The relationship between maladaptive health beliefs, pandemic-related stress, and health anxiety during the COVID-19 pandemic
Słowa kluczowe:
anxiety, cross-sectional, pandemic, health cognitions, COVID stress syndromeAbstrakt
Background
Research has demonstrated that people experience specific distress and anxiety regarding COVID-19. This distress may consist of interconnected symptom categories corresponding to a COVID stress syndrome. Susceptibility to COVID stress syndrome may be related to one’s maladaptive health beliefs; however, no research has investigated the association between maladaptive health beliefs and COVID stress. The present study explored the impact of health beliefs on COVID stress, health anxiety, and associated psychological constructs.
Participants and procedure
This cross-sectional survey study included 221 adults (M age = 20.59, SD = 2.28). Participants completed an online survey including demographic questionnaires and self-report measures of health beliefs, COVID stress, health anxiety, and related psychological constructs.
Results
Health anxiety, anxiety sensitivity, state/trait anxiety, intolerance of uncertainty, and depression accounted for significant variance in COVID stress (F(6, 214) = 11.18, R2 = .24, p <.001). Health beliefs (i.e., perceived likelihood of illness, medical service inadequacy, and difficulty coping) were associated with greater COVID stress, although health beliefs were not found to mediate the relationship between health anxiety and COVID stress.
Conclusions
Health beliefs were associated with greater COVID stress, although health beliefs did not mediate the relationship between health anxiety and COVID stress. The relationship between health anxiety and COVID stress may be better explained by other COVID-related cognitions (e.g., vaccine efficacy, dangerousness of COVID-19). The findings highlight the importance of peoples’ health beliefs during the pandemic. Given anxiety’s influence on peoples’ behavioural responses to the pandemic, further research should identify COVID-specific cognitions for prevention of COVID stress and health anxiety.
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Bibliografia
Abramowitz, J. S., Schwartz, S. A., & Whiteside, S. P. (2002). A contemporary conceptual model of hypochondriasis. Mayo Clinic Proceedings, 77, 1323– 1330. https://doi.org/10.4065/77.12.1323.
Abramowitz, J. S., Deacon, B. J., & Valentier, D. P. (2007). The Short Health Anxiety Inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31, 871–883. https://doi.org/10.1007/s10608-006-9058-1.
Akbari, M., Spada, M. M., Nikcevic, A. V., & Zamani, E. (2021). The relationship between fear of COVID-19 and health anxiety among families COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation. Clinical Psychology and Psychotherapy, 28, 1–13. https://doi.org/10.1002/cpp.2628.
Alberts, N. M., Hadjistavropoulos, H. D., Jones, S. L., & Sharpe, D. (2013). The Short Health Anxiety Inventory: a systematic review and meta-analysis. Journal of Anxiety Disorders, 27, 68–78. https://doi. org/10.1016/j.jaxdis.2012.10.009.
Alberts, N. M., Hadjistavropoulos, H. D., Sherry, S. B., & Stewart, S. H. (2016). Linking illness in parents to health anxiety in offspring: Do beliefs about health play a role? Behavioural and Cognitive Psychotherapy, 44, 18–29. https://doi.org/10.1017/ S1352465814000319.
Al-Metwali, B. Z., Al-Jumali, A. A., Al-Alad, Z. A., & Sorofman, B. (2021). Exploring the acceptance of COVID-19 vaccine among healthcare workers and general population using health belief model. Journal of Evaluation in Clinical Practice, 27, 1112–1122. https://doi.org/10.1111/jep.13581.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA Publishing.
Asmundson, G. J. G., Abramowitz, J. S., Richter, A. A., & Whedon, M. (2010). Health anxiety: Current perspectives and future directions. Current Psychiatry Reports, 12, 306–312. https://doi.org/10.1007/s11920-010-0123-9.
Asmundson, G. J., Carleton, R. N., Wright, K. D., & Taylor, S. (2004). Psychological sequelae of remote exposure to the September 11th terrorist attacks in Canadians with and without panic. Cognitive Behaviour Therapy, 33, 51–59. https://doi.org/10.1080/16506070410026435.
Asmundson, G. J. G., Paluszek, M. M., & Landry, C. (2020). Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping? Journal of Anxiety Disorders, 76, 102271. https://doi.org/10.1016/j.janxdis.2020.102271.
Asmundson, G. J. G., & Taylor, S. (2020a). Coronaphobia revisted: a state-of-the-art on pandemicrelated fear, anxiety, and stress. Journal of Anxiety Disorders, 76, 102326. https://doi.org/10.1016/j.janxdis.2020.102326.
Asmundson, G. J. G., & Taylor, S. (2020b). How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders, 71, 102211. https://doi.org/10.1016/j.janxdis.2020.102211.
Blakey, S. M., & Abramowitz, J. S. (2017). Psychological predictors of health anxiety in response to the Zika virus. Journal of Clinical Psychology in Medical Settings, 24, 270–278. https://doi.org/10.1007/s10880-017-9514-y.
Blakey, S. M., Reuman, L., Jacoby, R. J., & Abramowitz, J. S. (2015). Tracing “Fearbola”: Psychological predictors of anxious responding to the threat of Ebola. Cognitive Therapy and Research, 39, 816–825. https://doi.org/10.1007/s10608-015-9701-9.
Bruno, F., Vozzo, F., Arcuri, D., Maressa, R., La Cava, E., Malvaso, A., Lau, C., & Chiesi, F. (2022). The longitudinal association between perceived stress, PTSD symptoms, and post-traumatic growth during the COVID-19 pandemic: The role of coping strategies and psychological inflexibility. Current Psychology. https://doi.org/10.1007/s12144-022-03502-3.
Carleton, R. N., Norton, M. A., & Asmundson, G. J. G. (2007). Fearing the unknown: a short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105–117. https://doi.org/10.1016/j.janxdis.2006.03.014.
Čavojová, V., Šrol, J., & Ballová Mikušková, E. (2022). How scientific reasoning correlates with healthrelated beliefs and behaviors during the COVID-19 pandemic? Journal of Health Psychology, 27, 534– 547. https://doi.org/10.1177/1359105320962266.
Dennis, D., Radnitz, C., & Wheaton, M. G. (2021). A perfect storm? Health anxiety, contamination fears, and COVID-19: Lessons learned from past pandemics and current challenges. International Journal of Cognitive Therapy, 14, 497–513. https://doi.org/10.1007/s41811-021-00109-7.
Di Maggio, I., Romola, M., Lacava, E., Maressa, R., & Bruno, F. (2023). Dealing with COVID-19 stressful events, stress and anxiety: The mediating role of emotion regulation strategies in Italian women. Health Psychology Report, 11, 70–80. https://doi. org/10.5114/hpr/152331.
Faustino, B., Vasco, A. B., Delgado, J., Farinha‐Fernandes, A., & Guerreiro, J. C. (2022). Early maladaptive schemas and COVID‐19 anxiety: The mediational role of mistrustfulness and vulnerability to harm and illness. Clinical Psychology & Psychotherapy, 29, 1297–1308. https://doi.org/10.1002/cpp.2706.
Hadjistavropoulos, H. D., Janzen, J., Kehler, M., Leclerc, J., Sharpe, D., & Bourgault-Fagnou, M. (2012). Core cognitions related to health anxiety in selfreported medical and non-medical samples. Journal of Behavioral Medicine, 35, 167–178. https://doi.org/10.1007/s10865-011-9339-3.
Haig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2021). Practitioner review: Health anxiety in children and young people in the context of the COVID-19 pandemic. Behavioural and Cognitive Psychotherapy, 49, 129–143. https://doi.org/10.1017/S1352465820000636.
Hitchcock, P. B., & Mathews, A. (1992). Interpretation of bodily symptoms in hypochondriasis. Behaviour Research and Therapy, 30, 223–234. https:// doi.org/10.1016/0005-7967(92)90068-r.
Jasper, F., & Witthöft, M. (2011). Health anxiety and attentional bias: The time course of vigilance and avoidance in light of pictorial illness information. Journal of Anxiety Disorders, 25, 1131-1138. https://doi.org/10.1016/j.janxdis.2011.08.004.
Kibbey, M. M., Fedorenko, E. J., & Farris, S. G. (2020). Anxiety, depression, and health anxiety in undergraduate students living in initial US outbreak “hotspot” during COVID-19 pandemic. Cognitive Behaviour Therapy, 50, 409–421. https://doi.org/10.1080/165506073.2020.1853805.
Khoury, J., Watt, M. C., & MacLean, K. (2021). Anxiety sensitivity mediates relations between mental distress symptoms and medical care utilization during COVID-19 pandemic. International Journal of Cognitive Therapy, 14, 515–536. https://doi.org/ 10.1007/s41811-021-00113-x.
Knowles, K. A., & Olatunji, B. O. (2021). Anxiety and safety behavior usage during the COVID-19 pandemic: The prospective role of contamination fear. Journal of Anxiety Disorders, 77, 102323. https://doi. org/10.1016/j.janxdis.2020.102323.
Lee, H., Turkel, J. E., Cotter, S. P., Milliken, J. M., Cougle, J., Goetz, A. R., & Lesnick, A. M. (2013). Attentional bias toward personally relevant healththreat words. Anxiety, Stress & Coping, 26, 493–507. https://doi.org/10.1080/10615806.2012.713474.
Magnan, R. E., Gibson, L. P., & Bryan, A. D. (2021). Cognitive and affective risk beliefs and their association with protective health behavior in response to the novel health threat of COVID-19. Journal of Behavioral Medicine, 44, 285–295. https://doi.org/10.1007/s10865-021-00202-4.
Marcus, D. K. (1999). The cognitive-behavioral model of hypochondriasis: Misinformation and triggers. Journal of Psychosomatic Research, 47, 79–91. https://doi.org/10.1016/s0022-3999(99)00008-2.
McEvoy P. M., & Mahoney, A. E. J. (2011). Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. Journal of Anxiety Disorders, 25, 112–122. https://doi.org/10.1016/j.janxdis.2010.08.010.
Neng, J. M., & Weck, F. (2015). Attribution of somatic symptoms in hypochondriasis. Clinical Psychology & Psychotherapy, 22, 116–124. https://doi.org/ 10.1002/cpp.1871.
Nowak, B., Brzoska, P., Piotrowski, J., Sedikides, C., Zemojtel-Piotrowska, M., & Jonason, P. K. (2020). Adaptive and maladaptive behavior during the COVID-19 pandemic: The roles of Dark Triad traits, collective narcissism, and health beliefs. Personality and Individual Differences, 167, 110232. https://doi.org/10.1016/j.paid.2020.110232.
Oliver, J. E., & Wood, T. (2014). Medical conspiracy theories and health behaviors in the United States. JAMA Internal Medicine, 174, 817–818. https://doi. org/10.1001/jamainternmed.2014.190.
Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General Psychiatry, 33, e100213. https://doi.org/10.1136/gpsych-2020-100213.
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385– 401. https://doi.org/10.1177/014662167700100306.
Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853. https:// doi.org/10.1017/S0033291702005822.
Salkovskis, P. M., & Warwick, H. M. C. (2001). Making sense of hypochondriasis: a cognitive model of health anxiety. In G. J. G. Asmundson, S. Taylor, & B. Cox (Eds.), Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions (pp. 46–64). John Wiley and Sons.
Salkovskis, P. M., Warwick, H. M., & Deale, A. C. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment & Crisis Intervention, 3, 353–367. https://doi.org/10.1093/brief-treatment/mhg026.
Santor, D. A., Zuroff, D. C., Ramsay, J. O., Cervantes, P., & Palacios, J. (1995). Examining scale discriminability in the BDI and CES-D as a function of depressive severity. Psychological Assessment, 7, 131–139. https://doi.org/10.1037/1040-3590.7.2.131.
Sauer, K. S., Jungmann, S. M., & Witthöft, M. (2020). Emotional and behavioural consequences of the COVID-19 pandemic: The role of health anxiety, intolerance of uncertainty, and distress (in)tolerance. International Journal of Environmental Research and Public Health, 17, 7241. https://doi.org/10.3390/ ijerph17197241.
Schütte, K., Vocks, S., & Waldorf, M. (2016). Fears, coping styles, and health behaviors: a comparison of patients with hypochondriasis, panic disorder, and depression. Journal of Nervous and Mental Disease, 204, 778–786. https://doi.org/10.1097/NMD. 0000000000000566.
Simonovic, N., & Taber, J. M. (2022). Psychological impact of ambiguous health messages about COVID-19. Journal of Behavioral Medicine, 45, 159– 171. https://doi.org/10.1007/s10865-021-00266-2.
Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Consulting Psychologists Press. Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press.
Ştefănuţ, A. M., Vintilă, M., Tomiţă, M., Treglia, E., Lungu, M. A., & Tomassoni, R. (2021). The influence of health beliefs, of resources, of vaccination history, and of health anxiety on intention to accept COVID-19 vaccination. Frontiers in Psychology, 12, 729803. https://doi.org/10.3389/fpsyg.2021.729803.
Taylor, S. (2019). The psychology of pandemics: Preparing for the next global outbreak of infectious disease. Cambridge Scholars Publishing.
Taylor, S., & Asmundson, G. J. G. (2004). Treating health anxiety: a cognitive-behavioral approach. Guilford Press.
Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., McKay, D., & Asmundson, G. J. G. (2020a). COVID stress syndrome: Concept, structure, and correlates. Depression and Anxiety, 37, 706–714. https:// doi.org/10.1002/da.23071.
Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., McKay, D., & Asmundson, G. J. G. (2020b). Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders, 72, 102232. https://doi.org/10.1016/j.janxdis.2020.102232.
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., Abramowitz, J. S., Holaway, R. M., Sandin, B., Stewart, S. H., Coles, M., Eng, W., Daly, E. S., Arrindell, W. A., Bouvard, M., & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176–188. https://doi. org/10.1037/1040-3590.19.2.176.
Teovanović, P., Lukić, P., Zupan, Z., Lazić, A., Ninković, M., & Žeželj, I. (2021). Irrational beliefs differentially predict adherence to guidelines and pseudoscientific practices during the COVID‐19 pandemic. Applied Cognitive Psychology, 35, 486– 496. https://doi.org/10.1002/acp.3770.
Vazquez, C., Valiente, C., García, F. E., Contreras, A., Peinado, V., Trucharte, A., & Bentall, R. P. (2021). Post-traumatic growth and stress-related responses during the COVID-19 pandemic in a national representative sample: The role of positive core beliefs about the world and others. Journal of Happiness Studies, 22, 2915–2935. https://doi.org/10.1007/s10902-020-00352-3.
Wang, C., & Zhao, H. (2020). The impact of COVID-19 on anxiety in Chinese university students. Frontiers in Psychology, 22, 1168. https://doi.org/10.3389/ fpsyg.2020.001168.
Weck, F., Neng, J. M., Richtberg, S., & Stangier, U. (2012). Dysfunctional beliefs about symptoms and illness in patients with hypochondriasis. Psychosomatics, 53, 148–154. https://doi.org/10.1016/j. psym.2011.11.007.
Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Fabricant, L. E., & Olatunji, B. O. (2012). Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognitive Therapy and Research, 36, 210–218. https://doi.org/10.1007/s10608- 011-9353-3.