psychopharmacological treatment on the clinical outcomes of a cohort of FAs of the general medical practice in Italy. The study included 75 FAs assessed by the Structured Clinical Interview for DSM-5, Clinical Global Impression, Global Assessment Functioning, and Illness Behavior Inventory, administered at baseline (T0) and after 3 months (T1). Data were analyzed on the bases of the presence of any mental disorder and selective serotonin reuptake inhibitor (SSRI) treatment, with respect to other psychopharmacological treatments. Results showed better outcomes among patients with a mental disorder, particularly anxiety, depression, and somatic symptoms disorders, and when under SSRI treatment. Our findings corroborate the role of psychiatric comorbidity on frequent attendance in the context of general clinical practice with a positive outcome when receiving appropriate treatment with SSRI.

Relations between multidimensional attitude toward death and psychological distress in firefighters

To investigate firefighters' multidimensional attitude toward death and psychological distress, 60 firefighters completed the Death Attitude Profile-Revised and the General Health Questionnaire-28. As predicted, fear of death and escape acceptance were positively related to severe depression and anxiety/insomnia. However, contrary to predictions, neutral acceptance and death avoidance were not associated with psychological distress. Our results indicate that it would be advisable to examine the effectiveness of preventive and therapeutic interventions for firefighters aimed at reducing the fear of death and escape acceptance.

Relationships Between Somatic Symptoms and Panic-Agoraphobic Spectrum Among Frequent Attenders of the General Practice in Italy

Frequent attenders (FAs) of general practitioners (GPs) often complain of nonspecific physical symptoms that are difficult to define according to typical medical syndromes criteria but could be acknowledged as atypical manifestations of mental disorders. We investigated the possible correlation between somatic symptoms and panic-agoraphobic spectrum symptoms in a sample of 75 FAs of GPs in Italy, with particular attention to the impact on functional impairment. Assessments included the Patient Health Questionnaire, Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) lifetime version, Global Assessment of Functioning, and Clinical Global Impression. The PAS-SR total and domains scores were significantly higher among low-functioning FAs, especially anxious somatizations, hypochondriasis, anxious expectation, and reassurance orientation domains, suggesting this undetected symptom may determine the selective attention to the physical symptoms, illness-phobic/hypochondriac elaboration, and GP frequent attendance, often aimed at searching for reassurance, leading to severe impact on overall functioning and often inefficacious treatments.

Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review

OBJECTIVE

To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically unexplained symptoms (MUS).

METHODS

A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed.

RESULTS

Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible.

CONCLUSION

All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations.

Work-family conflict and job burn-out among Chinese doctors: the mediating role of coping styles

Background

Burn-out among doctors threatens their own health, and that of their patients. To identify risk factors of the doctor burn-out is vital to improving their health and increasing the quality of healthcare services. This study aims to explore the relationship between work-family conflict (WFC) and burn-out among Chinese doctors and the mediating role of coping styles in this relationship.

Methods

A cross-sectional survey was conducted in China, with a questionnaire packet which consisted of the Chinese Maslach Burnout Inventory (CMBI), WFC Scale and the Simplified Coping Style Questionnaire (SCSQ). A total of 2530 doctors participated in the survey. Correlation analysis was performed to explore the relationship between CMBI, WFC and SCSQ scores. A linear regression model was set to determine the mediating role of coping styles on the relationship between WFC and burn-out.

Results

Doctors who had higher scores on work interfering with family conflict, reported more emotional exhaustion (r=0.514, P<0.001) and had a sense of accomplishment (r=-0.149, P<0.001). Simultaneously, family interfering with work (FIW) was positively associated with all dimensions of burn-out (r=0.213, 0.504, 0.088, respectively, P<0.001). Coping styles had partial, complete and even mediating effects on the relationship between WFC and burn-out among Chinese doctors.

Conclusions

WFC was correlated with burn-out, and coping style was a mediator in this relationship among Chinese doctors. Coping style was a positive resource against burn-out.

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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