The Context Sensitivity Index (CSI): Measuring the Ability to Identify the Presence and Absence of Stressor Context Cues

Self-regulatory flexibility

Robust associations of self-control with successful goal pursuit have been amply demonstrated. Much less is known about the psychological processes that occur when people grapple with self-control conflicts and that may contribute to successful goal pursuit. Influenced by the neighboring fields of emotion regulation and coping, self-regulatory flexibility has been identified as one of such potential processes. The aim of this review is to provide an overview of selected models of regulatory flexibility, empirical evidence on associations with self-regulatory success, and to identify avenues for future research.

Exploring Working Memory in Context Sensitivity

Context sensitivity refers to the ability to identify cues regarding the nature of stressor situations. This skill is a necessary precursor to successful emotion regulation and may involve detecting the presence or absence of stressor cues. Previous research has suggested that context sensitivity relies in part on working memory (WM), one component of cognitive control or executive functioning. We explored this potential relationship in an empirical study (N = 112) that assessed WM via WAIS-IV Digit Span as well as the ability to detect the presence or absence of stressor cues via the Context Sensitivity Index. Results demonstrated that detection of both cue presence and absence were significantly associated with the ability to apply semantic knowledge to information held in WM. Our findings expand upon a potential cognitive mechanism for context sensitivity.

Translating theoretical insights into an emotion regulation flexibility intervention: assessing effectiveness

ABSTRACTObjective: Traditional research often categorizes emotion regulation strategies as adaptive or maladaptive, overlooking crucial situational and individual differences that dictate their efficacy. The literature highlights the need for a more nuanced approach, like the role of emotion regulation flexibility. Despite its importance, research on developing and testing interventions that promote this flexibility is scarce. Addressing this gap, our study designed and tested an "Emotion Regulation Flexibility Booster Program" (ERFBP). We aimed to assess its efficacy in improving emotion regulation flexibility (ERF) and its impact on various mental health indicators. Method: We recruited 153 participants with low emotion regulation flexibility, randomly assigning them to experimental, control, and no-treatment groups. The experimental group was provided with an intervention based on an ERF model. The control group received sessions on study habits, whereas no-treatment group received no training. Results: The analysis indicated that participants in the ERFBP group exhibited significant changes in ERF, subjective wellbeing, and emotion regulation goals and psychological distress compared to baseline measurements and post-intervention scores of other two groups. Conclusion: These findings support the effectiveness of the ERFBP in enhancing ERF and wellbeing. However, further research must confirm these findings across diverse contexts and populations.

Emotion Regulation Flexibility in Adolescents: A Systematic Review from Conceptualization to Methodology

Considerable attention has been devoted to the concept of flexible emotion regulation, which de-emphasizes the importance of any specific regulatory strategy in favor of the flexible deployment of strategies in response to specific situational challenges. The bulk of research in this area has been conducted on adult samples. Research on emotion regulation flexibility (ERF) in youth has been documented in only a limited number of studies and using various definitions. This systematic review aims to gather and summarize different conceptualizations and methodological approaches of adolescent ERF. We incorporate these findings into a general framework to understand ERF and its role in adolescents' emotional, behavioral and social functioning. Adhering to the PRISMA guidelines, 11 studies were included in the review. While ERF has been defined in various and inconsistent ways, the included studies utilized conceptualizations from two overarching domains: the regulation of expressed emotion and the repertoire of emotion regulation strategies. Promising approaches and future directions will be highlighted.

Face and context integration in emotion inference is limited and variable across categories and individuals

The ability to make nuanced inferences about other people's emotional states is central to social functioning. While emotion inferences can be sensitive to both facial movements and the situational context that they occur in, relatively little is understood about when these two sources of information are integrated across emotion categories and individuals. In a series of studies, we use one archival and five empirical datasets to demonstrate that people could be integrating, but that emotion inferences are just as well (and sometimes better) captured by knowledge of the situation alone, while isolated facial cues are insufficient. Further, people integrate facial cues more for categories for which they most frequently encounter facial expressions in everyday life (e.g., happiness). People are also moderately stable over time in their reliance on situational cues and integration of cues and those who reliably utilize situation cues more also have better situated emotion knowledge. These findings underscore the importance of studying variability in reliance on and integration of cues.

Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness

OBJECTIVES

Flexibility in self-regulation has emerged as an important component of mental health. Previous findings found that deficits in two components of regulatory flexibility were linked cross-sectionally to psychosis-proneness. We aimed to replicate and extend these findings longitudinally.

METHODS

We measured psychosis-proneness and components of emotion regulation flexibility (i.e. context sensitivity, repertoire and feedback) at two time points with three months in between.

RESULTS

Two flexibility components predicted psychotic-like experiences. The ability to detect the absence of contextual cues was implicated in both positive and negative dimensions but through opposite pathways. Expressive suppression ability-a subcomponent of repertoire-predicted positive symptoms. None of the flexibility components predicted distress related to the symptoms.

CONCLUSIONS

The current study provides further evidence on the implication of emotion regulation flexibility in the longer-term maintenance of psychotic-like experiences. Future studies can advance this work further by evaluating possible bidirectional relationships between psychotic-like experiences and deficits in emotion regulation flexibility.

Flexible emotional regulation typology: associations with PTSD symptomology and trait resilience

BACKGROUND

Multiple factors influence posttraumatic stress disorder (PTSD) risk in trauma exposed individuals. An established association exists between trait resilience and decreased PTSD distress and between emotion regulation (ER) ability/flexibility and trait resilience. Typologies in ER ability/flexibility, associated with trait resilience and PTSD experience, could explain the difference in risk. This study aimed to explore the relationship between ER ability, ER flexibility, context sensitivity, resilience, and PTSD.

METHODS

Data from N = 563 trauma exposed UK residents was used in a latent profile analysis (LPA) and membership in the resultant profiles was explored in a logistic regression of sociodemographics, resilience, and PTSD symptomology.

RESULTS

Analysis showed 2 latent profiles (High Flexibility, Low Flexibility) typified by emotion regulation ability and context sensitivity. Members of the Low Flexibility profile were more likely to be younger, male, endorsing less trait resilience, and experiencing negative cognition/mood and hyperarousal PTSD symptomology.

CONCLUSIONS

Difficulties in ER ability and flexibility could be improved with targeted learning in a therapeutic or home setting, potentially increasing trait resilience after trauma exposure and reducing PTSD distress.

Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat

Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.

Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial

BACKGROUND

Patients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS.

METHODS

We developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time).

RESULTS

Of 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete.

CONCLUSION

Current findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/ .

Latent profiles of regulatory flexibility in alcohol use disorder: Associations with delay discounting and symptoms of depression, anxiety, and stress

BACKGROUND

Regulatory flexibility (RF) involves three distinct components of self-regulation: context sensitivity, repertoire, and feedback responsiveness. Subgroups based on differences in RF have been identified in a general sample and are differentially associated with symptoms of anxiety and depression. However, potential RF profiles have not been examined in individuals with substance use disorders. This study examined RF subtypes in individuals with alcohol use disorder (AUD) and their associations with psychosocial outcomes (i.e., depression, anxiety, and stress) and delay discounting (a core feature of addiction).

METHODS

Individuals (n = 200) with an Alcohol Use Disorders Identification Test score of >16 (mean = 24.12 (±6.92)) were recruited from Amazon Mechanical Turk (mean = 37.26 years old (±11.41); 94 (47%) women). Participants completed the Context Sensitivity Index, the Flexible Regulation of Emotional Expression Scale, and the Coping Flexibility Scale to assess RF. Participants also completed an Adjusting Amount Delay Discounting Task and the Depression, Anxiety, and Stress Scale (DASS-21). Latent profile analyses (LPA) were used to identify patterns in RF deficits. Kruskal-Wallis and Dunn's tests were performed to examine differences in discounting rates and symptoms of depression, anxiety, and stress across RF profiles.

RESULTS

The LPA revealed a 2-profile characterization, including (1) context sensitive regulators (CSR; n = 39) and (2) moderate flexibility regulators (MFR; n = 161). CSR demonstrated significantly lower symptoms of depression (p = 0.004), anxiety (p < 0.001), and stress (p < 0.001) than MFR. CSR also displayed significantly lower AUDIT scores (p = 0.031).

CONCLUSIONS

Findings illustrate that among individuals with moderate-severe AUD, those high in context sensitivity coupled with moderate abilities in repertoire and feedback responsiveness have fewer symptoms of depression, anxiety, and stress. Together, context sensitivity may be an important and protective component of RF among individuals with AUD.

The Phenotype of Recovery X: Associations between delay discounting, regulatory flexibility, and remission from substance use disorder

INTRODUCTION

Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations among DD, RF, and remission from SUDs among individuals in recovery.

METHODS

Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an $1000 hypothetical reward Adjusting Amount Delay Discounting Task. The study considered individuals to be in remission from SUD if they did not endorse any SUD DSM-5 symptom other than craving (except tobacco use disorder) in the past three months. The study team used t-tests to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship among DD, RF, and remission status.

RESULTS

Remitted individuals (n = 82) had significantly lower DD (i.e., greater preference for larger, later rewards) rates (p < .001) and higher context sensitivity (p < .001) and coping flexibility (p < .001). The study found significant negative associations between DD and context sensitivity (p = .008), coping flexibility (p = .002), and emotion regulation flexibility (p < .001). Finally, context sensitivity (p = .023) and coping flexibility (p = .009) mediated the relationship between DD and SUD remission.

CONCLUSIONS

Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes.

Depression, anxiety and stress among healthcare workers in the context of the COVID-19 pandemic: a cross-sectional study in a tertiary hospital in Northern Vietnam

Introduction

The outbreak of coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) had significant effects on the mental well-being in general, particularly for healthcare professionals. This study examined the prevalence of depression, anxiety, and stress, and identified the associated risk factors amongst healthcare workers during the COVID-19 outbreak in a tertiary hospital located in Vietnam.

Methods

We conducted a cross-sectional study at a tertiary-level hospital, where the Depression Anxiety and Stress Scale 21 (DASS-21) web-based questionnaire was employed. We analyzed the determinant factors by employing multivariate logistic models.

Results

The prevalence of depression, anxiety, and stress symptoms were 19.2%, 24.7%, and 13.9%, respectively. Factors such as engaging in shift work during the pandemic, taking care of patients with COVID-19, and staff's health status were associated with mental health issues among health professionals. In addition, having alternate rest periods was likely to reduce the risk of stress.

Conclusion

The prevalence of mental health problems in healthcare workers during the COVID-19 pandemic was relatively high. Having resting periods could potentially mitigate the development of stress among health professionals. Our findings could be taken into account for improving mental health of the health professional population.

Trait-Anxious People Take Longer to Search for Happy Faces in the Presence of Neutral and Fearful Distractors

A large body of evidence suggests that processing of affective information is typically disrupted in anxiety. It has also been hypothesized that anxious individuals are less able to evaluate contextual cues and to respond in an adaptive way to stress. In the present study, 25 participants (16 females; 9 males) scoring high (scores of 45 or above) and 26 participants (13 females; 13 males) scoring low (scores of 35 and below) on a standardized measure of trait anxiety performed an emotion search task to investigate attentional biases when the task provides an explicit emotional context. An emotional context was set in each block by asking participants to look as quickly as possible at a face expressing a specific emotion, while eye movements were being recorded. On each trial, two faces appeared, one of them expressing the target emotion and the other one expressing a distractor emotion. High trait-anxious participants showed slower response times (time to look at the instructed emotion), regardless of the affective context, compared to the control group. Additionally, we found slower responses to happy faces (positive context) in the anxious group in the presence of neutral and fearful distractors. Cognitive control may therefore be disrupted in anxiety, as anxious people take longer to process (search for) happy faces, presumably because attentional resources are drawn by neutral and fearful distractors. Those differences were not observed in a simple reaction times task, which suggests that attentional biases, and not differential processing of low-level facial features, are responsible for those differences.

Components of emotion regulation flexibility and psychosis: The association between psychosis-proneness and context sensitivity

OBJECTIVES

Emotion regulation flexibility has been conceptualized as a multi-componential construct involving context sensitivity, repertoire and feedback responsiveness. Psychosis research has yet to incorporate these new developments in the study of emotion regulation. Thus, we sought to advance even further the knowledge on emotion regulation in psychosis by adopting the emotion regulation flexibility approach as proposed by Bonanno and Burton (Perspectives on Psychological Science, 2013, 8, 591).

METHOD

In total, 401 participants completed 4 scales assessing the multi-components of emotion regulation flexibility and psychosis-proneness.

RESULTS

Our results indicated that Context Sensitivity (i.e., Cue Absence) and Feedback Responsiveness (i.e., Evaluation) were associated with psychosis-proneness. Cue absence was specifically associated with the positive dimension, while both Cue Absence and Enhancement ability were associated with the negative dimension.

CONCLUSIONS

Overall, our results suggest that emotional context insensitivity is the most relevant component of regulatory flexibility in the case of psychosis-proneness. Thus, the disruption in this first step of flexible emotion regulation might be already present in those prone to psychosis. Difficulties in decoding appropriately the contextual cues might further disrupt the other steps of emotion regulation contributing to the psychotic (-like) experiences. This study needs replication in clinical and non-clinical samples.

The role of healthy emotionality in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study

Understanding pandemic-related psychopathology development is limited due to numerous individual and contextual factors. It is widely accepted that individual differences to endure or cope with distress predict psychopathology development. The present study investigated the influence of individual differences in neuroticism and healthy emotionality concerning the association between fear of COVID-19 and mental health problems. It was hypothesized that healthy emotionality would moderate the mediated link between fear of COVID-19 and mental health problems. A sample of 752 participants (351 males and 401 females) completed an online survey including the Emotional Style Questionnaire, Fear of COVID-19 Scale, the Neuroticism subscale of the Big Five Inventory, and General Health Questionnaire. The results showed that the fear of COVID-19 positively predicted mental health problems (β = .43, SE = .05, p < .001, Cohen's f 2 = .24). Neuroticism also showed a significant mediation effect on the relationship between fear of COVID-19 and mental health problems. Fear of COVID-19 indirectly predicted psychopathology through neuroticism (β = - .16, SE = .04, p < .001, t = 4.53, 95% CI [0.11, 0.23]). Moreover, healthy emotionality had a moderating effect on the relationship between fear of COVID-19 and mental health problems, β = - .21, SE = .03, p < .001, t = 5.91, 95% CI [- 0.26, - 0.14]. The study's findings are expected to contribute to a better understanding of the roles of both individual differences in personality traits and healthy emotionality in psychopathology development during the current pandemic.

Problem-Focused Coping Strategies Used by Victims of Gender Violence Across the Stages of Change

This study compares the problem-focused emotion regulation strategies used by 200 female survivors of intimate partner violence (age: M = 40.16, SD  =  11.27, 18 - 66 years) to cope with violence throughout various stages of change (SOC). It examines the relationship between problem-focused coping strategies and positive and negative affect, and the impact of these variables on the different SOC. Results suggest that victims differ and are flexible in the use of strategies throughout the various SOC. During the initial stages, victims tend to use passive/maladaptive behaviors that hamper change, while in the later stages they use more active/adaptive strategies to leave the abusive relationship.

Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population's mental health, given the lack of mental health professionals.

AIM

To investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders.

METHODS

In this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire.

RESULTS

The participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen's d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen's d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen's d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen's d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen's d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group.

CONCLUSION

This study's findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.

Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS)

Background

Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response.

Methods

UCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief.

Discussion

Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine.

Trial Registration

Clinicaltrials.gov NCT05127616. Registered on 9/19/21.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06554-9.

Expressive flexibility and health-related quality of life: The predictive role of enhancement and suppression abilities and relationships with trait emotional intelligence

This study aims to examine the ability to flexibly enhance and suppress emotional expression, known as expressive flexibility, in relation to physical and psychological health, as well as trait emotional intelligence (EI). A sample of 503 Italian (M_age  = 28.65 ± 9.26 years, 85.1% females) participants completed the Italian version of Flexible Regulation of Emotional Expression (FREE) Scale, the TEIQue-SF, and the Short Form-12 Health Survey. Confirmatory factor analysis indicated that the Italian version of FREE showed adequate psychometric properties. In both genders, results of correlational analyses indicated that enhancement ability was associated with well-being, emotionality, and sociability, whereas suppression ability was associated with self-control. Regression analyses, controlling for age and gender, indicated that suppression and inversely enhancement abilities, predicted the perceived psychological but not physical health. Well-being, self-control, and sociability also contributed to explaining variance in the model. The interaction effect of enhancement and suppression was not significantly associated with either physical or psychological health. Overall, these results suggest that enhancement and suppression abilities differentially contribute to psychological health when trait EI is accounted for. Clinical implications and future directions for research on expressive flexibility are discussed.

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

A path to post-trauma resilience: a mediation model of the flexibility sequence

Background: Psychological resilience has grown in popularity as a topic of study in psychotraumatology research; however, this concept remains poorly understood and there are several competing theories of resilience. Objective: This study sought to assess the support for one proposed theory of resilience: the flexibility sequence. Method: This study use secondary data analysis of panel survey data (N = 563). Participants were aged 18 years or over and based in the UK. A series of sequential mediation models was used to test the flexibility sequence theory as a proposed pathway of resilience on mental health outcomes (post-traumatic stress disorder, anxiety, and depression) among a trauma-exposed sample from the UK. Results: The 'feedback' component of the proposed flexibility sequence components was associated with reduced symptom severity with all outcomes, whereas 'context sensitivity' and 'repertoire' were significantly associated only with depression as an outcome. When indirect mediation pathways were modelled via the flexibility sequence, statistically significant effects were observed for all outcomes under investigation. Conclusions: These findings support the theorized flexibility sequence pathway of resilience, suggesting that the combination of these skills/processes performs more favourably as a framework of resilience than any in isolation. Further research into more elaborate associations and feedback loops associated with this pathway is warranted.

Coping flexibility: Variability, fit and associations with efficacy, emotion regulation, decentering and responses to stress

Coping flexibility is a promising approach to understanding risk and resilience, but it has been conceptualized in various ways. The aim of this study was to test convergence of coping-related flexibility measures with other coping-related competencies (coping self-efficacy, emotion regulation, decentering) and ways of coping. Participants were 885 students (M_age  = 21.5 years) who completed measures of flexibility (seven subscales), coping self-efficacy, emotion dysregulation, decentering, and ways of coping with recent interpersonal stressors. Breadth of coping was also examined, given its past use as a measure of flexibility. The seven flexibility subscales converged with each other as expected, and all were associated with greater coping-related competence, with moderate or large positive associations between the four measures of coping flexibility ability and other measures of coping-related competence. Regarding associations with ways of coping, multivariate models showed that perceived ability in coping flexibility had positive associations with engagement and negative associations with disengagement coping, but multiple situational/adaptive coping flexibility subscales were associated positively with both engagement and disengagement ways of coping. In addition, some findings were weak or counterintuitive, especially when ways of coping and breadth were considered, suggesting a need for more attention to precisely conceptualizing and appropriately measuring coping flexibility.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

BACKGROUND

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

OBJECTIVE

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

METHODS

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

RESULTS

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t_1,692=-2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t_1,692=-3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t_1,692=-3.69, P<.001, Cohen d=0.29).

CONCLUSIONS

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

Background

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

Objective

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

Methods

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

Results

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=–2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=–3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=–3.69, P<.001, Cohen d=0.29).

Conclusions

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.

Regulatory Flexibility of Sustaining Daily Routines and Mental Health in Adaptation to Financial Strain: A Vignette Approach

A vignette approach was adopted to investigate flexibility of sustaining daily routines and whether and how this ability was related to mental health at different levels of financial strain. Three separate studies were conducted with community-dwelling adults (N = 1685) in the USA. In Study 1, we drafted, tested, and modified vignettes with reference to pilot data on the relevance of the scenarios and response options. In Study 2, regulatory flexibility of sustaining daily routines, as calculated in term of context sensitivity and responsiveness to feedback, was formulated correlations with self-reported instruments to demonstrate its concurrent validity, discriminant validity, and criterion-related validity. In Study 3, path analysis examined the associations of regulatory flexibility of sustaining daily routines with psychological distress and well-being, and the moderating effects of subjective financial strain on the associations. Results showed that the inverse associations of context sensitivity and responsiveness to feedback with depressive symptoms were stronger at medium/high levels relative to lower levels of perceived financial strain. The inverse association between context sensitivity and positive affect was significant only at higher levels of strain. Our findings could provide a feasible direction for developing scalable behavioral interventions for potential mental health problems, especially among those with a lower socioeconomic status.

Depression, Anxiety, and Stress Among Healthcare Workers During the COVID-19 Outbreak and Relationships With Expressive Flexibility and Context Sensitivity

This study aimed at investigating depression, anxiety, and stress symptoms among healthcare workers and examine the role of expressive flexibility and context sensitivity as key components of resilience in understanding reported symptoms. We hypothesized a significant and different contribution of resilience components in explaining depression, anxiety, and stress. A total sample of 218 Italian healthcare workers participated in this study through an online survey during the lockdown, consequently to the COVID-19. The Depression Anxiety Stress Scales-21 (DASS-21) was used to measure depression, anxiety, and stress; the Flexible Regulation of Emotional Expression (FREE) scale was used to measure the ability to enhance and suppress emotional expression; the Context Sensitivity Index (CSI) was used to measure the ability to accurately perceive contextual cues and determine cue absence. Demographic and work-related data were also collected. DASS-21 cut-off scores were used to verify the mental status among the respondents. Correlational analyses examined relationships between DASS-21, FREE, and CSI, followed by three regression analyses with depression, anxiety, and stress as dependent variables, controlling for age, gender, and work experience. Enhancement and suppression abilities, cue presence, and cue absence served as independent variables. The results showed a prevalence of moderate to extremely severe symptoms of 8% for depression, 9.8% for anxiety, and 8.9% for stress. Results of correlational analysis highlighted that enhance ability was inversely associated with depression and stress. Suppression ability was inversely associated with depression, anxiety, and stress. The ability to perceive contextual cues was inversely associated with depression and anxiety. The regression analysis showed that the ability to enhance emotional expression was statistically significant to explain depression among healthcare workers. In predicting anxiety, age, and the ability to accurately perceive contextual cues and determine cue absence made substantial contributions as predictors. In the last regression model, age, work experience, and the ability to suppress emotional expression were significant predictors of stress. This study’s findings can help understand the specific contributions of enhancement and suppression abilities and sensitivity to stressor context cues in predicting depression, anxiety, and stress among healthcare workers. Psychological interventions to prevent burnout should consider these relationships.

Expressive Flexibility and Dispositional Optimism Contribute to the Elderly's Resilience and Health-Related Quality of Life during the COVID-19 Pandemic

The COVID-19 outbreak had a negative impact on psychological status among elderly subjects, negatively affecting their health-related quality of life (HRQoL). Psychological factors that promote resilience might beneficially contribute also to promoting a better HRQoL among elderly subjects. The main purpose of the present study was to investigate the contribution of dispositional optimism and expressive flexibility on the HRQoL of elderly outpatients during the COVID-19 outbreak. The outpatients were recruited from October 2018 to October 2019, and then followed-up during April 2020, by evaluating their HRQoL. The baseline sample consisted of 141 elderly outpatients (mean age 80.31 ± 6.84 years); the final number of outpatients included in the follow-up evaluation was 104 (mean age 80.26 ± 6.39). Univariate and multivariate linear regressions were developed to explore significant associations with the physical and mental component of HRQoL. Baseline dispositional optimism was a predictor of the mental component of HRQoL at follow-up; the flexible suppression of emotional expression was a predictor of the physical component of HRQoL at follow-up. From a psychogeriatric perspective, the accurate assessment of psychological factors, such as dispositional optimism and expressive flexibility, might help physicians and psychologists to recognize additional patients' vulnerabilities during the current emergency.

Dispositional Optimism and Context Sensitivity: Psychological Contributors to Frailty Status Among Elderly Outpatients

The association of resilience-related factors with frailty is a recent research topic. Dispositional optimism and context sensitivity are two psychological factors that differently contribute to individual resilience. This study aimed at investigating whether dispositional optimism and context sensitivity might contribute to a multifactorial model of frailty, together with established relevant factors such as cognitive and physical factors. This cross-sectional study involved 141 elderly outpatients (42 males and 99 females) aged ≥65 years, who were referred to the Geriatrics and Multidimensional Evaluation Clinic of the University Hospital of Messina. We used the following measures: the Mini-Mental State Examination (MMSE) to screen for global cognitive functioning; 4-m gait speed and handgrip strength to measure physical performance; a 35-item Frailty Index (FI) to evaluate patients’ frailty status; the revised Life Orientation Test (LOT-R) to gauge dispositional optimism; and the Context Sensitivity Index (CSI) to measure context sensitivity. We found that LOT-R (β = −0.190, p = 0.038), CSI (β = −0.191, p = 0.035), and MMSE (β = −0.466, p < 0.001) were all significantly associated with FI. Gait speed was only marginally associated with FI (β = −0.184, p = 0.053). The present study showed a novel association of dispositional optimism and context sensitivity with frailty among elderly outpatients. These preliminary findings support a multidimensional approach to frailty in which even peculiar psychological features might provide a significant contribution.

Individual Differences in the Contents and Form of Present-Moment Awareness: The Multidimensional Awareness Scale

Decentering, a detached, observer perspective on one's mental activity, is an important concept for understanding mental health. Meta-awareness, people's awareness of their own current mental activity, is thought to facilitate decentering. However, trait measures of these concepts are not available or have validity concerns. We sought to create a theoretically derived measure of meta-awareness and decentering that allowed an exploration of questions in the literature regarding whether there are multiple forms of decentered awareness and whether meta-awareness and external awareness are distinct. Across six samples and 2,480 participants, we developed the 25-item Multidimensional Awareness Scale, with subscales assessing meta-awareness (present moment awareness of mental activity), decentered awareness (meta-awareness from a psychologically distant perspective), and external awareness (present moment awareness of the world outside of oneself). The scales demonstrated acceptable reliability and validity. Results are discussed in terms of the conceptual implications of the scale structure and its potential uses.

Human fear conditioning is moderated by stimulus contingency instructions

Recent research findings indicate that human fear conditioning is affected by instructions, particularly those concerning the contingency between the conditioned stimulus (CS) and the unconditioned stimulus (US). However, whether or not such instructions were provided to participants often remains unsaid in fear conditioning studies. In the current study (N = 102), we investigated whether conditioned fear acquisition depends on CS-US contingency instructions. Participants were randomly assigned to one of three groups. The first group was instructed about the precise CS-US contingency before conditioning. The second group was instructed to discover the CS-US contingency. The third group did not receive any contingency instructions. We found facilitated fear acquisition (using skin conductance and startle) and increased contingency awareness in the first and second group compared to the third group. Furthermore, contingency reversal instructions immediately reversed conditioned responses. Based on these results, we advise to systematically report the contingency instructions used in fear conditioning research.

Intervening on fear after acute cardiac events: Rationale and design of the INFORM randomized clinical trial

OBJECTIVE

Many acute coronary syndrome (ACS) patients are nonadherent to cardiovascular medications despite their known benefits for lowering risk of recurrent cardiovascular events. Research suggests that greater cardiac-related fear of recurrence (FoR) may be associated with higher nonadherence to cardiovascular medications and avoidance of physical activity. We aim to test the effect of an intervention that targets FoR as a potentially modifiable mechanism underlying nonadherence to recommended health behaviors among patients with suspected ACS.

METHOD

The INFORM trial ("INvestigating Fear Of Recurrence as a modifiable Mechanism of behavior change to improve medication adherence in acute coronary syndrome patients") is a double-blind, parallel-group randomized clinical trial. It compares an 8-session, at-home, electronic tablet-delivered, cognitive bias modification training (CBMT) intervention with a sham control. Patients who experience high perceived threat at the time of presentation to the emergency department (ED) with a suspected ACS are enrolled and randomized within 6 weeks of their ED visit. The primary outcome, FoR, is measured by the adapted Concerns about Recurrent ACS Scale. The trial also tests the intervention's effect on a potential mechanism of health behavior change that is inversely correlated with fear: an expansive future time perspective. Additional outcomes include electronically measured adherence to a cardiovascular medication and self-reported physical activity.

CONCLUSIONS

This study takes a mechanistic approach to addressing the dangerous problem of poor health behaviors after ACS. The trial will test whether targeting FoR or future time perspective by CBMT is a promising approach to improving nonadherence after ACS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Understanding the role of regulatory flexibility and context sensitivity in preventing burnout in a palliative home care team

Although burnout syndrome has been investigated in depth, studies specifically focused on palliative home care are still limited. Moreover, there is still a lack of evidence regarding the interplay between emotional flexibility and sensitivity to context in preventing burnout in home care settings. For these reasons, the aims of this study were to examine burnout symptoms among practitioners specializing in palliative home care and to investigate the role of regulatory flexibility and sensitivity to context in understanding burnout. An exploratory cross-sectional design was adopted. A convenience sample (n = 65) of Italian specialist palliative care practitioners participated in this study. Participants were recruited between February and April 2019 from two palliative home care services that predominantly cared for end-of-life cancer patients. The Italian version of the Maslach Burnout Inventory (MBI), the Flexible Regulation of Emotional Expression (FREE) scale (a measure of emotional flexibility), and the Context Sensitivity Index (CSI) (a measure of sensitivity to context) were administered. Analyses of variance were conducted using the three MBI factors as dependent variables and profession as an independent variable. Subsequently, three identical analyses of covariance were conducted with age, work experience, flexibility and sensitivity to context as covariates. The results showed a low burnout risk for all three of the MBI factors, and there were no gender differences. An ANOVA revealed a significant effect of profession type and age on the emotional exhaustion factor of the MBI, and an ANCOVA indicated that these effects persisted after covariates were accounted for. The results also showed a significant effect of the FREE score on emotional exhaustion. These findings can help explain the differential contributions of profession type and age to the burnout symptoms investigated. In addition, the emotional flexibility component, as an aspect of resilience, represents a significant and specific factor of emotional exhaustion. Interventions to prevent burnout must consider these relationships.