Regulation strategies during COVID-19 quarantine: The mediating effect of worry on the links between coping strategies and anxiety

IntroductionThe COVID-19 outbreak forced Italian citizens into a generalized quarantine from March to May 2020. The quarantine is a successful measure to reduce the virus's spread through physical and social distancing, but it can also have negative psychological consequences on the population. People experience high levels of worry and anxiety and have to cope with the consequences of the health emergency. The aim of this study was to preliminarily assess the causal relations among coping, worry and state anxiety at the time of COVID-19 first wave, and the mediation role of worry between coping and state anxiety.MethodsDuring March 2020, 1273 Italian citizens completed an ad hoc online survey composed of sociodemographic and preoccupation-related questions, and standardized self-report questionnaire (Brief COPE, Penn State Worry Questionnaire and State-Trait Anxiety Inventory-State form). Three separate mediation models were performed.ResultsThe relationship between coping strategies (i.e.: problem-focused coping, emotion-focused coping and dysfunctional coping) and state anxiety resulted to be mediated by worry. Dysfunctional and problem-focused coping had a negative effect on anxiety scores and this effect was amplified by high levels of worry. Emotion-focused coping reduced state anxiety scores through its effect on reducing the levels of worry, which in turn was related to a reduction in anxiety.ConclusionThe present study offers first evidence for the mediation role of worry in the relation between coping and anxiety during quarantine caused by COVID-19 pandemic. It supports the clinical importance of investigating people's coping strategies along with the levels of (cognitive) worry and their long-term effects on the psychological well-being during the outbreak, in order to deliver adequate personalized interventions. Psychological support should enhance emotion-focused coping strategies that have a protective effect on both worry and anxiety.     

Systems of coping associated with dysphoria, anxiety and depressive illness: a multivariate profile perspective

As numerous coping strategies to deal with stressors can be used concurrently or sequentially, it may be productive to consider coping from a broad, systemic perspective. Using profile analysis and multivariate techniques, we demonstrated that coping profiles comprising multiple strategies distinguished between various mood states (dysphoria, anxiety, major depression, dysthymia and obsessive-compulsive disorder (OCD)). Generally, affective disturbances were associated with increased levels of rumination, cognitive distraction and emotion-focused coping (emotional expression, other-blame, self-blame, emotional containment and passive resignation) coupled with diminished problem solving and social support seeking. These coping profiles, however, varied as a function of anxiety vs. dysphoria, and severity of dysphoric symptoms, although the profile of dysphoric individuals was similar to that of clinically diagnosed dysthymic and major depressive patients. While coping profiles were generally stable over time (6 months), improvement or deterioration of mood was accompanied by corresponding alterations of coping profiles. Importantly, coping profile was not simply a correlate of dysphoric mood, but was also found to be an antecedent condition that favored the evolution of more severe affective problems. It is suggested that a multidimensional approach may prove useful in understanding coping as a dynamic system, and may have implications for clinical intervention.     

Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder

Background/ObjectiveThe main aim of this study was to analyze differences in inhibition and cognitive flexibility, taking into account some variables that may influence results (non verbal reasoning, depression, anxiety, intolerance of uncertainty, comorbidity, medication consumption).MethodThe participants were 95 adults aged 17-61 years old (M = 33.48, SD = 11.13), primary (most severe) Generalized Anxiety Disorder or Obsessive-Compulsive Disorder and a healthy control group. Neuropsychological neasures were completed using computerized Wisconsin Card Sorting Test, Stroop Color Word Test and Go/NoGo Task.ResultsClinical groups presented worse results in cognitive flexibility to the control group. The obsessive-compulsive group showed worse scores in flexibility than the generalized anxiety group, once non-verbal reasoning and tolerance to uncertainty were controlled. Comorbidity and medication use did not affect results in the obsessive compulsive group but did however influence the generalized anxiety group.ConclusionsCognitive flexibility could be included treatment in the treatment of obsessive-compulsive disorder and generalized anxiety disorder.     

Mindfulness-based psychotherapy in patients with obsessive-compulsive disorder: A meta-analytical Study

Background/ObjectiveObsessive compulsive disorder is a disorder of special relevance in mental health, however, not all patients respond adequately to traditional intervention systems. The present work aims to study the usefulness of mindfulness-based interventions in patients with obsessive compulsive disorder.MethodAn exhaustive search of the literature between 1996 and 2021 allowed us to locate 11 published articles. The effect size was the pretest-posttest standardized mean change calculated for obsession-compulsion, as well as depression symptoms and conscious coping.Resultshe results showed mean effect sizes for mindfulness in the reduction of obsessive-compulsive symptoms (d + = 0.648) and, to a lesser extent, depression (d + = 0.417) and the improvement in Mindfull coping (d + = 0.509). There was no significant decrease in effect size when mindfulness was applied in patients with residual symptoms from previous treatments.ConclusionsThese results are promising regarding the usefulness of the application of intervention programs based on mindfulness in people with obsessive compulsive disorder, both as an alternative option and as a complementary treatment to more traditional intervention formats.     

Pandémie de COVID-19 : attachement,anxiété, régulation émotionnelle et stratégies de coping chez les enfants d’âge scolaire

IntroductionAn impact of the COVID-19 pandemic on the emotions and behaviors of children has been found in several studies. However, this impact is not found in all studies. Attachment could be linked to different reactions and levels of anxiety.ObjectiveThe main aim of this study was to analyze the links between children's insecure attachment and variables related to anxiety, emotional and behavioral management of children during the pandemic.MethodStudy participants (n = 83 parents and their child aged 6 to 12) completed anonymously online questionnaires assessing attachment insecurity, state-anxiety, coping strategies and emotional regulation. They also answered socio-demographic questions related to their context of life and experience of the pandemic.ResultsState-anxiety is significantly related to children's emotional dysregulation but not to emotion-oriented coping strategy. Significant links were observed between attachment insecurity on the one hand, and children's state-anxiety, emotion-oriented coping strategy and children's emotional dysregulation on the other hand. Emotional dysregulation mediates the link between disorganized attachment and state anxiety.ConclusionThe links between attachment insecurity and children's state-anxiety on the one hand, and the emotion-oriented coping strategy on the other hand highlight the importance of taking individual and interactional factors into account in children's socio-emotional manifestations during the COVID-19 pandemic.     

Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety

ABSTRACT

The aim of this study was to examine the extent to which cognitive emotion regulation strategies were “common or transdiagnostic correlates” of symptoms of depression and anxiety and/or “specific correlates” distinguishing one problem category from the other. The sample comprised 582 13- to 16-year-old secondary school students. Symptoms of depression and anxiety were measured by the SCL-90, and cognitive emotion regulation strategies were measured by the CERQ, in a cross-sectional design. Multivariate regression analyses were performed. Before controlling for comorbidity, the same cognitive emotion regulation strategies that were related to symptoms of depression were also related to symptoms of anxiety. However, after controlling for comorbid anxiety symptoms, rumination, self-blame (only girls), positive reappraisal, and positive refocusing (the latter two inversely) were uniquely (and significantly) associated with depression symptoms; and after controlling for comorbid depression symptoms, catastrophising and other-blame were uniquely related to anxiety symptoms. The results supported the cognitive content-specificity model, in which anxiety is supposed to be uniquely characterised by thoughts concerning the overestimation of threats and harm, and depression is supposed to be uniquely characterised by negative evaluations of self, and of past and future events.     

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study

This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.     

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort

Obsessive-compulsive disorder (OCD) is a persistent psychiatric disorder causing significant impairment in functioning. The COVID-19 pandemic has exacerbated OCD-related symptoms and interrupted access to treatment. Recent research suggests mHealth apps are promising tools for coping with OCD symptoms. This randomized controlled trial evaluated the effects of a CBT-based mobile application designed to reduce OCD symptoms and cognitions in community participants considered at high risk of developing OCD symptoms. Following initial screening (n = 924), fifty-five community participants scoring 2 standard deviations above the OCI-R mean were randomized into two groups. In the immediate-app use group (iApp; n = 25), participants started using the application at baseline (T0), 4 min a day, for 12 days (T0–T1). Participants in the delayed-app group (dApp; n = 20) started using the mobile application at T1 (crossover) and used the app for the following 12 consecutive days (T1–T2). Intention to treat analyses indicated that using the app for 12 consecutive days was associated with large effect-size reductions (Cohen’s d ranging from .87 to 2.73) in OCD symptoms and maladaptive cognitions in the iApp group (from T0 to T1) and dApp group (from T1 to T2). These reductions were maintained at follow-up. Our findings underscore the usefulness of brief, low-intensity, portable interventions in reducing OCD symptoms and cognitions during the pandemic.     

Obsessive beliefs and uncertainty in obsessive compulsive and related patients

Background/objectiveThe aim of the present study was to examine obsessive beliefs and intolerance of uncertainty differences among patients Obsessive compulsive disoreder (OCD), trichotillomania, excoriation, generalized anxiety disorder (GAD) and a control group healthy.Method130 participants between the ages of 17 and 62 years (Mean = 29.56, SD = 11.81) diagnosed with OCD (n = 36), trichotillomania (n = 18), excoriation (n = 17), GAD (n = 31) and a healthy control group (n = 28) were evaluated by Obsessive Beliefs Spanish Inventory-Revised and Intolerance of Uncertainty Scale.ResultsThe trichotillomania group presented one of the highest obsessive beliefs highlighting over-importance of thoughts, thought action fusion-moral, importance of controlling one's thoughts. The OCD group also had higher scores in inflated responsibility and thought action fusion-likelihood. The GAD group excelled in inhibitory and prospective uncertainty. The level of depression influenced obsessive beliefs while anxiety affected inhibitory and prospective uncertainty.ConclusionsCognitive variables such as obsessive beliefs and Intolerance of Uncertainty should be considered in the prevention and intervention of obsessive and anxiety disorders.     

新冠肺炎疫情下的评估、应对与抑郁和焦虑的关系：多元多重中介模型

作为全球性公共卫生事件,新型冠状病毒肺炎疫情成为潜在心理应激事件。本研究以线上问卷调研形式在疫情爆发上升期考察了民众对此疫情的可控性评估及应对方式对抑郁焦虑的影响。结果表明：（1）自控性显著负向预测抑郁焦虑,他控性对抑郁焦虑无显著预测作用;（2）前行应对显著负向预测抑郁焦虑,创伤应对显著正向预测抑郁焦虑;（3）前行应对在自控性与抑郁焦虑之间起中介作用,即自控性通过正向预测前行应对进而负向预测抑郁焦虑;（4）前行应对在他控性与抑郁焦虑之间起中介作用,即他控性通过正向预测前行应对进而对抑郁焦虑产生积极影响;（5）然而,创伤应对也在他控性与抑郁焦虑之间起中介作用,即他控性通过正向预测创伤应对对抑郁焦虑产生消极影响。本研究对可控性评估和应对方式对抑郁焦虑的影响以及应对方式的中介作用进行了探究与讨论。     

Is thought-action fusion specific to obsessive-compulsive disorder?: a mediating role of negative affect

Thought-action fusion (TAF) is a cognitive bias presumed to underlie the development of obsessional problems (i.e. obsessive-compulsive disorder; OCD). Previous studies have found that TAF is related to not only OCD, but also to other anxiety disorders. In the present study we compared levels of TAF in OCD patients and in patients with other anxiety disorders, depression, and healthy controls to examine whether TAF is characteristic of individuals with emotional distress in general, as opposed to anxiety disorders per se. We also examined whether negative affect (i.e. anxiety and depression) mediates the relationship between OCD and TAF. Results indicated that OCD patients were characterized by higher scores on likelihood-self and likelihood-other TAF, but that this difference was predominately due to differences in negative affect. These findings support a model in which negative affect mediates the relationship between OCD and TAF.     

Dysfunctional cognitions mediate the relationships between religiosity,paranormal beliefs,and symptoms of obsessive-compulsive disorder

ABSTRACT

Research suggests that religious/paranormal beliefs are related to symptoms of obsessive-compulsive disorder (OCD), including scrupulosity (i.e., religious/moral obsessions and compulsions). However, the mechanisms that underlie these relationships are not well understood. This study focused on examining whether dysfunctional beliefs (DBs) mediate the relationships between: i) religiosity and OCD, ii) religiosity and scrupulosity, iii) paranormal beliefs and OCD, as well as iv) paranormal beliefs and scrupulosity. Students (n?=?775) completed a survey measuring religiosity, paranormal beliefs, OCD, scrupulosity, DBs (inflated sense of responsibility and over-estimation of threat [RT], intolerance of uncertainty and perfectionism [PC], and importance of and the need to control thoughts [ICT]), as well as depression and anxiety. Mediation analyses revealed that RT and ICT mediated all four relationships and PC mediated three of the four relationships. This suggests that paranormal and religious beliefs are associated with DBs which in turn may contribute to the severity of OCD.     

Determinants of sanitary measures and lockdown compliance among health professionals during the COVID-19 pandemic

IntroductionCOVID-19 pandemic forced several countries to establish sanitary and lockdown measures to prevent the spreading of the virus. Only necessary workers were allowed to work, including health workers in hospitals.ObjectivesThis study explores the association between some variables and sanitary measures compliance among health workers during a pandemic.MethodA total of 299 Health workers were recruited online using social networks. Participants completed questionnaires evaluating personality, coping, Anxiety and depression, psychological flexibility and sanitary measures compliance.ResultsCorrelations indicated most observant participants were more likely to present efficient coping and more based on problem solving. Also, Honesty-Humility as a personality trait was positively correlated to a better compliance. Regressions indicated the perceived utility of sanitary measures was the strongest predictor for compliance among health workers. Honesty-Humility and sanitary risks perception were predictors for compliance.ConclusionsThis study conducted among health workers points indicates variables associated with higher compliance. Our results suggest compliance and non-compliance as health behaviours or risk behaviours are linked to perceived threats. This perception is linked to health workers’ knowledges, their coping strategies, and personality.     

Obsessive-compulsive disorder symptoms and correlates in community exercisers

ObjectivesThe purpose of this study was to examine the potential relationship between OCD symptoms and the constructs of depression, anxiety, self-esteem, and commitment to exercise in community-based exercisers.Design and methodA mixed-methods approach was utilized. A sample of 64 female and 21 male participants (M age = 52.1 years) completed a series of online or written questionnaires related to the noted variables, while a subset of 10 participants participated in a qualitative interview to explain their OCD symptoms and exercise behavior.ResultsPearson correlations indicated all psychological constructs were significantly correlated with each other (absolute r's ranged from .27 to .78, all p's < .001), while a canonical correlation analysis revealed one significant function (Wilk's λ = .360, R_c = .80, p < .001). Set 1 (OCD symptoms) explained 36% of the variance in Set 2 (anxiety, depression, self-esteem and commitment to exercise), while Set 2 explained 64% of the variance in Set 1. Four primary themes were established from the qualitative data, including: 1) being involved in sport or physical activity from a young age, 2) high benefits versus low consequences of regular participation in exercise, 3) involvement in detail-oriented jobs, and 4) easy adjustments to unplanned deviations from an exercise schedule.ConclusionsOverall, this research suggests that community-based exercisers with elevated OCD symptoms simply display a healthy attention to the frequency and detail of their physical activity, which facilitates them staying active across a variety of conditions.     

Obsessive-compulsive disorder: boundary issues

The boundaries between obsessive-compulsive disorder (OCD) and other neuropsychiatric disorders remain unresolved and may well differ from one disorder to another. Endophenotypes are heritable, quantitative traits hypothesized to more closely represent genetic risk for complex polygenic mental disorders than overt symptoms and behaviors. They may have a role in identifying how closely these disorders are associated with another and with other mental disorders with which they share major comorbidity. This review maps the nosological relationships of OCD to other neuropsychiatric disorders, using OCD as the prototype disorder and endophenotype markers, such as cognitive, imaging, and molecular data as well as results from demographic, comorbidity, family, and treatment studies. Despite high comorbidity rates, emerging evidence suggests substantial endophenotypic differences between OCD and anxiety disorders, depression, schizophrenia, and addictions, though comparative data is lacking and the picture is far from clear. On the other hand, strong relationships between OCD, Tourette syndrome, body dysmorphic disorder, hypochondriasis, grooming disorders, obsessive-compulsive personality disorder, and pediatric autoimmune neuropsychiatric disorders associated with streptococcus are likely. Studies designed to delineate the cause, consequences, and common factors are a challenging but essential goal for future research in this area.     

The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability,Negative Beliefs,and Therapist Distress About Exposure-Based Interventions

Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.     

Depression and Social Anxiety in Children: Differential Links with Coping Strategies

Strategies that children use for coping with stressors are known to be related to emotional adjustment, but not enough is understood about specific links with social anxiety and depression. The present investigation tested differentiated associations of social anxiety and depression with specific types of coping strategies, and evaluated the direction of these associations over time. In Study 1, 404 children aged 8–13 years completed a coping scale modified from Kochendefer-Ladd and Skinner (Developmental Psychology 38:267-278, 2002) in order to evaluate factor structure and subscale internal consistency. In Study 2, 270 8–11-year-old children completed depression and social anxiety scales, a sociometric survey, and the coping scale from Study 1, with a follow-up timepoint 9 months later. In Study 1, factor analysis revealed six internally consistent coping subscales. In Study 2, social anxiety and depression were found to have distinctive longitudinal associations with subsequent coping strategies. Decreased problem-solving, social support-seeking, and distraction were uniquely predicted by depression but not by social anxiety. Internalising coping was a stronger outcome of social anxiety, and increased externalising was uniquely predicted by depression. There was also some evidence for a moderating role of peer relations. However, none of the coping strategies predicted changes in depression or social anxiety over the two timepoints. These results highlight the impact that emotional adjustment may have on children’s coping strategies, and clarify important distinctions between social anxiety and depression in relation to coping.     

The role of comorbid disruptive behavior in the clinical expression of pediatric obsessive-compulsive disorder

This study explored the impact of disruptive behavior disorder (DBD) comorbidity on a number of theoretically relevant outcomes among 192 children and adolescents with obsessive-compulsive disorder (OCD). Youth were divided into three groups: OCD Only, OCD+DBD comorbidity and OCD+Other comorbidity. Relative to those without a comorbid condition and those with any non-DBD comorbidity, comorbid DBD was associated with greater family accommodation and less symptom resistance. Youth with comorbid DBD exhibited greater OCD symptom severity, OCD-related impairment, anxiety, and internalizing problems than those with no comorbidity. Those with comorbid DBD were over 3.6 times as likely to be taking an atypical antipsychotic medication relative to children without comorbidity. The present results suggest that comorbid DBD contributes to more severe illness presentation above and beyond an OCD diagnosis alone, and may be associated with differing pharmacotherapy prescribing practices.     

The Association of Negative Urgency with Psychological Distress: Moderating Role of Proactive Coping Strategies

Abstract

Negative urgency, which is the tendency to act impulsively under the influence of negative emotions, is a risk factor for various psychological disorders including anxiety and depression. In contrast, proactive coping is a future oriented coping strategy that aims to prepare the self for future stressors by reappraising the stressors as challenges or keep oneself prepared for impending losses. Although the effect of proactive coping and preventive coping strategies on reducing depression and anxiety has been consistently documented, the association of their interaction with risk factors received little attention. In the current study, the moderator roles of two dimensions of Proactive Coping strategies in the association of negative urgency with anxiety and depression, is examined. Data were collected from 404 individuals (255 women) aged 18 to 59 (M?=?31.29, SD = 11.70) through scales assessing negative urgency, proactive coping, anxiety and depression from a community sample. The results revealed that the interaction of proactive coping with negative urgency to be significantly associated with individual differences in depression scores, indicating that appraising the threats as challenges may have potential for buffering the effects of negative urgency on depression. However, a similar pattern was not observed for anxiety or preventive coping.     

Coping with COVID: Use,factor structure,and health behavior implications of specific emotion regulation strategies during the coronavirus pandemic

This series of studies examined U.S. individuals' use of specific emotion regulation/coping strategies during the early months of the COVID-19 pandemic, investigated the factor structure among strategies during this universally experienced stressor, and the extent to which these factors predicted engagement in COVID-related health-promoting behaviors. In Study 1, participants (N = 520) rated their use of 17 strategies for coping with pandemic-related stress during the past 24 h. Differences emerged in strategy use across demographic groups (age, race, income). Results of exploratory factor analysis suggest a factor structure grouping strategies in terms of goals beyond emotion regulation per se, rather than phases of the emotion process or a binary adaptive versus maladaptive distinction. In Study 2 (N = 264), participants reported daily on their coping strategy use and weekly on their engagement in COVID-specific health behaviors for 22 days. Results of confirmatory factor analysis replicate the factor structure found in Study 1. Some significant associations of coping strategy use with health-promoting behaviors were observed, but these were sporadic and largely involved baseline measures rather than predicting change over time. Theoretical and practical implications are discussed.