Self-report Measures Of Anxiety Research Articles

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.

Computational modeling of social evaluative decision-making elucidates individual differences in adolescent anxiety.

Adolescents experience significant developmental changes during a time of heightened sensitivity to social cues, particularly rejection by peers, which can be especially overwhelming for those with elevated levels of social anxiety. Social evaluative decision-making tasks have been useful in uncovering the neural correlates of information processing biases; however, linking youths' task-based performance to individual differences in psychopathology (e.g., anxiety symptoms) has proven more elusive. Here, we address this weakness with drift diffusion modeling to decompose youths' performance on the social judgment paradigm (SJP) to determine if this approach is useful in discovering individual differences in anxiety symptoms, as well as puberty, age, and sex. A sample of 103 adolescents (55 males, Mage = 14.49, SD = 1.69) completed the SJP and self-report measures of anxiety, as well as self- and parent-reported measures of puberty. The decision threshold parameter, reflecting the amount of evidence needed to make a social evaluative decision, predicted youth self-reported anxiety, above and beyond typical metrics of SJP performance. Our results highlight the potential advantage of parsing task performance according to the underlying cognitive processes. Future research would likely benefit from applying computational modeling approaches to social judgment tasks when attempting to uncover performance-based individual differences in psychopathology.

Direct Losses and Media Exposure to Death: The Long-Term Effect of Mourning during the COVID-19 Pandemic.

Background: The social distancing policies adopted during the COVID-19 pandemic forced many individuals to confront their mortality and worry about losing loved ones, making it impossible to say goodbye to them properly. Those not directly experiencing loss were inundated with information about COVID-19-related deaths throughout social media, leading to vicarious grief. This study delved into the long-term effects of direct and vicarious mourning on people's mental health during the COVID-19 pandemic. Method: A sample of 171 adults (65% female) aged 19-66 years (Mage = 25.8, SD = 8.57) voluntarily participated in an online survey assessing self-reported psychological measures of complicated grief, stress, depression, dispositional neuroticism, trait anxiety, and situational anxiety. Results: MANOVAs revealed that direct mourning experiences had an extremely severe impact on anxiety, stress, and fear of COVID-19, and a moderate effect on those without personal losses. Indeed, participants reporting high media exposure showed higher scores of depression and stress. Conclusions: Findings from the current study displayed that during the COVID-19 pandemic, people engaged more in proximal defenses than distal ones, taking health-protective measures, experiencing increased anxiety levels toward virus infection, and feeling distressed. Additionally, vicarious mourning was more strongly associated with depression due to emotional empathy with others.

An evaluation of the validity of an aphasia friendly mood and anxiety measure for stroke patients

ABSTRACT Introduction People with post-stroke aphasia are at increased risk of experiencing depression and anxiety. Despite this, there is a lack of appropriate tools which can be used in routine stroke rehabilitation practice to support with the identification of patients experiencing these difficulties. The Stroke Aphasia Anxiety and Mood Screen (SAAMS) was developed by an interdisciplinary team of stroke rehabilitation professionals to improve mood and anxiety screening. The current study sought to evaluate the validity of this measure. Methods Twenty-one people undergoing in-patient stroke rehabilitation who experienced aphasia were administered the SAAMS, alongside the Stroke Aphasic Depression Questionnaire (SADQ-H10) and the Behavioural Outcomes of Anxiety (BOA). The inclusion criteria included patients whose aphasia prevented them from completing traditional self-report measures of mood and anxiety, but who demonstrated a reliable ability to correctly respond to yes/no closed questions in Speech and Language Therapy assessments. Results Both the SAAMS-anxiety (SAAMS-A) and depression (SAAMS-D) subscales achieved adequate internal consistency, and patients’ scores were correlated with observational measures of mood and anxiety. The SAAMS achieved fair classification accuracy for identifying clinical depression and anxiety. Conclusions Patients with aphasia provided reliable responses to questions about anxiety and depression, and this is of clinical importance. While the study identified that the SAAMS has reasonable classification accuracy, further research is required to validate the SAAMS more thoroughly before it can be used routinely in clinical practice.

Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial

AbstractMindfulness and acceptance-based approaches have shown promise as alternative interventions to trauma-focused therapies for PTSD. This open trial examined the potential effectiveness of an 8-session Acceptance and Commitment Therapy (ACT) group in reducing psychiatric symptoms and improving quality of life in outpatient adults (N = 86, 79% female) receiving treatment for PTSD in a health maintenance organization (HMO) psychiatry clinic. The group therapy was an adjunct to usual care and utilized the six core processes of ACT: acceptance, cognitive defusion, mindfulness, self-as-context, values, and committed action. Participants completed self-report measures of PTSD symptoms, depression, anxiety and quality of life; and self-report ACT-specific process measures of acceptance, cognitive defusion and mindfulness at pretreatment, posttreatment and 3-month follow-up. Repeated measures analyses of variance conducted with a completer sample (n = 55) demonstrated significant improvements on all variables with medium to large effect sizes at posttreatment and follow-up. The study findings support further investigation in a randomized controlled trial.

Changes to sleep patterns and insomnia symptoms following cognitive behavioural therapy for anxiety disorders in adolescents.

It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. Data was gathered from 179 participants with an anxiety disorder (11-17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n=73) had outcome data, which was used to examine changes in sleep following CBT. At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents' weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.

Psychometric Synthesis of the Beck Youth Inventory for Children and Adolescents–Second Edition

The Beck Youth Inventory for Children and Adolescents–Second Edition (BYI-II) is the most current version of a widely used instrument across a variety of settings with both clinical and nonclinical clients ages 7–18 years as a self-report measure of anxiety, depression, anger, disruptive behavior, and self-concept. This synthesis of 17 studies from 2005 through 2022 using the BYI-II resulted in aggregated internal consistency of .88−.96 across the five subscales. Convergent validity comparisons were very limited, and no test–retest reliability, diagnostic validity, or structural validity studies were located. Intrascale analysis indicated the Depression and the Anxiety subscales yielded the strongest correlation (r = .73). Implications for counseling practice and research are discussed, including use of the multifaceted BYI-II for screening and outcome research with youths. Many more studies of the BYI-II are needed to establish the usefulness of this legacy assessment with school-aged youth.

Exploratory and confirmatory factor analysis of emPHasis-10: The health-related quality-of-life measure in pulmonary hypertension.

The emPHasis-10 is a health-related quality of life (HRQoL) unidimensional measure developed specifically for adults with pulmonary hypertension. The tool has excellent psychometric properties and is well used in research and clinical settings. Its factor structure has not been examined, which may help to identity a complimentary approach to using the measure to examine patient functioning. We performed an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on a data set collected from 263 adults with PH recruited from a community setting. The EFA suggested the emPHasis-10 consists of three underlying latent variables, which based on the loading of items, were termed "fatigue" (Items 3, 4, and 5), "independence" (Items 7, 8, 9, and 10), and "breathlessness" (Items 1, 2, and 6). All factors were found to have good internal consistency. "Independence" accounted for most of the variance (29%), followed by "breathlessness" (22%) and "fatigue" (19%). The CFA looked to confirm the fit of a three-factor model. A higher-order model was found to be the best fit consisting of HRQoL as a superordinate factor, for which the association between this factor and the 10 items was mediated through the three latent factors. Further analyses were performed testing the validity of the latent variables revealing all were significantly correlated with self-reported measures of depression, anxiety, health-anxiety, and dyspnea. Our analyses support the emPHasis-10 as a measure of HRQoL, while also proposing the clinical utility of examining the three emergent factors, which could be used to glean additional insight into the respondent's functioning and inform care.

The acceptability and feasibility of a cognitive behavioural therapy managing emotions group on a male psychiatric intensive care unit: a mixed methods evaluation

Research suggests that the provision of psychological interventions within acute inpatient settings is effective and important for improving clinical outcomes. There remains limited research on the application of such interventions for individuals admitted to psychiatric intensive care units (PICU), and notably none for male-only PICU environments specifically. Two published protocols have been evaluated in female and mixed gender PICU settings, one a cognitive behavioural therapy (CBT) anger management group and one dialectical behaviour therapy (DBT) skills group. No studies have reported on a general CBT-based group in a male PICU. This study aimed to assess the acceptability and feasibility of a CBT-based managing emotions skills group, delivered in brief 30-minute sessions, within a 7-bed male PICU. All individuals admitted to the PICU during the study period were invited to attend a five-session group. A mixed methods design was used incorporating measuring attendance and retention, a pre–post quasi-experimental design and a qualitative component. Pre- and post-group self-report outcome measures of calmness, anxiety, recovery, and qualitative feedback were gathered and analysed. Pre- and post-outcome measures demonstrate significant improvements in calmness and reduction in anxiety following attendance. Attendance, retention and qualitative feedback data suggests that the group was acceptable and feasible for the participants. Initial findings suggest that adapted CBT skills group-based interventions tailored to the male PICU population are acceptable, feasible, and beneficial to participants. The clinical and research implications are discussed.

The psychological burden of NMOSD - a mixed method study of patients and caregivers.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved ones, so as to inform a specialized intervention. 31 adults living with NMOSD and 22 caregivers of people with NMOSD in the United States and Canada, recruited from NMOSD patient advocacy groups, social media groups, and through word of mouth from other participants, completed a battery of standardized self-report measures of anxiety, depression, trauma, cognitive fusion, valued living, and coping styles. Semi-structured focus group sessions were conducted via HIPAA-compliant Zoom with 31 patients, and separate focus groups were conducted with 22 caregivers. A subset of these samples, comprised of 16 patients and 11 caregivers, participated in individual semi-structured interviews, prioritizing inclusion of diverse perspectives. Descriptive statistics and bivariate correlations were run on quantitative self-report data using SPSS [Version 28.0.1]; data were stored in REDCap. Reflexive thematic analysis was employed regarding qualitative individual interview data. The majority of patients reported experiencing anxiety, depression, cognitive fusion, over-controlled coping, and lack of values-based living. Caregivers also reported heightened anxiety, cognitive fusion, and over-controlled coping, although they did not endorse clinically significant depression. Patient and caregiver degree of anxiety and of overcontrolled coping were both strongly positively correlated, likely affecting how both parties manage NMOSD-related stressors, both individually and as a dyad. Patients reported more anxiety, depression, psychological inflexibility, and lack of values-based living, compared with caregivers. Patient and caregiver narrative themes included mistrust of medical professionals, lack of support immediately following diagnosis, changes in relationships, deviation from values-based living, internalization of feelings, and avoidant coping strategies to manage the psychological burden of NMOSD. A novel mental health intervention targeting the specific psychological burden of life with NMOSD is proposed.

Social comparison, resilience, life satisfaction, depression, and anxiety among earthquake survivors in Turkey

The aftermath of seismic disasters presents a multifaceted challenge for survivors, impacting various aspects of their well-being and mental health. The present study aimed to investigate the mediating role of resilience in the relationships between social comparison, life satisfaction, depression, and anxiety. The study included 388 participants (age range: 18–69 years; mean age = 34.50 ± 13.18) who were residing in the most earthquake-stricken regions of Turkey and completed the self-reported measures of social comparison, resilience, life satisfaction, depression, and anxiety using a paper-and-pencil format. The results showed that social comparison significantly predicted resilience, satisfaction with life, depressive symptoms, and anxiety. Resilience significantly predicted life satisfaction, depression, and anxiety. More importantly, resilience partially mediated the associations between social comparison and life satisfaction, depression, and anxiety. These findings suggest the importance of interventions that contribute to resilience in earthquake survivors. Post-disaster interventions should focus on strategies to diminish the influence of social comparison on mental health and well-being by cultivating the capacity to bounce back from adversity and cope effectively with challenges.

Statistics anxiety or statistics fear? A reinforcement sensitivity theory perspective on psychology students’ statistics anxiety, attitudes, and self-efficacy

AbstractThis research investigates the role of reinforcement sensitivity theory (RST) in statistics education among two distinct samples of undergraduate psychology students. In Study 1, 318 students in a third-year statistics course completed self-report measures of RST, anxiety, attitudes, and self-efficacy concerning the study of statistics. In Study 2, 577 students from first-, second-, and third-year statistics courses participated. Controlling for age and gender, both studies found students who were high in goal-drive persistence reported lower statistics anxiety, higher statistics self-efficacy and more favourable attitudes toward learning statistics, while students who were high in the tendency to avoid threat reported higher statistics anxiety. Those with a more sensitive behavioural inhibition system reported greater statistics anxiety and less favourable attitudes, in Study 2 but not Study 1. Results indicate that RST dimensions account for as much as 23% of additional variance in statistics anxiety, 18% in statistics self-efficacy, and 11% in attitudes, after controlling for age and gender. These studies highlight the utility of RST dimensions, notably goal-drive persistence, threat sensitivity, and behavioural inhibition, in providing critical information as to personality differences among students that need to be considered when developing programs targeting statistics anxiety, attitudes, and self-efficacy.

Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study.

Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology.

How Society Anxiety Influences Attention Control in College Students: The Moderated Mediation Effect of Cognitive Flexibility and Resting-state Electroencephalography Activity.

Social anxiety is a prevalent issue among college students, adversely affecting their overall well-being. Drawing from the cognitive model of social anxiety and attention control theory, heightened levels of social anxiety may correspond to poorer attention control ability. However, little is known about the underlying cognitive mechanisms of the relationship between social anxiety and attention control. To address this research gap, the current study recruited a sample of 156 college students (56 women) who underwent self-report measures of social anxiety, cognitive flexibility, and attention control, followed by a resting-state EEG recording. The results revealed a significant negative predictive effect of social anxiety on attention control, with cognitive flexibility partially mediating this relationship. Furthermore, resting-state theta power emerged as a significant moderator, accentuating the negative impact of social anxiety on cognitive flexibility among individuals with lower theta power. In addition, frontal alpha asymmetry (FAA) demonstrated a moderating effect, with lower FAA intensifying the predictive influence of cognitive flexibility on attention control. Taken together, these results suggested that social anxiety can predict attention control either directly or indirectly via the mediating role of cognitive flexibility, and lower theta power and FAA has a risk amplification effect, which provide novel insights into the treatment and prevention of social anxiety and its negative impact on college students.

Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study.

Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.

Sleep quality impacts the link between reactivity to uncertain threat and anxiety and alcohol use in youth.

Individual differences in reactivity to unpredictable threat (U-threat) have repeatedly been linked to symptoms of anxiety and drinking behavior. An emerging theory is that individuals who are hyper-reactive to U-threat experience chronic anticipatory anxiety, hyperarousal, and are vulnerable to excessive alcohol use via negative reinforcement processes. Notably, anxiety and alcohol use commonly relate to disruptions in sleep behavior and recent findings suggest that sleep quality may impact the link between reactivity to U-threat and psychiatric symptoms and behaviors. The aim of the current study was to examine the unique and interactive effects of reactivity to U-threat and sleep quality on anxiety symptoms and drinking behavior in a cohort of youth, ages 16-19 years. Participants (N = 112) completed a well-validated threat-of-shock task designed to probe individual differences in reactivity to U-threat and predictable threat (P-threat). Startle eyeblink potentiation was recorded during the task as an index of aversive reactivity. Participants also completed well-validated self-report measures of anxiety and depression symptoms, lifetime alcohol use, and current sleep quality. Results revealed significant startle reactivity to U-threat by sleep quality interactions on anxiety symptoms and lifetime drinking behavior. At high levels of sleep disturbance (only), greater reactivity to U-threat was associated with greater anxiety symptoms and total number of lifetime alcoholic beverages. These results suggest that sensitivity to uncertainty and chronic hyperarousal increases anxiety symptoms and alcohol use behavior, particularly in the context of poor sleep quality.

Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study.

A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth. We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up. The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression. Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.

The COVID-19 representation and implications for children's well-being: A three-way perspective

The present research investigated the COVID-19 representation and its implications on children?s psychological health. We used multiple perspectives to explore this issue, i.e., children?s (N = 50, age range 8 ? 10), parents? (N = 100, age range 28 ? 54), and teachers? (N = 2, age 22 and 26) viewpoints, in a short longitudinal approach (Time 1 ? November 2020, Time 2 ? December 2020), during one of the most critical COVID-19 periods in Romania. We assumed similar patterns between parents? and children?s representations of the COVID-19 pandemic, and our qualitative analyses confirmed this assumption. Next, our findings suggested that children?s higher levels of fear of COVID-19 correlated with higher anxiety levels at Time 1; meanwhile, at Time 2, children?s fear of COVID-19 significantly correlated with their well-being, which might indicate the potentially protective role of fear of COVID-19 through perceived threat. At Time 1, children?s self-reported measures of anxiety were significantly associated with parents? and teachers? perceived anxiety. At Time 2, teachers? perceived anxiety concerning their students was not associated with children?s self-reported levels, as were their parents. Finally, at Time 1 (but not at Time 2), children?s fear of COVID-19 moderated the link between anxiety and children?s well-being. Results also suggested a partial mediating effect of parents? fear of COVID-19 on the relationship between children?s fear of COVID-19 and well-being at Time 2, but not at Time 1. Finally, our results suggested that focusing on the future did not significantly impact children?s well-being, fear of COVID, or anxiety. However, children who wrote in their diaries focusing on present behaviors and emotions reported significantly higher anxiety levels at Time 2 compared to Time 1. We discuss our results concerning their practical implications in the 2020?2022 COVID-19 pandemic at personal, family, and educational levels.

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

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. 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. 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. 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.

Impact of Psychological Stress on Emotion Regulation Strategies during COVID-19 in Young Adults with Self-Reported Social Anxiety

Background: This study sought to evaluate the relations among expressive suppression (ES), cognitive reappraisal (CR), and stress during COVID-19 in young adults with self-reported social anxiety. We hypothesized that social anxiety would positively relate to ES but negatively relate to CR. Furthermore, we predicted that stress severity would moderate the relation between social anxiety and emotion regulation, where higher reports of stress and social anxiety would predict greater ES and lower CR. Methods: Participants were young adults (N = 84; 18-24 years old) who completed self-report measures of social anxiety, stress, and emotion regulation amid COVID-19. Zero-order correlations assessed relations among these variables. Moderation analyses assessed stress as a moderator of the relation between social anxiety and emotion regulation. Results: Results indicated that social anxiety was significantly correlated with ES but not CR. The relation between social anxiety and ES was moderated by stress severity, such that as stress increased, individuals with higher social anxiety engaged in less ES. Stress did not moderate the relation between social anxiety and CR. Conclusions: The current study suggests that self-reported social anxiety is positively associated with ES (but not CR) during COVID-19; however, individuals with high social anxiety and perceived stress engaged in less ES.