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Profiles in COVID-19: peritraumatic stress symptoms and their relation with death anxiety, anxiety sensitivity, and emotion dysregulation

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Background The COVID-19 pandemic might be experienced as an ongoing traumatic event and could result in peritraumatic stress symptoms. Evidence implies that individuals’ levels of death anxiety, anxiety sensitivity, and difficulties in emotion regulation may contribute to their peritraumatic stress symptomatology in the aftermath of trauma exposure. Objective The current study aimed to explore these hypotheses in the context of the COVID-19 pandemic. Method An online survey was conducted among a convenience sample of 846 Israeli adults from April 2 to 19 April 2020. COVID-19-related stressors, death anxiety, anxiety sensitivity, difficulties in emotion regulation, and peritraumatic stress symptoms were assessed via self-report questionnaires. Results Analyses indicated significant relations between death anxiety, anxiety sensitivity, and emotion regulation difficulties, on the one hand, and peritraumatic stress symptoms, on the other. Three distinct profiles were identified. Furthermore, profile type – namely having low, medium, and high levels of death anxiety, anxiety sensitivity, and emotion dysregulation – had a significant effect in explaining peritraumatic stress symptoms. Conclusions Results suggest that during the pandemic, levels of death anxiety, anxiety sensitivity, and emotion dysregulation may explain heterogeneity in individuals’ trauma-related symptomatology.
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European Journal of Psychotraumatology
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zept20
Profiles in COVID-19: peritraumatic stress
symptoms and their relation with death anxiety,
anxiety sensitivity, and emotion dysregulation
Alana Siegel, Inbar Mor & Yael Lahav
To cite this article: Alana Siegel, Inbar Mor & Yael Lahav (2021) Profiles in COVID-19:
peritraumatic stress symptoms and their relation with death anxiety, anxiety sensitivity, and
emotion dysregulation, European Journal of Psychotraumatology, 12:1, 1968597, DOI:
10.1080/20008198.2021.1968597
To link to this article: https://doi.org/10.1080/20008198.2021.1968597
© 2021 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Group.
Published online: 24 Sep 2021.
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BASIC RESEARCH ARTICLE
Proles in COVID-19: peritraumatic stress symptoms and their relation with
death anxiety, anxiety sensitivity, and emotion dysregulation
Alana Siegel , Inbar Mor and Yael Lahav
Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
ABSTRACT
Background: The COVID-19 pandemic might be experienced as an ongoing traumatic event
and could result in peritraumatic stress symptoms. Evidence implies that individuals’ levels of
death anxiety, anxiety sensitivity, and diculties in emotion regulation may contribute to their
peritraumatic stress symptomatology in the aftermath of trauma exposure.
Objective: The current study aimed to explore these hypotheses in the context of the COVID-
19 pandemic.
Method: An online survey was conducted among a convenience sample of 846 Israeli adults
from April 2 to 19 April 2020. COVID-19-related stressors, death anxiety, anxiety sensitivity,
diculties in emotion regulation, and peritraumatic stress symptoms were assessed via self-
report questionnaires.
Results: Analyses indicated signicant relations between death anxiety, anxiety sensitivity, and
emotion regulation diculties, on the one hand, and peritraumatic stress symptoms, on the
other. Three distinct proles were identied. Furthermore, prole type namely having low,
medium, and high levels of death anxiety, anxiety sensitivity, and emotion dysregulation – had
a signicant eect in explaining peritraumatic stress symptoms.
Conclusions: Results suggest that during the pandemic, levels of death anxiety, anxiety sensitivity, and
emotion dysregulation may explain heterogeneity in individuals’ trauma-related symptomatology.
Perles en COVID-19: síntomas de estrés peritraumático y su relación
con la ansiedad por la muerte, sensibilidad de la ansiedad,
y desregulación emocional
Antecedentes: La pandemia del COVID-19 podría ser experimentada como un evento
traumático en curso y podría resultar en síntomas de estrés peritraumático. La evidencia
implica que los niveles individuales de la ansiedad por la muerte, la sensibilidad de la ansiedad,
y las dicultades en la regulación emocional podrían contribuir a su sintomatología del estrés
peritraumático en las secuelas de la exposición al trauma.
Objetivo: El presente estudio buscó explorar estas hipótesis en el contexto de la pandemia del
COVID-19.
Método: Se realizó una encuesta en línea en una muestra por conveniencia de 846 adultos israelíes
desde el 2 al 19 de abril de 2020. Los estresores relacionados al COVID-19, la ansiedad por la muerte, la
sensibilidad de ansiedad, las dicultades en la regulación emocional, y los síntomas de estrés
peritraumático fueron evaluados por medio de cuestionarios de auto-reporte.
Resultados: Los análisis indicaron relaciones signicativas entre la ansiedad por la muerte, la
sensibilidad de la ansiedad, y las dicultades de regulación emocional, por un lado, y los
síntomas de estrés peritraumático, por el otro lado. Tres perles distintivos fueron identica-
dos. Además, el tipo de perl – especícamente tener niveles bajos, medios, y altos de ansiedad
por la muerte, sensibilidad de la ansiedad, y desregulación emocional – tuvieron un efecto
signicativo en explicar los síntomas de estrés peritraumático.
Conclusión: Los resultados sugieren que, durante la pandemia, los niveles de ansiedad por la
muerte, sensibilidad de la ansiedad, y desregulación emocional podrían explicar la heteroge-
neidad en la sintomatología relacionada al trauma de los individuos.
COVID-19 概况: 创伤后应激症状及其与死亡焦虑, 焦虑敏感性和情绪失调
的关系
背景: COVID-19 疫情可能被视为一件持续的创伤性事件, 并可能导致创伤性应激症状° 证据
表明个体的死亡焦虑水平, 焦虑敏感性和情绪调节困难可能会导致他们在创伤暴露后的创伤
性应激症状°
ARTICLE HISTORY
Received 13 April 2021
Revised 14 July 2021
Accepted 9 August 2021
KEYWORDS
Peritraumatic stress
symptoms; death anxiety;
anxiety sensitivity; emotion
regulation; COVID-19;
coronavirus; pandemic
PALABRAS CLAVE
Síntomas de estrés
peritraumático; ansiedad por
la muerte; sensibilidad de la
ansiedad; regulación
emocional; COVID-19;
coronavirus; pandemia
关键词
创伤性应激症状; 死亡焦
; 焦虑敏感性; 情绪调节;
新冠肺炎; COVID-19; 疫情
HIGHLIGHTS
Death anxiety was related
to peritraumatic stress
symptoms.
Anxiety sensitivity was
related to peritraumatic
stress symptoms.
Emotion regulation was
related to peritraumatic
stress symptoms.
Three profiles were found.
Profile type explained peri-
traumatic stress symptoms.
CONTACT Yael Lahav yaellah1@tauex.tau.ac.il Department of Occupational Therapy, the Stanley Steyer School of Health Professions, Sackler
Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv 69978, Israel
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY
2021, VOL. 12, 1968597
https://doi.org/10.1080/20008198.2021.1968597
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which
permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
目的: 当前研究旨在于 COVID-19 疫情背景下探索这些假设°
方法: 2020 4 2 日至 4 19 日期间, 在一个 846 名以色列成年人便利样本中进行了一
项在线调查° 通过自我报告问卷评估 COVID-19 相关应激源, 死亡焦虑, 焦虑敏感性, 情绪调节
困难和创伤性应激症状°
结果: 分析表明, 一方面死亡焦虑, 焦虑敏感性和情绪调节困难之间存在显著关联, 另一方面
也与创伤性应激症状之间存在显著关联° 确定了三个不同的剖面° 此外, 剖面类型——即具有
, 中和高水平的死亡焦虑, 焦虑敏感性和情绪失调——在解释创伤性应激症状上有显著效
°
结论: 结果表明, 在疫情期间, 死亡焦虑, 焦虑敏感性和情绪失调的水平可以解释个体创伤相
关症状的异质性°
1. Introduction
In December 2019, the novel and highly infectious
severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) – the virus that causes COVID-19
broke out in Wuhan, China and quickly escalated into
a global pandemic by 11 March 2020. SARS-CoV-2 is
highly transmissible in humans and may lead to a wide
range of symptoms ranging from mild symptoms (e.g.
fever, dry cough) to severe illness (e.g. difficulty
breathing or shortness of breath, chest pain or pres-
sure; Johns Hopkins University & Medicine, 2021).
Since the outbreak of the COVID-19 pandemic,
186.4 million people globally have been diagnosed
with it, and 4.03 million people have died as a result
of it (Johns Hopkins University & Medicine, 2021).
The pandemic has had worldwide catastrophic reper-
cussions, including national lockdowns, unprece-
dented levels of unemployment and economic crises,
overwhelmed hospital systems, and closures of work-
places, schools, and cultural centres (OECD, 2020).
The pandemic has unleashed a multitude of stres-
sors in the daily lives of many, including but not
limited to loneliness and isolation during lockdowns
and social distancing (Beam & Kim, 2020); the stress
of belonging to a high-risk group (Sun, Qiu, Huang, &
Yang, 2020); and fear for the health and safety of loved
ones at risk for COVID-19 (Mertens, Gerritsen,
Duijndam, Salemink, & Engelhard, 2020). In addition,
many have had to deal with the fear of death (Menzies
& Menzies, 2020) or of surviving COVID-19 with
lasting negative health effects (Marshall, 2020). In the
United States between mid-February and mid-March
2020, the rise in stressors was reflected in the increased
demand for prescriptions for anti-anxiety medication
(by 34.1%), anti-depressants (by 18.6%), and sleep
medications (by 14.8%; Digon, 2020).
Furthermore, COVID-19 might be experienced as
an ongoing traumatic event and could potentially
eventuate in peritraumatic stress symptoms which
reflect responses that occur during and immediately
following trauma exposure, comprising intrusion,
avoidance, negative changes in mood and cognition,
and hyperarousal clusters (Horesh & Brown, 2020).
The intrusion cluster signifies a re-experiencing of the
traumatic event (e.g. flashbacks, nightmares). The
avoidance cluster reflects persistently avoiding stimuli
associated with the traumatic event (e.g. avoidance of
trauma reminders). The negative changes in mood
and cognition cluster consists of pessimistic beliefs
(e.g. negative views about oneself or the world) and
negative mood states (e.g. fear, guilt, shame). Lastly,
the hyperarousal cluster reflects elevated reactivity to
stimuli (e.g. exaggerated startle response, irritability,
and aggression; American Psychiatric Association,
2013).
Previous studies have indeed documented peritrau-
matic stress symptomatology during the pandemic. In
a study conducted in the immediate aftermath of the
COVID-19 outbreak that examined peritraumatic
stress symptoms in 6,049 participants, 13.0% exhibited
moderate and 6.1% displayed high levels of symptoms
(Jiang, Nan, Lv, & Yang, 2020). In another study,
conducted in the first month after the U.S. declared
a state of emergency due to the pandemic, 898 parti-
cipants reported high levels of depression (43.3%),
anxiety (45.4%), and peritraumatic stress symptoms
(31.8%; Liu, Zhang, Tin, Hyun, & Hahm, 2020).
Yet trauma-related symptomatology may vary
across individuals, with some being susceptible to
peritraumatic stress symptoms more than others. In
the face of the ongoing pandemic, conducting
momentary assessment methods in order to identify
vulnerable populations and factors related to elevated
symptomatology is of importance (Horesh & Brown,
2020). Specifically, although evidence indicates that
only a minority of people are vulnerable to long-
term distress in the aftermath of trauma exposure
(Bonanno, 2004; Santiago et al., 2013), the global
scale and ongoing nature of the present pandemic
may significantly increase the mental health burden
of peritraumatic symptomatology (Horesh & Brown,
2020). Furthermore, as peritraumatic distress has been
found to be one of the most powerful predictors of
subsequent posttraumatic stress disorder (PTSD)
(Thomas, Saumier, & Brunet, 2012; Vance, Kovachy,
Dong, & Bui, 2018), uncovering factors that are asso-
ciated with elevated symptomatology during the peri-
traumatic phase may contribute to the development of
preventative interventions meant to reduce the inci-
dence of COVID-19-related traumatic stress (Horesh
& Brown, 2020). The present investigation addressed
2A. SIEGEL ET AL.
this subject matter and explored the contribution of
death anxiety, anxiety sensitivity, and emotion regula-
tion in explaining peritraumatic stress symptoms dur-
ing the pandemic.
Given the higher mortality rates of COVID-19
compared to previous coronaviruses and influenza
(Maragakis, 2021), death anxiety could be expected
to be implicated in one’s trauma-related symptoms
(Lee, Jobe, Mathis, & Gibbons, 2020). Death anxiety
is defined as the anticipation and awareness of the
reality of dying and death that includes cognitive,
emotional, and motivational components that can
vary by sociocultural life occurrences and one’s devel-
opmental stage (Lehto & Stein, 2009). It has been
argued that death anxiety is a personality trait, sug-
gesting that some individuals may be more vulnerable
to experiencing it than others (Pettigrew & Dawson,
1979). Becker claimed that human behaviour is basi-
cally motivated by death anxiety, and that the indivi-
dual expends a great deal of energy in denying death in
order to keep death anxiety under control (Becker,
1973). Nevertheless, when these efforts fail, the experi-
ence of death anxiety may lead to maladaptive
responses, such as existential worries or avoidant self-
protective responses (Sharif Nia et al., 2019), and to
psychopathology (Furer & Walker, 2008).
Death anxiety may also affect reactions to the cur-
rent pandemic, and be related to peritraumatic stress
symptoms. Studies have found death anxiety to be
associated with PTSD in the aftermath of disease
(e.g. Cella & Tross, 1987; Safren, Gershuny, &
Hendriksen, 2003). In a sample of 75 adults with
HIV, it was found that those with higher death anxiety
may have been interpreting their illness symptoms in
a more maladaptive and catastrophic way than those
with lower death anxiety, resulting in more PTSD
symptoms (Safren et al., 2003). A similar process
may be taking place during the current pandemic,
such that individuals’ death anxiety may contribute
to their peritraumatic stress symptoms.
Anxiety sensitivity appears to be another factor
that, during this pandemic, could be associated with
trauma-related symptomatology. Anxiety sensitivity is
conceptualized as a fear of anxiety-related somatic
sensations due to the expectation of consequences
that can be catastrophic (Reiss, 1991). Individuals
with high levels of anxiety sensitivity tend to nega-
tively interpret benign somatic sensations as being
potentially dangerous or catastrophic (Rosmarin,
Bourque, Antony, & McCabe, 2009). This tendency,
in turn, may intensify the sense of threat in the face of
the current pandemic and increase one’s vulnerability
to trauma-related symptomatology. Individuals with
high levels of anxiety sensitivity might interpret nor-
mal sensations as indications of having contracted
COVID-19 or of other serious medical conditions
that would make them particularly vulnerable at this
time, and, as a result, experience elevated fears and
worries (Rogers et al., 2021), as well as peritraumatic
stress symptomatology.
Research has indicated that anxiety sensitivity
might intensify the experience of threat during the
pandemic, resulting in a fear of contamination and
compulsive hygiene checks (Taylor et al., 2020). Stress
stemming from COVID-19 has been found to be asso-
ciated with a greater likelihood of clinically significant
anxious arousal symptom severity and global anxiety
symptom severity at higher levels of anxiety sensitivity
(Manning et al., 2021). Furthermore, research has
found associations between anxiety sensitivity and
PTSD (e.g. Elwood, Mott, Williams, Lohr, &
Schroeder, 2009), perhaps due to anxiety sensitivity
serving as a broad-based cognitive vulnerability for
anxiety and related problems (Leen-Feldner, Feldner,
Reardon, Babson, & Dixon, 2008).
One’s ability to modulate emotions, known as emo-
tion regulation, may be a third factor contributing to
peritraumatic stress symptoms in the context of this
pandemic. Emotion regulation has been defined as ‘the
ability to monitor, understand, and accept emotions,
and to engage in goal-directed behavior when emo-
tionally activated’ (Roemer et al., 2009, p. 143), and is
the conscious or unconscious effort to affect the inten-
sity or duration of an emotion (Gross & Thompson,
2007). Difficulties in emotion regulation can lead to
challenges in controlling one’s behaviours when
experiencing emotional distress, prevent the indivi-
dual from employing adaptive coping strategies, and
lead to further maladaptive reactions such as rumina-
tion, catastrophizing, and a lack of positive reappraisal
(Gratz & Roemer, 2004). Emotion dysregulation
appears to play a role in various mental health diffi-
culties, including PTSD symptomatology (Bardeen,
Kumpula, & Orcutt, 2013; Weiss, Dixon-Gordon,
Peasant, & Sullivan, 2018). In studies of participants
in the early phase of the COVID-19 outbreak, emotion
dysregulation was related to depression severity
(Moccia et al., 2020) and health anxiety (Jungmann
& Witthöft, 2020). Furthermore, peritraumatic stress
symptomatology was found to increase with greater
levels of exposure to COVID-19 when participants
demonstrated a greater reliance on maladaptive versus
adaptive strategies to modulate emotions (Jiang et al.,
2020).
The aforementioned literature suggests that death
anxiety, anxiety sensitivity, and emotion dysregulation
may be associated with trauma-related symptoms in
the context of the pandemic, such that higher levels of
each of these factors may be related to elevated levels
of peritraumatic stress symptoms. Nevertheless, the
relation between different patterns of combinations
between these three factors and peritraumatic stress
symptoms is unknown. One could postulate that dis-
tinct profiles of death anxiety, anxiety sensitivity, and
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 3
emotion dysregulation might exist and explain the
heterogeneity in peritraumatic stress symptomatology
among individuals. For example, it might be that indi-
viduals who are characterized by high levels of death
anxiety, anxiety sensitivity, and emotion dysregulation
are particularly vulnerable to peritraumatic stress
symptomatology during the pandemic. These indivi-
duals may interpret benign somatic sensations as indi-
cations of having contracted COVID-19, and be
especially anxious over the threat of dying as a result
of the disease. Moreover, given the challenges they
have in being aware of the existence of their emotions
as well as in understanding and modulating them,
these individuals may experience their emotions as
unmanageable, and may over-rely on maladaptive
strategies, which could further intensify their peritrau-
matic distress in the long run. Conversely, individuals
who are characterized by lower levels of death anxiety,
anxiety sensitivity, and emotion dysregulation might
be relatively resilient in the face of the pandemic.
These individuals might be less threatened by bodily
sensations and rightly ascertain normal bodily experi-
ences as innocuous. They may be less preoccupied
with existential worries, more able to keep the threat
of death due to COVID-19 at bay, and more capable of
utilizing adaptive strategies to handle their emotional
responses. These tendencies, in turn, may reduce their
risk for trauma-related symptomatology, as mani-
fested in lower levels of peritraumatic stress
symptomatology.
To explore this prospect – that is, to uncover
differential profiles of death anxiety, anxiety sensi-
tivity, and emotion dysregulation and their link
with peritraumatic symptomatology it may not
be satisfactory to utilize traditional variable-centred
statistical approaches. Rather, a more nuanced
exploration, which takes into account a wide
range of combinations and patterns between the
explanatory variables, is needed. Nevertheless, to
the best of our knowledge, to date this sort of
investigation has not been conducted. Being the
first, presumably, to address this gap, the current
study, which was conducted during the first wave
of the pandemic in Israel, was exploratory in nat-
ure. Three main goals were set:
(a) To explore the relations between death anxiety,
anxiety sensitivity, and emotion dysregulation,
on the one hand, and peritraumatic stress
symptoms, on the other.
(b) To identify profiles of death anxiety, anxiety
sensitivity, and emotion dysregulation, and
their prevalence.
(c) To assess the contribution of profile type (i.e.
a combination of death anxiety, anxiety sensi-
tivity, and emotion dysregulation) in explain-
ing peritraumatic stress symptoms.
2. Methods
2.1. Participants and procedure
An online survey was conducted among a convenience
sample of Israeli adults. The survey was accessible
through Qualtrics, a secure web-based survey data
collection system. The survey took an average of
25 minutes to complete and was open from
2 April 2020 to 19 April 2020. It was anonymous and
no data were collected that linked participants to
recruitment sources. The Tel Aviv University institu-
tional review board (IRB) approved all procedures and
instruments. Clicking on the link to the survey guided
potential respondents to a page that provided infor-
mation about the purpose of the study, the nature of
the questions, and a consent form (stating that the
survey was voluntary, respondents could quit at any
time, and responses would be anonymous). The first
page also offered researcher contact information. Each
participant was given the opportunity to take part in
a lottery that rewarded four $60 gift vouchers to the
winners.
A total of 1,500 people began the survey, and 976
answered some of the questionnaires. Of them, 846
participants (86.7%) who provided data concerning
the study variables were included in this study.
Participants’ ages ranged from 18 to 78 (M= 43.97,
SD = 14.08). Most of the sample were women (80.8%);
secular (67.1%); with a high school education or under
(51.5%); and in a relationship (64.0%). Half of the
sample had an average Israeli income or above (50.3%).
2.2. Measures
2.2.1. Background variables
Participants completed a brief demographic question-
naire that assessed age, gender, education, relational
status, religiosity, and income.
2.2.2. COVID-19-related stressors
Specific stressors related to the COVID-19 pandemic
were measured via items designed by the research
team. Participants were asked to indicate 1) how
they perceived their own physical health, 2) whether
they were in quarantine, 3) whether they were living
alone during the outbreak, 4) whether they belonged
to a high-risk group for COVID-19, 5) whether they
had close others who belonged to a high-risk
group, 6) whether they had close others who were
hospitalized due to the disease, 7) whether they had
close others diagnosed with the disease, 8) whether
they were diagnosed with the disease, 9) whether they
experienced the loss of close others due to the dis-
ease. All stressors, apart from perceiving one’s health,
were coded as dummy variables, with ‘0’ reflecting
the absence of a stressor and ‘1’ reflecting the pre-
sence of a stressor. Participants’ perceptions
4A. SIEGEL ET AL.
regarding their own health ranged from 1 (bad) to 5
(excellent). Given that fewer than eight participants
reported experiencing either of the last two stressors
(being diagnosed with the disease and experiencing
the loss of close others due to the disease), these
specific stressors were not included in the present
analyses.
2.2.3. Peritraumatic stress symptoms during the
pandemic
Peritraumatic stress symptoms were measured via
a modified version of the PTSD Checklist for the
DSM-5 (PCL-5; Weathers et al., 2013). This 20-item
self-report measure asks participants to indicate the
extent to which they experienced each PTSD symp-
tom, on a 5-point Likert scale ranging from 0 (not at
all) to 4 (extremely). The original version was adapted
for the current study so that the timeframe for experi-
encing each symptom was changed from ‘in the past
month’ to ‘since the outbreak of the COVID-19 pan-
demic,’ and the index event was the COVID-19 pan-
demic. The PCL-5 demonstrates high internal
consistency and test-retest reliability (Bovin et al.,
2016). Internal consistency reliabilities in this study
for intrusion, avoidance, negative alterations in mood
and cognition, and hyperarousal clusters were good
(α = 0.89, 0.82, 0.83, 0.83, respectively).
2.2.4. Difficulties in emotion regulation
Difficulties in emotion regulation were measured via
the 16-item Difficulties in Emotion Regulation Scale
(Bjureberg et al., 2016), which assesses five domains:
non-acceptance of negative emotions, inability to
engage in goal-directed behaviours when distressed,
difficulties controlling impulsive behaviours when dis-
tressed, limited access to effective emotion regulation
strategies, and lack of emotional clarity. Participants
are asked to rate the extent to which each item applies
to them on a 5-point Likert-type scale from 1 (almost
never) to 5 (almost always). The DERS-16 has been
found to have good test-retest reliability and adequate
convergent validity (Bjureberg et al., 2016). Internal
consistency reliability in this study for the total score
was excellent (α = 0.94).
2.2.5. Death Anxiety Scale (Templer, 1970)
Death anxiety was assessed via the Death Anxiety Scale
(Templer, 1970) which includes 15 items. Participants
were asked to indicate whether they agreed with each
of the statements (‘0’ reflecting disagreement and ‘1’
reflecting agreement). Higher scores reflected greater
levels of death anxiety. In a prior study, this scale was
reported to have good internal consistency (Templer,
1970). In this study, internal consistency reliability was
reasonably high (α = 0.71).
2.2.6. The Anxiety Sensitivity Index Revised (ASI-R;
Cox, Taylor, Borger, Fuentes, & Ross, 1996)
The ASI-R is a 36-item, self-report rating scale used to
assess anxiety sensitivity. Participants are asked to
indicate the extent to which they agree with each
statement on a 5-point Likert-type scale ranging
from 0 (not at all) to 4 (very much). The total score
is computed by summing all items and ranges from 0
to 144, with higher scores reflecting higher levels of
anxiety sensitivity. The ASI-R has been found to have
good psychometric properties (Cox et al., 1996).
Internal consistency reliability in this study for the
total score was excellent (α = 0.96).
2.3. Analytic strategy
To explore the relations between death anxiety, anxi-
ety sensitivity, and emotion dysregulation on the one
hand, and peritraumatic stress symptoms, on the
other, we conducted Pearson correlation analyses. To
derive discrete latent variables that describe distinct
subgroups of participants who share similar patterns
of death anxiety, anxiety sensitivity, and emotion dys-
regulation, a latent profile analysis (LPA) was con-
ducted. Four models were tested with increasing
numbers of profiles: (1) a model with equal variances
and covariances fixed to 0, (2) a model with equal
variances and equal covariances, (3) a model with
varying variances and covariances fixed to 0, and (4)
a model with varying variances and varying covar-
iances. The best fitting model was determined by an
analytic hierarchy process that makes use of Akaike’s
Information Criterion (AIC), Approximate Weight of
Evidence (AWE), Bayesian Information Criterion
(BIC), Classification Likelihood Criterion (CLC),
Kullback Information Criterion (KIC), entropy and
by theoretical interpretability (Akogul & Erisoglu,
2017).
Next, to examine the association between latent
class membership derived from the LPA and peri-
traumatic stress symptoms, MANCOVAs were con-
ducted. Age, gender, income, perception of one’s
health, and belonging/not belonging to a high-risk
group for COVID-19, which were found to be
related to peritraumatic stress symptoms (Ps<.05),
were entered as covariates. The tidy LPA R package
was used to conduct the LPA, while SPSS 27 was
used to conduct Pearson correlation analyses and
the MANCOVAs.
3. Results
3.1. Stressors during the COVID-19 pandemic
Several COVID-19-related stressors were reported by
the respondents. These included being in quarantine
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 5
(n = 75, 8.8%), living alone during the outbreak
(n = 127, 15.0%), belonging to a high-risk group for
COVID-19 (n = 274, 32.3%), perceiving one’s health as
not good or as poor (n = 58, 6.8%), having close others
who belonged to a high-risk group (n = 708, 83.4%),
and having close others who were diagnosed with the
disease (n = 59, 6.9%).
3.2. Death anxiety, anxiety sensitivity, emotion
dysregulation, and peritraumatic stress symptoms
Of the total sample, 27.8% (n = 321) reported at
least one intrusion symptom, 26.9% (n = 228)
reported at least one avoidance symptom, 59.4%
(n = 504) reported at least one symptom reflecting
negative alterations in mood and cognition, and
62.2% (n = 528) reported at least one hyperarousal
symptom. Table 1 presents the study’s variables and
inter-correlations. As can be seen in the table,
death anxiety, anxiety sensitivity, and emotion dys-
regulation were associated with peritraumatic stress
symptoms: The higher the scores on death anxiety,
anxiety sensitivity, and emotion dysregulation, the
higher the intrusion, avoidance, alteration in cogni-
tion and mood symptoms, and hyperarousal peri-
traumatic stress symptoms.
3.3. Proles of death anxiety, anxiety sensitivity,
emotion dysregulation
Results indicated that the best fitting model was
a three-profile model with varying variances and
varying covariances (see Table 2). This model fit
best across criteria, except for entropy, which was,
nevertheless, in the acceptable range (Jung &
Wickrama, 2008). Profile 1 (n = 142; 16.7% of
entire sample) was characterized by relatively low
levels of death anxiety, anxiety sensitivity, and
emotion dysregulation. Profile 2 (n = 429; 50.5%
of the entire sample) was characterized by relatively
moderate levels of death anxiety, anxiety sensitivity,
and emotion dysregulation. Last, Profile 3 (n = 278;
32.7% of the entire sample) was characterized by
relatively high levels of death anxiety, anxiety sen-
sitivity, and emotion dysregulation (see Figure 1).
3.4. Prole membership and peritraumatic stress
symptoms
We conducted MANCOVAs to assess the contribu-
tion of profile variation in explaining peritraumatic
stress symptoms, above and beyond age, gender,
income, perception of one’s health, and belonging/
not belonging to a high-risk group for COVID-19
Table 1. Inter-correlations between death anxiety, anxiety sensitivity, and emotion dysregulation, and peritraumatic stress
symptoms, since the outbreak of the COVID-19 pandemic (n = 849).
Measure 1 2 3 4 5 6 7
1. Death anxiety -
2. Anxiety sensitivity .47*** -
3. Emotion dysregulation .26*** .52*** -
4. Peritraumatic intrusion symptoms .35*** .47*** .33*** -
5. Peritraumatic avoidance symptoms .32*** .41*** .32*** .69*** -
6. Peritraumatic negative
alterations in mood and cognition
.32*** .45*** .48*** .67*** .59*** -
7. Peritraumatic hyperarousal symptoms .36*** .52*** .48*** .69*** .58*** .76*** -
M (SD) 8.01 (2.97) 31.69 (25.17) 29.76 (11.55) 3.24 (3.90) 1.35 (1.79) 5.13 (4.74) 5.53 (4.67)
Range 14 137 64 19 8 26 21
*** p < .001.
Table 2. Latent profile analysis fit indices (n = 849).
Model number Classes AIC BIC Entropy
1
(equal variances and covariances fixed to 0)
1 7237.07 7265.54 1.00
1 2 6753.76 6801.20 0.85
1 3 6629.09 6695.51 0.75
2
(equal variances and equal covariances)
1 6767.01 6809.70 1.00
2 2 6559.11 6620.78 0.89
2 3 6565.08 6645.73 0.52
3
(varying variances and covariances fixed to 0)
1 7237.07 7265.54 1.00
3 2 6431.21 6492.88 0.73
3 3 6240.84 6335.72 0.70
4
(varying variances and varying covariances)
1 6767.01 6809.70 1.00
4 2 6245.65 6335.79 0.67
4
a
3 6164.99 6302.57 0.69
a
The best fitting model. AIC = Akaike information criterion, BIC = Bayesian information criterion. Lower AIC, BIC
values indicate a better fitting model. Entropy values approaching 1 indicate high classification probabilities, and
entropy values between 0.60 and 0.80 are still in the acceptable range.
6A. SIEGEL ET AL.
(see Table 3). As can be seen, profile type had signifi-
cant effects in explaining peritraumatic stress symp-
toms. Participants who were classified as Profile 3 were
characterized by high death anxiety, anxiety sensitiv-
ity, and emotion dysregulation and had the highest
scores on intrusion, avoidance, alteration in cognition
and mood symptoms, and hyperarousal peritraumatic
stress symptoms (M = 5.14, SD = 4.54; M = 2.06,
SD = 1.98; M = 8.19, SD = 5.18; M = 8.46, SD = 5.04,
respectively); following participants who were classi-
fied as Profile 2 and were characterized by medium
levels of death anxiety, anxiety sensitivity, and emo-
tion dysregulation (M = 2.78, SD = 3.33; M = 1.24,
SD = 1.70; M = 4.22, SD = 3.85; M = 4.81, SD = 3.81,
respectively); and participants who were classified as
Profile 1 and were characterized by low levels of death
anxiety, anxiety sensitivity, and emotion dysregulation
(M = .85, SD = 1.91; M = .30, SD = .77; M = 1.92,
SD = 2.55; M = 1.95, SD = 2.42, respectively). These
effects were significant above and beyond the effects of
age, gender, income, perception of one’s health, and
belonging/not belonging to a high-risk group for
COVID-19.
4. Discussion
Given that for some people the COVID-19 pan-
demic might be experienced as an ongoing trau-
matic event (Horesh & Brown, 2020), identifying
the factors that are related to individuals’ peritrau-
matic symptomatology is important. This study
explored the link between death anxiety, anxiety
sensitivity, emotion dysregulation, and peritrau-
matic stress symptoms during the pandemic’s first
wave in Israel. Results indicated significant correla-
tions between death anxiety, anxiety sensitivity,
emotion dysregulation, and peritraumatic stress
symptoms: The higher the scores on death anxiety,
anxiety sensitivity, and emotion dysregulation, the
higher the intrusion, avoidance, alteration in cogni-
tion and mood, and hyperarousal peritraumatic
stress symptoms. Furthermore, results revealed
Table 3. The contribution of profile variation in explaining peritraumatic stress symptoms since the outbreak of the COVID-19
pandemic (n = 849).
Peritraumatic intrusion
symptoms
Peritraumatic avoidance
symptoms
Peritraumatic negative
alterations in mood and
cognition
Peritraumatic
hyperarousal symptoms
Fη
2p
Fη
2p
Fη
2p
Fη
2p
Age 2.79 (1, 838) .00 4.92* (1, 838) .01 19.81*** (1, 838) .02 19.71*** (1, 838) .02
Gender 3.24 (1, 838) .00 .10 (1, 838) .00 .16 (1, 838) .00 .68 (1, 838) .00
Income 2.15 (1, 838) .00 6.24* (1, 838) 01 9.20** (1, 838) .01 6.30* (1, 838) .01
Perceived health 14.03*** (1, 838) .02 3.90* (1, 838) .01 16.58*** (1, 838) .02 12.32*** (1, 838) .01
Belong/don’t belong
to risk group
4.25* (1, 838) .01 3.37 (1, 838) .00 .23 (1, 838) 00 2.49 (1, 838) .00
Profile type 54.06*** (2, 838) .11 40.61*** (2, 838) .09 96.52*** (2, 838) .19 100.94*** (2, 838) .19
*p < .05; ** p < .01; *** p < .001.
Figure 1. Mean standardized values of death anxiety, anxiety sensitivity, and emotion dysregulation according to profile.
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 7
different patterns of death anxiety, anxiety sensitiv-
ity, and emotion dysregulation among participants,
which explained levels of peritraumatic stress
symptoms.
The present results indicated that elevated death
anxiety was related to higher levels of peritraumatic
stress symptoms. Our findings are in line with Becker’s
(1973) theory, according to which death anxiety can
play a role in psychopathology. They are also consis-
tent with previous findings, such as from a study con-
ducted among 1,210 Chinese participants that took
place at the start of the outbreak, which found that
participants’ perceptions of their mortality were
related to their virus-related distress (Wang et al.,
2020).
Given the current state of affairs – that is, the global
spread of a highly contagious virus which can result in
death individuals who suffer from elevated anxiety
concerning their mortality may experience the pan-
demic as an ongoing and severe threat. Moreover, the
newness of the SARS-CoV-2 virus, the fact that much
is not yet known about its long-term consequences,
and the unending media coverage devoted to it (Su
et al., 2021) may intensify these individuals’ distress
(Bendau et al., 2020), leading them to experience the
pandemic as traumatic and to develop, as a result,
peritraumatic symptomatology.
Our results also indicated positive relations
between anxiety sensitivity and peritraumatic stress
symptoms. These findings are consistent with previous
research that revealed a link between anxiety sensitiv-
ity and trauma-related symptoms in the aftermath of
disease (Rogers et al., 2021; Taylor et al., 2020). It
might be that individuals with elevated anxiety sensi-
tivity respond more intensely to traumatic or stressful
events, such as those related to the pandemic, and thus
suffer from elevated distress (Rogers et al., 2021). Also,
it is reasonable to suggest that during the current
pandemic, the propensity to focus on one’s bodily
signals and negatively appraise benign physical sensa-
tions increases the experience of threat and leads to
perseveration and rumination about the possibility of
contagion, illness, or even death, which in turn con-
tributes to trauma-related symptomatology.
The third factor examined, emotion regulation, was
also associated with participants’ peritraumatic stress
symptomatology, so that higher levels of emotion reg-
ulation difficulties were related to elevated symptoms.
Individuals who suffer from emotion dysregulation
may experience more intensive negative emotions
which could last for longer periods of time (Gratz &
Roemer, 2004). Furthermore, difficulties in emotion
regulation may not only prevent individuals from
employing adaptive coping strategies, they may also
lead to reliance on maladaptive strategies (Gubler,
Makowski, Troche, & Schlegel, 2020), which exacer-
bate distress in the long run. These adverse
implications may in turn intensify one’s vulnerability
when facing the ongoing stress of the pandemic, lead-
ing to trauma-related symptomatology.
Emotion dysregulation has previously been found to
play a role in psychopathology via rumination, catastro-
phizing, or self-blame (Aldao, Nolen-Hoeksema, &
Schweizer, 2010). A study among 127 healthy individuals
who suffered from increased trait anxiety indicated that
maladaptive emotion regulation strategies measured
prior to the pandemic predicted state anxiety and per-
ceived stress during the pandemic (Brehl, Schene, Kohn,
& Fernández, 2021). Another study comprising 6,049
participants in China revealed associations between emo-
tion regulation strategies and peritraumatic stress symp-
toms during the pandemic: Cognitive appraisal, which is
an adaptive emotion regulation strategy, was negatively
associated with belonging to a profile that was character-
ized by elevated peritraumatic stress symptoms, whereas
expression inhibition, a maladaptive emotion regulation
strategy, had the opposite direction of association (Jiang
et al., 2020).
As this study was cross-sectional, the directionality
of the associations found cannot be determined. Thus,
the relations between death anxiety, anxiety sensitiv-
ity, and emotion regulation, on the one hand, and
peritraumatic stress symptoms, on the other, might
also reflect the effects of trauma-related symptomatol-
ogy on all three factors or reciprocal relations between
them. The latter suggests that a vicious cycle might
exist wherein individuals’ death anxiety, anxiety sen-
sitivity, and emotion dysregulation contribute to ele-
vated peritraumatic stress symptomatology, which in
turn, intensifies all three. Research has provided sup-
port for this line of thought. For example, a study
among 677 survivors of traumatic physical injury
revealed that the associations between anxiety sensi-
tivity and PTSD symptom severity were bidirectional,
insofar as the anxiety sensitivity predicted subsequent
PTSD symptom severity which, in turn, predicted later
anxiety sensitivity (Marshall, Miles, & Stewart, 2010).
Additionally, findings from a study examining emo-
tion regulation difficulties and posttraumatic stress
symptoms among students in the aftermath of
a school shooting on their university campus indicated
that emotion regulation difficulties and posttraumatic
stress symptoms were reciprocally influential from
pre- to post-shooting (Bardeen et al., 2013).
When examining patterns of death anxiety, anxiety
sensitivity, and emotion dysregulation among the
study’s participants, three profile types were identified:
Profile 1, which was characterized by relatively low
levels of death anxiety, anxiety sensitivity, and emo-
tion dysregulation; Profile 2, which was characterized
by relatively moderate levels of death anxiety, anxiety
sensitivity, and emotion dysregulation; and Profile 3,
which was characterized by relatively high levels of
death anxiety, anxiety sensitivity, and emotion
8A. SIEGEL ET AL.
dysregulation. Furthermore, our results indicated that
profile type had a significant effect in explaining all
four clusters of peritraumatic stress symptoms:
Participants who were classified as Profile 3 had the
highest scores on intrusion, avoidance, alteration in
cognition and mood symptoms, and hyperarousal
peritraumatic stress symptoms. Then came partici-
pants who were classified as Profile 2, and then parti-
cipants who were classified as Profile 1. These effects
were significant even after controlling for age, gender,
income, perception of one’s health, and belonging/not
belonging to a high-risk group for COVID-19.
Management of stress and fear in the face of
a traumatic stressor can be impacted by factors ran-
ging from genetic predispositions, temperaments,
attachment issues, maltreatment, or other life chal-
lenges (Pyszczynski, Lockett, Greenberg, & Solomon,
2020). The profiles presented in this study may well
reflect participants’ characteristics in terms of death
anxiety, anxiety sensitivity, and emotion dysregulation
that might shape their appraisals and reactions when
navigating the pandemic, and thus explain their
trauma-related responses.
It might be that individuals who are characterized by
high levels of death anxiety, anxiety sensitivity, and
emotion dysregulation (Profile 3) interpret normal
bodily sensations in a catastrophic fashion, as an indi-
cation for COVID-19 or other serious illnesses, and be
particularly preoccupied with the threat of death impli-
cated in the pandemic. Moreover, as these individuals
suffer from elevated emotion dysregulation, they may
lack adaptive coping strategies that would ease their
negative emotional reaction. Instead, they may tend to
rely upon strategies such as avoidance, expressive sup-
pression, and rumination that often lead to emotional
relief in the short term, but exacerbate distress in the
long term (Crowell, Puzia, & Yaptangco, 2015). These
processes, in turn, may negatively shape the way that
these individuals view the current pandemic as well as
themselves while navigating it: That is, they may lead to
evaluating the pandemic as particularly intimidating
and threatening and to appraising themselves as unable
to handle it. Both types of appraisals, which have been
found to be related to distress during trauma exposure
(Benight, Cieslak, Molton, & Johnson, 2008; Ehlers &
Clark, 2000; Lapid Pickman, Greene, & Gelkopf, 2017),
may therefore contribute to peritraumatic stress symp-
tomatology in the face of the pandemic.
Conversely, individuals who are characterized by
moderate (Profile 2) or by low (Profile 1) levels of
death anxiety, anxiety sensitivity, and emotion dys-
regulation may be more resilient. These individuals
may be less prone to evaluate bodily sensations in
a negative fashion and may be more capable of inter-
preting normal bodily sensations as harmless. They
may be more able to keep the threat of mortality due
to COVID-19 under control, and to employ effective
strategies to modulate their emotions. These propen-
sities, in turn, may serve as important resources
when facing the various ongoing challenges of the
current pandemic: They may enable individuals to
view the current pandemic as less threatening and
themselves as capable of coping with it, and in this
way decrease their risk of peritraumatic stress
symptomatology.
This study has several limitations. First, convenience
sampling was used, as were self-report online question-
naires, which could potentially lead to a response bias.
Second, the sample was relatively small, the standard
deviations of some scales were relatively large, and
most of the respondents were female, secular, and
Israeli, limiting the generalizability of the present find-
ings. Third, the present study was conducted shortly
after the outbreak of the COVID-19 pandemic. Thus,
measures of COVID-19-related stressors were designed
by the research team. Fourth, as this was a cross-
sectional study, we cannot establish causality or the
directionality of the associations between the study
variables. Fifth, although many variables were exam-
ined, the potential mechanisms underlying the rela-
tions between death anxiety, anxiety sensitivity,
emotion dysregulation, and peritraumatic stress symp-
toms, such as perceived threat or coping strategies,
were not assessed. Future longitudinal studies should
further explore the relations between these constructs
in the context of the pandemic among varied samples,
while also assessing the potential mechanisms that
might underlie the present findings.
Notwithstanding these limitations, this study has
important theoretical and clinical implications. The
current findings suggest that, in the face of this pan-
demic, individuals who are characterized by elevated
levels of death anxiety, anxiety sensitivity, and emo-
tion dysregulation might be more susceptible to peri-
traumatic stress symptoms. Furthermore, given that
distress during the peritraumatic phase has been
found to be one of the most potent precursors for
future PTSD (Thomas et al., 2012; Vance et al.,
2018), the present findings may imply that this group
of individuals could also be susceptible to long-lasting
distress, after the COVID-19 pandemic finally comes
to an end.
Thus, screening for individuals who exhibit
a specific profile typified by elevated levels in all
three factors – death anxiety, anxiety sensitivity,
and emotion dysregulation – as part of the psy-
chological intake with mental health services is
recommended. Moreover, given that the peritrau-
matic phase of the COVID-19 pandemic is likely
to be rather long, and given that evidence-based
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 9
treatments for PTSD are plagued by high rates of
non-response and dropout (Bradley, Greene, Russ,
Dutra, & Westen, 2005), providing this vulnerable
group with clinical interventions during the peri-
traumatic phase, as a way to reduce current dis-
tress and to prevent the crystalizing of symptoms
into full-blown PTSD, is of particular importance
(Horesh & Brown, 2020).
Utilizing therapeutic methods intended to reduce
death anxiety, anxiety sensitivity, and emotional dys-
regulation, alongside evidence-based treatments for
trauma, may be effective. For example, providing
strategies of cognitive behavioural therapy such as
education, cognitive restructuring, and in vivo and
imaginal exposure online, may lead to changes in
interpretations of somatic sensations, and to
a reduction in death anxiety, while promoting reli-
ance on adaptive strategies in order to cope with
emotional reactions (Furer & Walker, 2008; Smits,
Berry, Tart, & Powers, 2008). At the same time,
providing evidence-based treatments for trauma,
such as prolonged exposure therapy (Foa, Hembree,
& Rothbaum, 2007; Wells et al., 2020) or eye move-
ment desensitization and reprocessing therapy
(EMDR; Lenferink, Meyerbröker, & Boelen, 2020;
Shapiro, 2017) online, might enable individuals to
reprocess their current peritraumatic reactions and
alleviate their distress.
Ethics statement
Institutional review board approval information: The Tel
Aviv University institutional review board (IRB) approved
all procedures and instruments.
Informed consent/ Patient consent statement: All parti-
cipants signed an informed consent form.
Disclosure statement
No potential conflict of interest was reported by the
author(s).
ORCID
Alana Siegel http://orcid.org/0000-0001-6631-3614
Yael Lahav http://orcid.org/0000-0003-1242-9042
Data availability statement
Due to the nature of this research, participants of this study
did not agree for their data to be shared publicly, so sup-
porting data is not available.
Funding
There have not been funding sources supporting the present
study.
References
Akogul, S., & Erisoglu, M. (2017). An approach for deter-
mining the number of clusters in a model-based cluster
analysis. Entropy, 19, 452. doi:10.3390/e19090452
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010).
Emotion-regulation strategies across psychopathology:
A meta-analytic review. Clinical Psychology Review, 30
(2), 217–237. doi:10.1016/j.cpr.2009.11.004
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
Bardeen, J. R., Kumpula, M. J., & Orcutt, H. K. (2013).
Emotion regulation difficulties as a prospective predictor
of posttraumatic stress symptoms following a mass
shooting. Journal of Anxiety Disorders, 27, 188–196.
doi:10.1016/j.janxdis.2013.01.003
Beam, C. R., & Kim, A. J. (2020). Psychological sequelae of
social isolation and loneliness might be a larger problem
in young adults than older adults. Psychological Trauma:
Theory, Research, Practice, and Policy, 12, 58–60.
doi:10.1037/tra0000774
Becker, E. (1973). The denial of death. New York: Free Press.
Bendau, A., Petzold, M. B., Pyrkosch, L., Mascarell
Maricic, L., Betzler, F., Rogoll, J., . . . Plag, J. (2020).
Associations between COVID-19 related media con-
sumption and symptoms of anxiety, depression and
COVID-19 related fear in the general population in
Germany. European Archives of Psychiatry and Clinical
Neuroscience, (0123456789). doi:10.1007/s00406-020-
01171-6
Benight, C. C., Cieslak, R., Molton, I. R., & Johnson, L. E.
(2008). Self-evaluative appraisals of coping capability and
posttraumatic distress following motor vehicle accidents.
Journal of Consulting and Clinical Psychology, 76,
677–685. doi:10.1037/0022-006X.76.4.677
Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E.,
Sahlin, H., Lundh, L. G., . . . Gratz, K. L. (2016).
Development and validation of a Brief Version of the
Difficulties in Emotion Regulation Scale: The DERS-16.
Journal of Psychopathology and Behavioral Assessment, 38
(2), 284–296. doi:10.1007/s10862-015-9514-x
Bonanno, G. A. (2004). Loss, trauma, and human resilience:
Have we underestimated the human capacity to thrive
after extremely aversive events? American Psychologist,
59, 20–28. doi:10.1037/0003-066X.59.1.20
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W.,
Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016).
Psychometric properties of the PTSD checklist for diag-
nostic and statistical manual of mental disorders–fifth
edition (PCL-5) in veterans. Psychological Assessment,
28, 1379–1391. doi:10.1037/pas0000254
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D.
(2005). A multidimensional meta-analysis of psychother-
apy for PTSD. American Journal of Psychiatry, 162(2),
214–227. doi:10.1176/appi.ajp.162.2.214
Brehl, A., Schene, A., Kohn, N., & Fernández, G. (2021).
Maladaptive emotion regulation strategies in a vulnerable
population predict increased anxiety during the Covid-19
pandemic: A pseudo-prospective study. Journal of
Aective Disorders Reports, 100113. doi:10.1016/j.
jadr.2021.100113
Cella, D. F., & Tross, S. (1987). Death anxiety in cancer survival:
A preliminary cross-validation study. Journal of Personality
Assessment, 51, 451–461. doi:10.1207/s15327752jpa5103_12
Cox, B. J., Taylor, S., Borger, S., Fuentes, K., & Ross, L.
(1996). Development of an expanded Anxiety Sensitivity
10 A. SIEGEL ET AL.
Index: Multiple dimensions and their correlates. In
S. Taylor (Chair), New studies on the psychopathology of
anxiety sensitivity. Symposium conducted at the Thirtieth
Annual Meeting of the Association for Advancement of
Behavior Therapy, New York, NY.
Crowell, S. E., Puzia, M. E., & Yaptangco, M. (2015). The
ontogeny of chronic distress: Emotion dysregulation
across the life span and its implications for psychological
and physical health. Current Opinion in Psychology, 3,
91–99. doi:10.1016/j.copsyc.2015.03.023
Digon, J. (2020, April 21). Anti-anxiety prescription meds
increase amid COVID-19 pandemic, report says.
International Business Times. Retrieved from https://
www.ibtimes.com/anti-anxiety-prescription-meds-
increase-amid-covid-19-pandemic-report-says-2962093
Ehlers, A., & Clark, D. M. (2000). A cognitive model of
posttraumatic stress disorder. Behavior Research and
Therapy, 38, 319–345. doi:10.1016/s0005-7967(99)
00123-0
Elwood, L. S., Mott, J., Williams, N. L., Lohr, J. M., &
Schroeder, D. A. (2009). Attributional style and anxiety
sensitivity as maintenance factors of posttraumatic stress
symptoms: A prospective examination of a diathesis–
stress model. Journal of Behavior Therapy and
Experimental Psychiatry, 40, 544–557. doi:10.1016/j.
jbtep.2009.07.005
Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged
exposure therapy for PTSD: Emotional processing of trau-
matic experiences therapist guide. New York: Oxford
University Press.
Furer, P., & Walker, J. (2008). Death anxiety: A
cognitive-behavioral approach. Journal of Cognitive
Psychotherapy, 22, 167–182. doi:10.1891/0889-
8391.22.2.167
Gratz, K., & Roemer, L. (2004). Multidimensional assess-
ment of emotion regulation and dysregulation:
Development, factor structure, and initial validation of
the difficulties in emotion regulation scale 1. Journal of
Psychopathology and Behavioral Assessment, 26, 41–54.
doi:10.1023/B:JOBA.0000007455.08539.94
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation:
Conceptual foundations. In J. J. Gross (Ed.), Handbook of
emotion regulation (pp. 3–27). New York, NY: Guilford.
Gubler, D. A., Makowski, L. M., Troche, S. J., & Schlegel, K.
(2020). Loneliness and well-being during the Covid-19
pandemic: Associations with personality and emotion
regulation. Journal of Happiness Studies, 1–20. Advance
online publication. doi:10.1007/s10902-020-00326-5
Horesh, D., & Brown, A. D. (2020). Traumatic stress in the
age of COVID-19: A call to close critical gaps and adapt
to new realities. Psychological Trauma: Theory, Research,
Practice, and Policy, 12, 331. doi:10.1037/tra0000592
Jiang, H., Nan, J., Lv, Z., & Yang, J. (2020). Psychological
impacts of the COVID-19 epidemic on Chinese people:
Exposure, post-traumatic stress symptom, and emotion
regulation. Asian Pacific Journal of Tropical Medicine, 13
(6), 252–259. doi:10.4103/1995-7645.281614
Johns Hopkins University & Medicine. (2021, July 11).
Coronavirus Resource Center. Retrieved from https://cor
onavirus.jhu.edu/
Jung, T., & Wickrama, K. A. (2008). An introduction to
latent class growth analysis and growth mixture
modeling. Social and Personality Psychology Compass, 2
(1), 302–317. doi:10.1111/j.1751-9004.2007.00054.x
Jungmann, S. M., & Witthöft, M. (2020). Health anxiety,
cyberchondria, and coping in the current COVID-19
pandemic: Which factors are related to coronavirus
anxiety? Journal of Anxiety Disorders, 73, 102239.
doi:10.1016/j.janxdis.2020.102239
Lapid Pickman, L., Greene, T., & Gelkopf, M. (2017). Sense
of threat as a mediator of peritraumatic stress symptom
development during wartime: An experience sampling
study. Journal of Traumatic Stress, 30(4), 372–380.
doi:10.1002/jts.22207
Lee, S. A., Jobe, M. C., Mathis, A. A., & Gibbons, J. A.
(2020). Incremental validity of coronaphobia:
Coronavirus anxiety explains depression, generalized
anxiety, and death anxiety. Journal of Anxiety Disorders,
74, 102268. doi:10.1016/j.janxdis.2020.102268
Leen-Feldner, E. W., Feldner, M. T., Reardon, L. E.,
Babson, K. A., & Dixon, L. (2008). Anxiety sensitivity
and posttraumatic stress among traumatic
event-exposed youth. Behaviour Research and Therapy,
46(4), 548–556. doi:10.1016/j.brat.2008.01.014
Lehto, R. H., & Stein, K. F. (2009). Death anxiety: An
analysis of an evolving concept. Research and Theory for
Nursing Practice, 23(1), 23–41. doi:10.1891/1541-
6577.23.1.23
Lenferink, L. I. M., Meyerbröker, K., & Boelen, P. A. (2020).
PTSD treatment in times of COVID-19: A systematic
review of the effects of online EMDR. Psychiatry
Research, 293, 113438. doi:10.1016/j.
psychres.2020.113438
Liu, C. H., Zhang, E., Tin, G., Hyun, S., & Hahm, H. (2020).
Factors associated with depression, anxiety, and PTSD
symptomatology during the COVID-19 pandemic:
Clinical implications for U.S. young adult mental health.
Psychiatry Research, 290, 113172. doi:10.1016/j.
psychres.2020.113172
Manning, K., Eades, N. D., Kauffman, B. Y., Long, L. J.,
Richardson, A. L., Garey, L., & Gallagher, M. W. (2021).
Anxiety sensitivity moderates the impact of
COVID-19 perceived stress on anxiety and functional
impairment. Cognitive Therapy and Research, 45,
689–696. doi:10.1007/s10608-021-10207-7
Maragakis, L. (2021, January 17). Coronavirus disease 2019 vs. the
flu. Johns Hopkins Medicine. Retrieved from https://www.
hopkinsmedicine.org/health/conditions-and-diseases/corona
virus/coronavirus-disease-2019-vs-the-flu
Marshall, G. N., Miles, J. N., & Stewart, S. H. (2010). Anxiety
sensitivity and PTSD symptom severity are reciprocally
related: Evidence from a longitudinal study of physical
trauma survivors. Journal of Abnormal Psychology, 119,
143–150. doi:10.1037/a0018009
Marshall, M. (2020, September 14). The lasting misery of
coronavirus long-haulers: Months after infection with
SARS-CoV-2, some people are still battling crushing fati-
gue, lung damage and other symptoms of ‘long COVID’.
Nature, 585, 339–341. Retrieved from https://www.nat
ure.com/articles/d41586-020-02598-6
Menzies, R. E., & Menzies, R. G. (2020). Death anxiety in the
time of COVID-19: Theoretical explanations and clinical
implications. Cognitive Behaviour Therapist, 13(19),
1–11. doi:10.1017/S1754470X20000215
Mertens, G., Gerritsen, L., Duijndam, S., Salemink, E., &
Engelhard, I. M. (2020). Fear of the coronavirus
(COVID-19): Predictors in an online study conducted
in March 2020. Journal of Anxiety Disorders, 74, 102258.
doi:10.1016/j.janxdis.2020.102258
Moccia, L., Janiri, D., Giuseppin, G., Agrifoglio, B.,
Monti, L., Mazza, M., . . . Janiri, L. (2020). Reduced
hedonic tone and emotion dysregulation predict
depressive symptoms severity during the COVID-19
outbreak: An observational study on the Italian
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 11
general population. International Journal of
Environmental Research and Public Health, 18(1),
255. doi:10.3390/ijerph18010255
OECD. (2020, September 7). Culture shock: COVID-19 and
the cultural and creative sectors. Retrieved from https://
www.oecd.org/coronavirus/policy-responses/culture-
shock-covid-19-and-the-cultural-and-creative-sectors
-08da9e0e/
Pettigrew, C. G., & Dawson, J. G. (1979). Death anxiety:
“state” or “trait”? Journal of Clinical Psychology, 35(1),
154–158. doi:10.1002/1097-4679(197901)35:1<154::aid-
jclp2270350125>3.0.co;2-e
Pyszczynski, T., Lockett, M., Greenberg, J., & Solomon, S.
(2020). Terror Management Theory and the COVID-19
pandemic. Journal of Humanistic Psychology, 1–17.
doi:10.1177/0022167820959488
Reiss, S. (1991). Expectancy model of fear, anxiety, and
panic. Clinical Psychology Review, 11(2), 141–153.
doi:10.1016/0272-7358(91)90092-9
Roemer, L., Lee, J., Salters-Pedneault, K., Erisman, S.,
Orsillo, S., & Mennin, D. (2009). Mindfulness and emo-
tion regulation difficulties in generalized anxiety disorder:
Preliminary evidence for independent and overlapping
contributions. Behavior Therapy, 40(2), 142–154.
doi:10.1016/j.beth.2008.04.001
Rogers, A. H., Bogiaizian, D., Salazar, P. L., Solari, A.,
Garey, L., Fogle, B. M., . . . Zvolensky, M. J. (2021).
COVID-19 and anxiety sensitivity across two studies in
Argentina: Associations with COVID-19 worry, symp-
tom severity, anxiety, and functional impairment.
Cognitive Therapy and Research, 45, 697–707.
doi:10.1007/s10608-020-10194-1
Rosmarin, D. H., Bourque, L. M., Antony, M. M., &
McCabe, R. E. (2009). Interpretation bias in panic dis-
order: Self-referential or global? Cognitive Therapy and
Research, 33, 624–632. doi:10.1007/s10608-009-9249-7
Safren, S. A., Gershuny, B. S., & Hendriksen, E. (2003).
Symptoms of posttraumatic stress and death anxiety in
persons with HIV and medication adherence difficulties.
AIDS Patient Care and STDs, 17(12), 657–664.
doi:10.1089/108729103771928717
Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S.,
Spiegel, D., Lewis-Fernandez, R., . . . Fullerton, C. S.
(2013). A systematic review of PTSD prevalence and
trajectories in DSM–5 defined trauma exposed popula-
tions: Intentional and non-intentional traumatic events.
PLoS ONE, 8, e59236. doi:10.1371/journal.pone.0059236
Shapiro, F. (2017). Eye Movement Desensitization and
Reprocessing (EMDR) Therapy: Basic principles, protocols,
and procedures. New York: Guilford.
Sharif Nia, H., Lehto, R. H., Pahlevan Sharif, S.,
Mashrouteh, M., Goudarzian, A. H., Rahmatpour, P., . . .
Yaghoobzadeh, A. (2019). A cross-cultural evaluation of
the construct validity of Templer’s Death Anxiety Scale:
A systematic review. Journal of Death and Dying.
doi:10.1177/0030222819865407
Smits, J. A., Berry, A. C., Tart, C. D., & Powers, M. B. (2008).
The efficacy of cognitive-behavioral interventions for
reducing anxiety sensitivity: A meta-analytic review.
Behaviour Research and Therapy, 46(9), 1047–1054.
doi:10.1016/j.brat.2008.06.010
Su, Z., McDonnell, D., Wen, J., Kozak, M., Abbas, J.,
Šegalo, S., . . . Xiang, Y. T. (2021). Mental health
consequences of COVID-19 media coverage: The
need for effective crisis communication practices.
Globalization and Health, 17(1), 1–8. doi:10.1186/
s12992-020-00654-4
Sun, Q., Qiu, H., Huang, M., & Yang Y. (2020). Lower
mortality of COVID-19 by early recognition and
intervention: Experience from Jiangsu Province.
Annals of Intensive Care, 10, 33. doi:10.1186/s13613-
020-00650-2
Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A.,
McKay, D., & Asmundson, G. J. G. (2020). COVID stress
syndrome: Concept, structure, and correlates. Depression
and Anxiety, 1–9. doi:10.1002/da.23071
Templer, D. I. (1970). The construction and validation of
a death anxiety scale. The Journal of General
Psychology, 82(2), 165–177. doi:10.1080/002213
09.1970.9920634
Thomas, E., Saumier, D., & Brunet, A. (2012). Peritraumatic
distress and the course of posttraumatic stress disorder
symptoms: A meta-analysis. The Canadian Journal of
Psychiatry, 57, 122–129. doi:10.1177/0706743712057
00209
Vance, M. C., Kovachy, B., Dong, M., & Bui, E. (2018).
Peritraumatic distress: A review and synthesis of 15
years of research. Journal of Clinical Psychology, 74,
1457–1484. doi:10.1002/jclp.22612
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., &
Ho, R. C. (2020). Immediate psychological responses and
associated factors during the initial stage of the 2019
coronavirus disease (COVID-19) epidemic among the
general population in China. International Journal of
Environmental Research and Public Health, 17, 1729.
doi:10.3390/ijerph17051729
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A.,
Marx, B. P., & Schnurr, P. P. (2013). The life events
checklist for DSM-5 (LEC-5). Scale available from the
National Center for PTSD. Retrieved from https://www.
ptsd.va.gov
Weiss, N., Dixon-Gordon, K., Peasant, C., & Sullivan, T.
(2018). An examination of the role of difficulties reg-
ulating positive emotions in posttraumatic stress
disorder. Journal of Traumatic Stress, 31, 775–780.
doi:10.1002/jts
Wells, S. Y., Morland, L. A., Wilhite, E. R., Grubbs, K. M.,
Rauch, S. A., Acierno, R., & McLean, C. P. (2020). Delivering
prolonged exposure therapy via videoconferencing during the
COVID-19 pandemic: An overview of the research and special
considerations for providers. Journal of Traumatic Stress, 33(4),
380–390. doi:10.1002/jts.22573
12 A. SIEGEL ET AL.
... The virus was highly transmissible and contagious [24], causing "fear" [25] and negative emotions among Chinese college students [26]. Previous studies have suggested that individuals' perception of risk is one of the drivers of Internet addiction behavior [27], and it may also cause individuals' difficulties in emotion regulation [28]. Recent studies have confirmed that difficulties in emotion regulation are also an important contributing factor to Internet addiction among college students [29][30][31]. ...
... A study confirmed that as soldiers often operate in combat environments, they are often faced with the threat of death, generating negative emotions of insecurity and vulnerability in soldiers, thus continuously depleting their emotional regulation ability, which eventually may lead to emotion dysregulation [59]. Another study of 846 volunteers in Israel found that because of changes in daily life and general concern about the risk of infection and even death, participants may find themselves unable to effectively control and regulate their emotions when facing the great risk of COVID-19 [28]. ...
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This study focused on COVID-19 perceived risk and Internet addiction among Chinese college students during the lockdown. On the basis of the Social Cognitive Theory, this study proposed a mediating model to evaluate the mediating role of difficulties in regulating emotion between the COVID-19 perceived risk and Internet addiction. A questionnaire survey was conducted among 690 college students during the COVID-19 lockdown in China. The results showed that the COVID-19 perceived risk was significantly positively associated with Internet addiction (r = 0.236, p < 0.001) and difficulties in emotion regulation (r = 0.220, p < 0.001), difficulties in emotion regulation was significantly positively associated with Internet addiction (r = 0.368, p < 0.001). The COVID-19 perceived risk had a significant and positive predictive effect on Internet addiction (β = 0.233, p < 0.001) among Chinese college students. The analysis of the mediation model showed that difficulties in emotion regulation partially mediated the relationship between COVID-19 perceived risk and Internet addiction (indirect effect value was 0.051 with 95% Confidence Interval ranging from 0.027 to 0.085). The findings not only enhanced our understanding of the internal influence mechanism of COVID-19 perceived risk on Internet addiction but also provided a practical basis for college education works. Finally, discussions and suggestions were provided on the basis of the results.
... Siegel et al. examined the symptoms of stress, emotions, sensitivity, and anxiety during COVID-19 to determine the mental health problems [28]. COVID-19 anxiety increased among hospital workers, and many of their family members suffered from depression and anxiety. ...
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Objective: To examine the effects of coronavirus disease-2019 (COVID-19) exposure, expressive suppression/cognitive reappraisal, and demographic variables on post-traumatic stress symptoms (PTS) among Chinese. Methods: Participants were recruited by social media through WeChat and 6 049 Chinese (aged from 17 to 63 years; median=24) from 31 provinces were included in the study. PTS symptoms, expressive suppression, and cognitive reappraisal were assessed after the outbreak of COVID-19. A regression mixture analysis was conducted in Mplus 7. Results: A regression mixture model identified three latent classes that were primarily distinguished by differential effects of COVID- 19 exposures on PTS symptoms: (1) Class 1 (mildly PTS symptoms, 80.9%), (2) Class 2 (moderate PTS symptoms, 13.0%), and (3) Class 3 (high PTS symptoms, 6.1%). The results demonstrated that the young, women and people with responsibilities and concerns for others were more vulnerable to PTS symptoms; and they had more expression inhibition and less cognitive reappraisal in three latent classes. Conclusions: The findings suggest that more attention needs to be paid to vulnerable groups such as the young, women and people with responsibilities and concerns for others. Therapies to encourage emotional expression and increase cognitive reappraisal may also be helpful for trauma survivors. © 2020 Asian Pacific Journal of Tropical Medicine Produced by Wolters Kluwer-Medknow. All rights reserved.
Article
Months after infection with SARS-CoV-2, some people are still battling crushing fatigue, lung damage and other symptoms of ‘long COVID’. Months after infection with SARS-CoV-2, some people are still battling crushing fatigue, lung damage and other symptoms of ‘long COVID’. Credit: Marco Di Lauro/Getty A recovered Coronavirus patient is monitored by a medical staff at the Department of Rehabilitative Cardiology of ASL 3 Genova A recovered Coronavirus patient is monitored by a medical staff at the Department of Rehabilitative Cardiology of ASL 3 Genova