Abstract
The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one’s chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.
Highlights
The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 has severely affected the Italian population which was subjected to extreme and unprecedented social distancing measures for almost 2 months (Remuzzi and Remuzzi, 2020)
Another study conducted on an Italian sample of 18,147 indicated that 37% of participants experienced post-traumatic stress, while 21–23% reported high anxiety, perceived stress, insomnia, and adjustment disorders (Rossi et al, 2020). In view of these data on the adverse effects of the COVID-19 pandemic on mental health, the purpose of the present study was to explore the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to elevated health anxiety during the COVID19 pandemic and lockdown
The present study examined the role of psychological flexibility, including its six processes, as mediators and moderators of the effects of health anxiety on the mental health outcomes of COVID-19 peritraumatic distress, anxiety, and depression
Summary
The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 has severely affected the Italian population which was subjected to extreme and unprecedented social distancing measures for almost 2 months (Remuzzi and Remuzzi, 2020). In order to contain the spread of COVID-19, the Italian government on March 9 implemented a national lockdown in which movements outside one’s city were forbidden and all Italians were required to stay home and refrain from any social contact with friends and relatives outside their household (Lazzerini and Putoto, 2020). Mandatory quarantine was required to reduce the exponential spread of the virus and to alleviate the pressure on the healthcare system. Registered over 28,884 deaths due to COVID-19 (Italian Ministry of Health, 2020)
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