Available via license: CC BY 4.0
Content may be subject to copyright.
Citation: Wagner-Skacel, J.; Tietz, S.;
Fleischmann, E.; Fellendorf, F.T.;
Bengesser, S.A.; Lenger, M.;
Reininghaus, E.Z.; Mairinger, M.;
Körner, C.; Pieh, C.; et al. Believing
Processes during the COVID-19
Pandemic: A Qualitative Analysis.
Int. J. Environ. Res. Public Health 2022,
19, 11997. https://doi.org/
10.3390/ijerph191911997
Academic Editor: Paul B. Tchounwou
Received: 8 August 2022
Accepted: 20 September 2022
Published: 22 September 2022
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affil-
iations.
Copyright: © 2022 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
International Journal of
Environmental Research
and Public Health
Article
Believing Processes during the COVID-19 Pandemic: A
Qualitative Analysis
Jolana Wagner-Skacel 1, Sophie Tietz 2,3, Eva Fleischmann 2, Frederike T. Fellendorf 2, Susanne A. Bengesser 2,
Melanie Lenger 2, Eva Z. Reininghaus 2, Marco Mairinger 2, Christof Körner 3, Christoph Pieh 4,
Rüdiger J. Seitz 5, Hannes Hick 6, Hans-Ferdinand Angel 7and Nina Dalkner 2, *
1Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria
2Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz,
8036 Graz, Austria
3Department of Psychology, University of Graz, 8010 Graz, Austria
4Department of Psychosomatic Medicine and Psychotherapy, University of Continuous Education Krems,
3500 Krems, Austria
5Department of Neurology, Centre of Neurology and Neuropsychiatry, Medical Faculty, LVR-Klinikum
Düsseldorf, Heinrich-Heine-University Düsseldorf, 40625 Düsseldorf, Germany
6Institute of Machine Components and Methods of Development, University of Technology Graz,
8010 Graz, Austria
7Department of Catechetics and Religious Education, University of Graz, 8010 Graz, Austria
*Correspondence: nina.dalkner@medunigraz.at; Tel.: +43-316-385-30081
Abstract:
Cognition, emotion, emotional regulation, and believing play a special role in psychosocial
functioning, especially in times of crisis. So far, little is known about the process of believing during
the COVID-19 pandemic. The aim of this study was to examine the process of believing (using the
Model of Credition) and the associated psychosocial strain/stress during the first lockdown in the
COVID-19 pandemic. An online survey via LimeSurvey was conducted using the Brief Symptom
Inventory-18 (BSI-18), the Pittsburgh Sleep Quality Index (PSQI), and a dedicated Believing Ques-
tionnaire, which assesses four parameters of credition (propositions, certainty, emotion, mightiness)
between April and June, 2020, in Austria. In total, n= 156 mentally healthy participants completed
all questionnaires. Negative credition parameters were associated with higher global symptom load
(from BSI-18): narratives: r= 0.29, p< 0.001; emotions r= 0.39, p< 0.001. These findings underline the
importance of credition as a link between cognition and emotion and their impact on psychosocial
functioning and stress regulation in implementing novel strategies to promote mental health.
Keywords: COVID-19; cognition; emotion; credition; psychosocial functioning
1. Introduction
The ongoing coronavirus disease 2019 (COVID-19) pandemic is emotionally chal-
lenging for everyone; it shakes the world and modifies our ethics [
1
]. A wide variety of
stress-related symptoms (including sleep disorders, depression, somatization, anxiety, and
increased alcohol consumption) are potential consequences in large parts of the population
worldwide, especially for individuals who were already vulnerable [
2
]. Furthermore, the
outbreak of COVID-19 has posed challenges and great economic problems for the whole
European continent with uncertainty about jobs and personal independence [
3
]. Supposed
stressors were fear of infection, fear for relatives, fear of job loss, but also boredom and
isolation. Stress has been considered as a physiological and behavioral response to a stimu-
lus with adaptation to external demands [
4
]. The amount of perceived stress symptoms
depends on personality structure, individual coping-mechanism, resilience, and other
protective and non-protective factors [
5
]. Coping strategies with impact on stress related
mental and physical health are defined as an action-oriented intrapsychic effort to manage
stressful situations including individual differences [
6
]. Increased symptoms of general
Int. J. Environ. Res. Public Health 2022,19, 11997. https://doi.org/10.3390/ijerph191911997 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022,19, 11997 2 of 13
anxiety, depression, and distress were reported by younger people and especially females
during the pandemic [
7
]. Psychological variables such as emotional stability and higher
levels of dispositional self-control were found to be an important protective factor against
perceived stress during the COVID-19 pandemic. The importance of personal and inter-
personal skills as conscientiousness and agreeableness with the ability to remain calm and
maintain emotional balance with a sense of acceptance could be useful to reduce stress [
8
].
Decisions on quarantine arrangements and social distancing measures could have had a
further negative impact on psychological well-being and the attitude towards the COVID-
19 pandemic. Brooks et al. investigated the effects of quarantine and observed associations
with frustration, boredom, and post-traumatic stress symptoms [
9
]. There are numerous
studies that have examined mental health symptoms as a response to the pandemic [
10
,
11
],
as well as studies that have examined specific beliefs during the COVID-19 pandemic [
12
].
However, there is only one study from our research group [
13
] that investigates underlying
believing processes.
Believing—the capacity to make a meaning out of others’ and one’s own behavior
in terms of held mental states—is a highly developed human social and psychological
achievement [
14
]. It involves a complex and demanding spectrum of capacities that are
susceptible to different strengths, weaknesses, and failings.
Mental imagery has been maintained to be the basis of beliefs combining cognitive di-
mensions, culture, and social interactions [
15
] interwoven with emotional processes which
are linked to cognitive operations and reflective awareness [
16
,
17
]. Importantly, personal
beliefs might be challenged and even modified in such abnormal circumstances, as they
are susceptible to new information contradicting earlier experiences [
18
]. In philosophy,
belief is discussed as the state of mind, which might be associated with stability and stable
beliefs [
19
]. In contrast, more recent approaches to belief place much more emphasis on its
fluidity and character than on processes of belief [20,21].
The term “credition” is a neologism that is based on the Latin verb “credere” (to be-
lieve). It was coined to denote the fluidity and functionality of believing processes, and
to indicate that beliefs and belief formation are narrowly connected with emotions [22]. It
has recently been proposed that processes of believing are higher cognitive brain functions,
which have emerged together with the evolution of the brain [
21
,
23
,
24
]. From a metatheo-
retical perspective, credition represents the processes which underpin believing and might
be understood as part of the big ensemble of cognitive processes and functions.
Thus, the processes of believing belong to the driving forces which are interrelated
to many other processes, such as perceiving, learning, valuating, planning, or decision-
making [
25
–
27
]. Owing to fast neural processing, the majority of these coherent con-
structs is acquired typically without conscious awareness, whereas coherent constructs
with language-based conceptual content become manifest as explicit beliefs, such as in
autobiographic, religious, and political beliefs [25].
According to the Model of Credition, believing is not possible without an associated
emotion. Thus, the model refers to a triadic substructure of psychological processes
integrating cognition and emotion and assumes four parameters relevant for the believing
process: propositions, certainty, emotion and mightiness [21].
A theoretically important issue is to clarify the relation between basic findings and
their conceptual relevance for understanding believing on the one hand, and the design
of the model on the other hand. Here, a continuing valuation is needed to adapt the
model to innovative findings. The Model of Credition is a functional model. It describes
the inner processes that take place between the beginning of the believing process at a
certain instant in time and the end of the believing process at a certain instant in time. To
understand the functionality, a translation of everyday believing situations into a model-
related terminology is required. What might be called in our daily language “I believe”
must be translated into a non-personal functionality which is “can be included”. For
instance, if one says, “I believe the meat is eatable”, the important message to believe or to
disbelieve is “eatable”.
Int. J. Environ. Res. Public Health 2022,19, 11997 3 of 13
•Proposition
: In our example, “eatable” is the propositional content of a bab/clum.
Bab is a neologism that was coined as a central unit of the functional process model
of credition. As the believing process partly remains subliminal, it is important to
integrate the aspect of subconsciousness. Blob and clum is the term which desig-
nates a subconscious bab. Thus, in the terminology of the model of credition, the
mental mindset of someone is forced to start a believing process is called bab–blob
configuration.
•Certainty
: Regarding doubtable issues, persons may differ whether they are sure
about them or not. In the language of the model of credition, we call this degree of
certainty. In our example, the degree of certainty may differ between different persons.
If someone has a degree of certainty of, for instance, 90%, they will be more ready
to accept the clum “eatable” in their bab configuration than another person whose
degree of certainty is only 55%.
•Emotional loading
: The emotional loading of the clum eatable may be “disgusting”.
In this case, it will be less likely that the clum can be integrated (i.e., believing that
the meat is eatable) than in the case that the emotional loading might be shaped by
“a little bit strange but interesting”.
•Sense of mightiness
: The perspective of a subject is not limited to the emotions of a
bab. It also includes the intensity of the emotion reflected by the sense of mightiness.
If the emotional loading of disgust is mighty, it is less likely that the meat will be eaten
than in the case that the disgust is more temporary and of a lower intensity.
For our study, we refer exclusively to the Model of Credition as it is published by
Angel and Seitz [
21
] focussing on the three main elements credition, cognition, emotion,
and providing the basis for a practical approach. This study aimed at investigating be-
lieving processes based on the Model of Credition and associations with psychosocial
symptoms in mentally healthy people at the beginning of the COVID-19 pandemic. The
uncertainty combined with emotional and cognitive modifications and individual abilities
as personality traits lead to high levels of psychological stress in these times [
28
]. Individual
differences in believing processes with cognitive and emotional responses to the lockdown
and social distancing measures might be reflected in a worsened psychological response
to the pandemic. Thus, we conducted a single-institution prospective mixed-methods
analysis to address the question of how beliefs are formed and modified in times of deep
crisis and what psychosocial impact this entails. Within this framework, the aim of this
study was to answer the following exploratory scientific questions.
1.
How do individuals experience the COVID-19 outbreak and which believing processes
can be found?
a
Which credition profiles can be generated (proposition, certainty, emotional
loading, sense of mightiness)?
b Is the propositional content related to the emotion and vice versa?
2.
What is the association between beliefs and psychological symptoms (depression,
anxiety, somatization, global symptom load, and sleep quality)?
We hypothesized that propositional content (positive, negative, indifferent) and emo-
tional loading would be associated with psychological symptoms.
2. Materials and Methods
This study took place during the first Austrian lockdown, which started on 16 March
2020, and encompassed travel restrictions, physical distancing, and the closure of institu-
tions, such as schools, leisure venues, and nonessential shops. In April 2020, 2237 cases of
COVID-19 infection were confirmed and 274 had died in relation to this disease. On 1 May
2020, strict measures were starting to get loosened: facilities were reopened, with shops,
hairdressers, and leisure venues being opened first, and schools, restaurants, and places of
worship following in the middle of May [29].
Int. J. Environ. Res. Public Health 2022,19, 11997 4 of 13
2.1. Procedure
The online survey was sent out via a survey tool (LimeSurvey 3.27.4 accessed on
1 June 2020
) (between 9 April and 4 June 2020. Before participation, participants gave
informed consent and answered the questionnaires anonymously or pseudo-anonymously
(if they had a participant code from their participation in previous studies at the depart-
ment). This study was part of the ongoing study “Psychological impact and effect of
the corona virus (SARS-CoV-2) pandemic in individuals with psychiatric disorders—an
online survey” (EK number 32-363 ex 19/20) at the Department of Psychiatry and Psy-
chotherapeutic Medicine and was approved by the local ethics committee in accordance
with the current revision of the Declaration of Helsinki, ICH guideline for Good Clinical
Practice and current regulations (Medical University of Graz, Austria). Some parts of this
study targeting psychiatric disorders with partially overlapping subjects have already been
published [30].
2.2. Participants
The participants were recruited via social media or the LimeSurvey link was sent
to relatives and acquaintances of the study group, or former study participants of the
University clinic for Psychiatry and Psychotherapeutic Medicine. Included in this analysis
were mentally healthy, German speaking adults who reported not having a psychiatric
disorder, which was checked by two control items: 1. Do you have a diagnosed psychiatric
disorder? (yes/no), 2. Do you have first-degree relatives with a severe mental disorder
(schizophrenia, bipolar disorder, major depressive disorder? (yes/no). Participants were
aged between 18 and 90 years, and gave informed consent. In total, 199 individuals were
recruited. After excluding those not meeting the inclusion criteria, n= 156 remained for the
final analysis. The sample partially overlaps with the subjects of the study by Tietz et al.
who have surveyed believing processes in mental illness vs. healthy controls and have
matched 52 individuals from this sample to their bipolar disorder sample [13].
2.3. Psychological Inventories
The following self-report questionnaires in German language were used in this study:
The Brief Symptom Inventory-18 (BSI-18) [
31
] was constructed by Derogatis and
Fitzpatrick, based on the longer Symptom-Checklist-90-Revised (SCL-90-R) [
32
]. It was
used to measure psychological symptoms during the last week (on a scale from 0–4),
encompassing the Global Severity Index (GSI) as a sum of the three subscales Anxiety
[Nervousness or shakiness inside, Feeling tense or keyed up, Suddenly scared for no reason,
Spells of terror or panic, Feeling so restless you couldn’t sit still, Feeling fearful], Depression
[Feeling no interest in things, Feeling lonely, Feeling blue, Feelings of worthlessness, Feeling
hopeless about the future, Thoughts of ending your life], and Somatization [Faintness or
dizziness, Pains in heart or chest, Nausea or upset stomach, Trouble getting your breath,
Numbness or tingling in parts of your body, Feeling weak in parts of your body], each
of them having acceptable internal consistency (Cronbach’s alpha: GSI
α
= 0.79, anxiety
α= 0.68, depression α= 0.79, and somatization α= 0.63) [33].
The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire that assesses
sleep quality and disturbances over a one-month time interval [
34
]. The questionnaire
consists of 19 items [example item: During the past month, how would you rate your sleep quality
overall? Very good—fairly good—fairly bad—very bad], which generate seven components:
subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep distur-
bances, use of sleep medication, and daytime sleepiness. Each component scores from 0 (no
difficulty) to 3 (severe difficulty). A total PSQI score (range 0–21) of more than
5 yielded
a diagnostic sensitivity of 89.6% and specificity of 86.5% (
kappa = 0.75
,
p≤0.001
) in dis-
tinguishing between good and poor sleepers, whereas higher scores indicate worse sleep
quality. Acceptable measures of internal homogeneity, consistency (test-retest reliability),
and validity for the PSQI were obtained [34].
Int. J. Environ. Res. Public Health 2022,19, 11997 5 of 13
The self-constructed Believing Questionnaire, assessed credition parameters, and
beliefs about the COVID-19 pandemic. The BQ consisted of six questions:
1. When I think of the current very special situation, I believe:
2. When I think about my body, I believe:
3. When I think about my mental/emotional situation, I believe:
4. When I think of the coronavirus disease (COVID-19), I believe:
5. When I think about the time in three months, I believe:
6. When I think about the time in six months, I believe:
The BQ assessed the four credition parameters: propositional content (narrative),
degree of certainty, emotional loading, and sense of mightiness. Certainty was rated
on a scale from 0–100 [On a scale from 0 (=not sure) to 100 (=very sure), how sure are you
about your belief?]. The emotional loading was assessed with an “Emotion Wheel”, which
consisted of three concentric circles. The innermost circle showed the six basic emotions as
described by Paul Ekman: fear, anger, joy, sadness, contempt, disgust, and surprise [
35
],
and the individuals had to choose one predominant emotion [Please name an emotion that
best describes your state while you are believing]. Furthermore, the intensity of the emotion
(sense of mightiness) was rated [On a scale from 0 (not at all) to 100 (very much), how strongly
do you experience the emotion while believing?]. The difference between Item 5 and item 6
refers to the concept that credition is a process and describes the inner processes that take
place between the beginning of the believing process at a certain instant in time and the
end of the believing process at a certain instant in time.
Certainty and mightiness were metric variables, and emotion was categorized into
positive (happy), negative (sad, angry, anxious, disgusted), and indifferent (surprised)
emotions. In addition, we evaluated whether the narrative was positive or negative and
whether it matched the emotion (congruent) or not (incongruent).
2.4. Data Analysis and Statistical Methods
The qualitative data of the BQ were coded and processed using MAXQDA 2020
(VERBI GmbH, 2019) [
36
]. The data were coded positive, negative, and indifferent (neither
positive nor negative) by two independent raters according to the valence of the narratives
or emotions. In total, there were six different codes (positive narratives, negative narratives,
indifferent narratives, positive emotions, negative emotions, indifferent emotions). The
resulting interrater reliability was
κ
= 0.95, which can be considered satisfying. The analyses
could therefore continue with one coded data set.
For the analysis with the Statistical Package for Social Sciences (SPSS version 26, IBM,
Armonk, NY, USA), six new variables were created, consisting of the respective frequencies
of the different codes. In addition, a variable was created that measures the frequency of
incongruence between the valence of a person’s narrative and the named emotion.
Partial correlation analyses with age, sex, education, relationship status, children, and
current occupation as control variables were used for the correlations between the credition
parameters and the scores in the BSI-18 and PSQI.
Bonferroni correction was used to correct for multiple tests, with an adjusted alpha-
level of 0.001. All data met the assumed criteria of variance and linearity. The criterion
of normality was not met for all variables. According to the central limit theorem, the
sample was adequately large (
≥
30) to assume a normal distribution. We used the software
MAXQDA 2020 (VERBI Software, Berlin, Germany) for the qualitative analysis to present
prepositions and emotions for each item of the study. Word clouds are a useful method to
simultaneously visualize the words as well as their frequency. The following word clouds
show the most frequently used words of each item translated from German into English,
with a possible loss of information due to the translation.
Int. J. Environ. Res. Public Health 2022,19, 11997 6 of 13
3. Results
3.1. Descriptive Statistics
The final sample consisted of 156 participants (52 males, 104 females;
mean age = 39.4 +/−SD
). Descriptive statistics about BSI-18, PSQI, and credition parame-
ters are reported in Table 1. Neither the participants nor their close contacts were tested
positive for COVID-19 or were quarantined at the time of testing.
Table 1. Descriptive statistics of psychiatric symptoms and credition parameters.
M SD Min. Max.
BSI-18 GSI 5.0 5.3 0 31
BSI-18
Somatization 1.1 1.8 0 12
BSI-18
Depression 2.1 2.7 0 17
BSI-18 Anxiety 1.8 2.1 0 11
PSQI 4.2 2.5 0 13
Positive
narratives 3.7 1.6 0 6
Negative
narratives 1.1 1.2 0 4
Indifferent
narratives 1.2 1.1 0 5
Positive
emotions 4.0 1.7 0 6
Negative
emotions 1.7 1.6 0 6
Indifferent
emotions 0.3 0.7 0 5
Incongruence 11.5 1.2 0 5
Certainty 282.6 12.2 25.7 100
Mightiness 275.3 15.0 26.8 100
M = Mean; SD = Standard deviation; BSI-18 = Brief-Symptom Inventory-18; GSI = Global Severity Index;
PSQI = Pittsburgh Sleep Quality Index; 1Incongruence between the narratives and the emotions; 2in percent.
Table 2depicts the frequencies of the coded credition parameters of the six BQ items in
detail: narrative and emotion, both classified into the three categories positive, negative, and
indifferent, as well as the incongruence of both variables. Positive narratives and emotions
were most often expressed and showed the least incongruence when participants were
asked about their current situation. In contrast, individuals reported negative narratives
and emotions most frequently in relation to the coronavirus. The greatest incongruence
between narratives and emotions was found when asking about the time in three months.
Table 2. Frequencies of the credition parameters across the items of the Believing Questionnaire.
Narrative Emotion Incongruence 1
Positive Negative Indifferent Positive Negative Indifferent Yes No
Item
When I think . . . , I believe n%n%n%n%n%n%n%n%
. .. of my current particular situation
. . .
118 75.6
17
10.9
21
13.5 130 83.3
23
14.7
3 1.9 30
19.2 126 80.8
. . . about my body . . . 91
58.3
24
15.2
41
26.3 104 66.7
46
29.5
6 3.8 46
29.5 110 70.5
. .. about my mental/emotional
situation
113 72.4
24
15.4
19
12.2 122 78.2
31
19.6
3 1.9 27
17.3 129 82.7
..of the coronavirus disease
(COVID-19) . . . 72
46.2
47
30.1
37
23.7
80
51.6
61
39.4
14 9.0 41
26.5 114 73.5
. . .
about the time in three months
. . . 86
55.1
36
23.1
34
21.8
88
56.4
53
34.0
15 9.6 49
31.4 107 68.6
. .. about the time in six months . . . 99
63.9
28
18.1
28
18.1
99
63.5
45
28.8
12 7.7 37
24.0 117 76.0
1Incongruence between the narratives and the emotions.
Int. J. Environ. Res. Public Health 2022,19, 11997 7 of 13
The descriptive statistics of the certainty and the sense of mightiness are shown in
Table 3. Participants were most confident when narrating about their situation and the
coronavirus, and least confident when thinking about the time in six months; however, all
six BQ items displayed similar mean values and standard deviations. The same applies
to emotional mightiness, which was rated the highest concerning the mental/emotional
situation and the lowest regarding the time in six months.
Table 3.
Descriptive statistics of certainty and mightiness across the items in the Believing Questionnaire.
Item
When I think . . . , I believe
Certainty Mightiness
M SD Min Max M SD Min Max
. . .
of my current particular situation
. . . 85.2 14.9 19 100 76.1 16.9 25 100
. . . about my body . . . 84.5 17.3 5 100 73.3 22.6 0 100
. . . about my mental/emotional
situation 84.7 15.8 23 100 78.0 19.3 23 100
..of the coronavirus disease (COVID-19)
. . . 85.6 15.4 23 100 76.3 18.9 14 100
. .. about the time in three months . . . 79.6 17.8 18 100 74.5 18.4 25 100
. .. about the time in six months . . . 75.7 19.3 15 100 73.5 20.2 15 100
3.2. Correlations between Psychological Variables and Credition Parameters
Correlations that remained significant after Bonferroni correction were found between
psychological variables and both narratives as well as emotions with negative as well
as positive connotations (see Table 4). Positive narratives correlated negatively with the
BSI-18 Depression score. Negative narratives were positively associated with the BSI-18
score and the BSI-18 Depression score. Negative correlations were found between positive
emotions and the BSI-18 score, the BSI-18 Somatization score and the BSI-18 Depression
score. Negative emotions were positively related to the GSI score and the BSI-18 Depression
score. No significant correlations could be found between any of the following variables:
indifferent narratives, indifferent emotions, incongruence, certainty, mightiness, BSI-18
Anxiety, and PSQI score.
Table 4.
Bonferroni-adjusted partial correlations between the credition parameters and the psychiatric
symptomatology.
BSI-18 GSI BSI-18 Soma BSI-18 Depr BSI-18 Anxi PSQI6
Positive
narratives −0.24 * −0.17 * −0.28 *** −0.10 −0.10
Negative
narratives 0.29 *** 0.17 * 0.36 *** 0.13 0.14
Indifferent
narratives 0.04 0.04 0.04 0.01 −0.03
Positive
emotions −0.36 *** −0.29 *** −0.40 *** −0.16 −0.17 *
Negative
emotions 0.39 *** 0.23 ** 0.45 *** 0.21 ** 0.16
Indifferent
emotions −0.02 0.17 * −0.07 −0.10 0.05
Incongruence 10.08 0.14 0.04 0.03 0.02
Certainty −0.13 −0.07 −0.11 −0.13 −0.14
Mightiness −0.06 −0.03 −0.02 −0.09 −0.04
In bold letters, the Bonferroni-corrected significant correlations (Bonferroni-adjusted p< 0.001); Influence of
variables age, sex, education, relationship, children and current occupation is partialized out; BSI-18 = Brief-
Symptom Inventory-18; GSI = Global Severity Index, BSI-18 subscales: Soma = Somatization, Depr = Depression,
Anxi = Anxiety; PSQI = Pittsburgh Sleep Quality Index;
1
Incongruence between the narratives and the emotions;
*p< 0.05; ** p< 0.01; *** p< 0.001.
Int. J. Environ. Res. Public Health 2022,19, 11997 8 of 13
3.3. Word Clouds
Figure 1displays the word clouds showing the most frequently used words of the
study population concerning their beliefs (narratives) during the first lockdown of the
COVID-19 pandemic along the six items of the BQ. The most frequently used words of
each item were translated from German into English, with a possible loss of information
due to the translation.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 9 of 14
Figure 1. Most frequent words for the items of the Believing Questionnaire.
4. Discussion
In this study, creditions according to the Mode of Credition by Angel and Seitz [21]
were investigated using a self-constructed questionnaire measuring reported processes of
believing during the COVID-19 pandemic. The activation of believing processes in re-
sponse to adaptive stress behaviors shows the use of positive, negative, and indifferent
narratives as well as positive, negative, and indifferent emotions.
The concept of credition as functionally understood processes of believing and the
derived framework of the Credition Model assume cognitive and emotional efforts to
manage the specific internal and external demands during the first lockdown in Austria
with the imaginative ability to act in one’s own terms of mental states. This is the first
implementation of this model in an empirical context and has already brought successful
data with mentally ill individuals in the study by Tietz et al. [13]. This goes in line with
the study by Seitz, emphasizing the relevance of the concept in neuropsychological and
neuropsychiatric disorders [25].
Figure 1. Most frequent words for the items of the Believing Questionnaire.
Word clouds for item 1 (“When I think of my current situation, I believe”) show
that individuals used a total of 253 words with the most often used words “I”, “again”,
“everything”, “optimistic”, “sanguine”, “m2”, “content”. For item 2 (“When I think about
my body, I believe”), individuals used a total of 273 words and for item 3 (“When I think
about my mental/emotional situation, I believe”) 292 words. For item 2, individuals used
the word “I” most often, followed by positive emotional words as predominantly used
positive words about their body, such as “fit”, “fitter”, and “healthy”. As for item 3 and
item 4 (“When I think of the coronavirus, I believe”), the individuals used the word “I” most
Int. J. Environ. Res. Public Health 2022,19, 11997 9 of 13
frequently in item 5 (“When I think about the time in three months, I believe”) followed
by positive emotion words such as “content”, “good”, “balanced”, and “calm”. For item 6
(“When I think about the time in six months, I believe”), it was notable that individuals used
the word “We” most frequently, followed by positive emotion words such as “optimistic”,
“hopefully”, “normality”, and “sanguine”.
4. Discussion
In this study, creditions according to the Mode of Credition by Angel and Seitz [
21
]
were investigated using a self-constructed questionnaire measuring reported processes
of believing during the COVID-19 pandemic. The activation of believing processes in
response to adaptive stress behaviors shows the use of positive, negative, and indifferent
narratives as well as positive, negative, and indifferent emotions.
The concept of credition as functionally understood processes of believing and the
derived framework of the Credition Model assume cognitive and emotional efforts to
manage the specific internal and external demands during the first lockdown in Austria
with the imaginative ability to act in one’s own terms of mental states. This is the first
implementation of this model in an empirical context and has already brought successful
data with mentally ill individuals in the study by Tietz et al. [
13
]. This goes in line with
the study by Seitz, emphasizing the relevance of the concept in neuropsychological and
neuropsychiatric disorders [25].
The findings suggest that positive narratives and emotions related to the subjective
situation during the COVID-19 pandemic were correlated negatively with psychological
distress parameters. Stress adaptation as the relationship between a person and the en-
vironment is appraised by the person as taxing or exceeding their individual cognitive
and behavioral efforts to manage the specific demands [
37
]. Recent conceptualizations
of coping behavior focus on a more flexible and situational use of positive and negative
coping strategies [
38
]. Positive coping includes behavior such as the use of social support,
problem solving, or the cognitive reappraisal of an individual’s psychological capacity to
adapt to adverse environmental circumstances. Individual beliefs play an important role
in this context and are relatively stable accounts of what a subject holds to be true and to
predict future events [
39
]. Organisms have to act upon incomplete information and reward
uncertainty in a changing environment [40,41].
It is important to consider the relationship between coping strategies and stress in
recent literature. Bongelli et al. showed that emotionally focused coping was negatively
related to perceived stress and dysfunctional coping was positively related to stress [
28
].
This emotionally focused coping under stressful situations may allow an accurate percep-
tion of one’s own mental state cautiously comparable to defense mechanism. According
to psychodynamic therapy, defense mechanism with splitting, projection, and projective
identification are three mechanisms of the ego with protection and coping strategies which
fulfill the task of making or keeping unconscious unpleasurable/negative effects, including
feelings of fear, pain, or guilt. This is only to be regarded as pathological if the defense
processes lead to a significant reduction in free self-development and self-realization, as
well as a restriction of the ego function [
42
]. This may mean that a defense mechanism was
functional at a certain point in development, ensuring ego protection and accommodat-
ing the demand, but, over time, that same defense mechanism can do the opposite and
become dysfunctional.
In this study, there was a strong correlation between positive or negative narratives
with the symptoms of distress and depression. In addition, the other credition param-
eters, such as certainty, emotion, and mightiness were also associated with self-rated
stress symptoms.
Narratives as tertiary processes are linked to abstract cognitive operations and re-
flective awareness with language-based summarization of complex memory, cognitive,
and executive functions, identity, and mindfulness [
43
]. Positive narratives, such as good,
optimistic, and sanguine, are expressions of the idea of a progress narrative that we are
Int. J. Environ. Res. Public Health 2022,19, 11997 10 of 13
heading for improvement. The future is thought of as a space full of possibilities that
are open to design and controllable in a positive sense. In relation to the subject, this
corresponds to self-growth and self-actualization, key concepts of positive psychology [
44
].
Foucault speaks of a security positive [
45
]. It is primarily no longer about self-improvement,
but about self-protection. Negative narratives, such as insecure, excited, and disillusioned,
carry the risk of normalizing negative expectations over a longer period of time. Believing
processes with negative emotional loading including strategies such as aggression, escape,
or avoidance, could expose the body and mind to sustained and increase allostatic load and
therefore lead to elevated distress [
46
]. Thus, credition with negative emotional loading
was associated with increased psychological symptoms, depression, and increased global
distress in this study. The relationship between negative coping strategies and mental
health is well documented [
47
]. The way in which individuals cope with stressful events is
more significant to psychological and physical well-being than the frequency and severity
of the stressful episodes themselves [
37
]. Belief formation is not only impaired in neuropsy-
chological syndromes, but beliefs are in close relation to the pathophysiological etiology of
distress and depressive symptoms [25].
Subjective probabilistic representations or beliefs are typically formed subconsciously
as stable, non-verbal precursors, and possess high predictability for future actions [
27
].
Narratives that were written as an answer to the item “When I think about the time in 3 or
6 months, I believe” were, for example, in 3 months, “that everything will soon be back
to normal” and in 6 months, “that we/I will have a drug against COVID-19”. Another
person wrote about the time in 3 months “that absolute normality will not yet set in” and
in 6 months “that it is better than now”. The world frequency analyses show that instead
of the most frequent word “I” in the 1st, 2nd, and 3rd item, in the items 5 and 6 that are
based on the beliefs for the future “I” changes to “We”, which could signalize that there
is an inwardness inherent in one we. During the crisis, we are no isolated creatures, but
people who inherent a soul or an idea that is uniting. With a “We”, we create joint action
and determination. The most frequent words in the items were words like good, sanguine,
and optimistic.
The trend to negative correlations between the credition parameter certainty and
distress or depression underscores again the importance of confidence, self-esteem, and
self-perception in the formation of distress and depression. Healthy features are charac-
terized by a coherent sense of the self with self-perception and affective regulation with
flexible functioning when stressed by external or internal conflicts. Incoherent sense of
self, problems in self-other differentiation, and problems in affect and impulse regulation,
mentalization, and inflexibility lead to rigidity in several domains [
48
]. The self with cogni-
tion and emotion has been investigated extensively in neuroscience and has been related
to a cerebral network as well as resting state, enhanced perception, and embodied simula-
tion [
49
]. The core self is considered as a trans-species functional entity based on subcortical
midline structures in a mutually regulating process with a more complex reflective and
conscious self-distributed system linked with external events [
50
]. Self-processing has been
operationalized and associated with basic functions, such as perception, action, reward,
and emotions [
51
]. Cognitive emotional regulation in distress or depression with maladap-
tive strategies, such as self-blame, rumination, and catastrophizing, or adaptive strategies,
such as acceptance, positive refocusing on planning, and putting into perspective, were
connected to psychopathology [
52
]. In the context of credition, these positive strategies
with more certainty could be a protection against mood-related disorders. The certainty
about the narrative and the emotion could lead to an imaginative and perceptive capacity to
understand one’s own behavior and intention. Covering a wide range of intrapsychic and
metacognitive processes, such as self-monitoring (cognitive awareness of oneself), mindful-
ness (emotional awareness of oneself), and theory of mind (understanding of beliefs), show
that this certainty and congruence between emotions and narratives could be a strong,
intentional, and multifaceted concept for action [
53
]. By considering these mental states,
they can be experienced as subjective modulatory processes. Behavior can be perceived as
Int. J. Environ. Res. Public Health 2022,19, 11997 11 of 13
the result of underlying emotions, thoughts, and beliefs that can be represented, integrated,
changed, and regulated by actions or reappraisal [
54
]. Believing processes can therefore
be viewed as a protective resource and the knowledge about credition may eventually be
integrated into therapy plans.
Limitations
There are several limitations that should be considered when interpreting the results:
A major limitation is that we did not use a validated questionnaire to assess credition; thus,
the Believing Questionnaire was self-constructed. Additionally, we cannot say for sure
whether the questionnaire measures really those beliefs which are verbally expressed. The
qualitative data had to be transferred into positive, negative, and indifferent categories
with a reduction and loss of information. Future studies should use content analysis for
qualitative distinction between positive, negative, indifferent emotions. Furthermore, the
cross-sectional design does not allow for any causal conclusions. The surveys were sent
out through individual emails, mailing lists, and social media platforms. There is no way
of identifying, understanding, and describing the population that could have accessed
and responded to the survey, and to whom the results of the survey can be generalized.
Furthermore, online surveys are only completed by persons who are literate, motivated,
and who have access to the internet, which further biases the results. The entire survey was
quite long (at least 20 min with the BQ at the end) and participants may have had trouble
concentrating until the end.
5. Conclusions
This study suggests that believing parameters play a significant role in the processing
of psychosocial stressors. The processes of believing, so-called creditions, appear to enable
people to formulate and integrate their intentional strategies for a successful adaptation to
adverse circumstances, such as the lockdown at the beginning of the COVID-19 pandemic.
We suggest that thinking about and verbalizing beliefs is a helpful transtheoretical and
transdiagnostic concept to focus the attention of participants to a so far little observed
phenomenon and explain vulnerability for stress-related mental disorders and probably
for their treatment. Additionally, this may indicate that early treatment of individuals
with maladaptation to stress should focus on the association of cognition, emotion, and
beliefs. Socially embedded treatment strategies with adaptive functioning of imaginations
in relation to inter- and intrasubjective capabilities may foster the therapeutic outcome.
Author Contributions:
Conceptualization, J.W.-S., N.D.; Methodology, S.T., M.L.; Software, S.T., E.F.
and M.L.; Validation, J.W.-S., E.F. and F.T.F.; Formal analysis, S.T., E.F.; Investigation, N.D., M.L., F.T.F.,
S.A.B., E.Z.R. and M.M.; Resources, E.Z.R., N.D. and R.J.S.; Data curation, S.T. and E.F.; writing—
original draft preparation, J.W.-S.; Writing—review and editing, N.D., E.F., H.-F.A., C.K., C.P., E.Z.R.,
F.T.F., M.L., R.J.S. and H.H.; Visualization, M.M.; Supervision, N.D., H.-F.A.; Project administration,
N.D., M.L. and F.T.F.; Funding acquisition, S.A.B. All authors have read and agreed to the published
version of the manuscript.
Funding:
The COVID-19 research at the Clinical Department of Psychiatry and Psychotherapeutic
Medicine has been funded by the FWF Austrian Science Fund KLIF project 968.
Institutional Review Board Statement:
The study was conducted in accordance with the Declaration
of Helsinki, and approved by the local Ethics Committee of the Medical University of Graz (EK
number 32-363 ex 19/20).
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.
Int. J. Environ. Res. Public Health 2022,19, 11997 12 of 13
References
1.
Daly, M.; Sutin, A.R.; Robinson, E. Longitudinal Changes in Mental Health and the COVID-19 Pandemic: Evidence from the UK
Household Longitudinal Study. Psychol. Med. 2020, 1–10. [CrossRef]
2.
Castellini, G.; Rossi, E.; Cassioli, E.; Sanfilippo, G.; Innocenti, M.; Gironi, V.; Silvestri, C.; Voller, F.; Ricca, V. A Longitudinal
Observation of General Psychopathology before the COVID-19 Outbreak and during Lockdown in Italy. J. Psychosom. Res.
2021
,
141, 110328. [CrossRef]
3.
Godini´c, D.; Obrenovic, B.; Khudaykulov, A. Effects of Economic Uncertainty on Mental Health in the COVID-19 Pandemic Context:
Social Identity Disturbance, Job Uncertainty and Psychological Well-being Model. Int. J. Innov. Econ. Dev. 2020,6, 61–74. [CrossRef]
4.
de Kloet, E.R.; Joels, M.; Holsboer, F. Stress and the Brain: From Adaptation to Disease. Nat. Rev. Neurosci.
2005
,6, 463–475. [CrossRef]
5.
Morales-Rodriguez, F.M.; Martinez-Ramon, J.P.; Mendez, I.; Ruiz-Esteban, C. Stress, Coping, and Resilience before and After COVID-19:
A Predictive Model Based on Artificial Intelligence in the University Environment. Front. Psychol. 2021,12, 647964. [CrossRef]
6.
Taylor, S.E.; Stanton, A.L. Coping Resources, Coping Processes, and Mental Health. Annu. Rev. Clin. Psychol.
2007
,3, 377–401. [CrossRef]
7.
Bauerle, A.; Teufel, M.; Musche, V.; Weismuller, B.; Kohler, H.; Hetkamp, M.; Dorrie, N.; Schweda, A.; Skoda, E.M. Increased
Generalized Anxiety, Depression and Distress during the COVID-19 Pandemic: A Cross-Sectional Study in Germany. J. Public
Health 2020,42, 672–678. [CrossRef]
8.
Flesia, L.; Monaro, M.; Mazza, C.; Fietta, V.; Colicino, E.; Segatto, B.; Roma, P. Predicting Perceived Stress Related to the COVID-19
Outbreak through Stable Psychological Traits and Machine Learning Models. J. Clin. Med. 2020,9, 3350. [CrossRef]
9.
Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The Psychological Impact of
Quarantine and how to Reduce it: Rapid Review of the Evidence. Lancet 2020,395, 912–920. [CrossRef]
10.
Jones, E.A.K.; Mitra, A.K.; Bhuiyan, A.R. Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review. Int. J.
Environ. Res. Public Health 2021,18, 2470. [CrossRef]
11.
Pieh, C.; Budimir, S.; Probst, T. The Effect of Age, Gender, Income, Work, and Physical Activity on Mental Health during
Coronavirus Disease (COVID-19) Lockdown in Austria. J. Psychosom. Res. 2020,136, 110186. [CrossRef] [PubMed]
12.
Smith, L.E.; Mottershaw, A.L.; Egan, M.; Waller, J.; Marteau, T.M.; Rubin, G.J. The Impact of Believing You have had COVID-19 on
Self-Reported Behaviour: Cross-Sectional Survey. PLoS ONE 2020,15, e0240399. [CrossRef]
13.
Tietz, S.; Wagner-Skacel, J.; Angel, H.; Ratzenhofer, M.; Fellendorf, F.T.; Fleischmann, E.; Körner, C.; Reininghaus, E.Z.; Seitz, R.J.;
Dalkner, N. Believing Processes during the COVID-19 Pandemic in Individuals with Bipolar Disorder: An Exploratory Study.
World J. Psychiatry 2022,12, 929–943. [CrossRef]
14. Frith, C.D.; Frith, U. The Neural Basis of Mentalizing. Neuron 2006,50, 531–534. [CrossRef]
15.
Bernroider, G.; Panksepp, J. Mirrors and Feelings: Have You seen the Actors Outside? Neurosci. Biobehav. Rev.
2011
,35, 2009–2016.
[CrossRef] [PubMed]
16.
Bastiaansen, L.; Hopwood, C.J.; Van den Broeck, J.; Rossi, G.; Schotte, C.; de Fruyt, F. The Twofold Diagnosis of Personality
Disorder: How do Personality Dysfunction and Pathological Traits Increment each Other at Successive Levels of the Trait
Hierarchy? Personal. Disord. 2016,7, 280–292. [CrossRef]
17.
Panksepp, J.; Solms, M. What is Neuropsychoanalysis? Clinically Relevant Studies of the Minded Brain. Trends Cogn. Sci.
2012
,
16, 6–8. [CrossRef]
18.
Seitz, R.J.; Paloutzian, R.F.; Angel, H.F. From Believing to Belief: A General Theoretical Model. J. Cogn. Neurosci.
2018
,30,
1254–1264. [CrossRef] [PubMed]
19.
Churchland, P.S.; Churchland, P.M. The Neural Basis of Human Belief Systems, 1st ed.; Psychology Press: Hove, UK, 2013; pp. 1–18.
20. Baumann, Z. Modernity as History of Time. Concepts Transform. 1999,4, 229–248. [CrossRef]
21. Angel, H.F.; Seitz, R.J. Violations of Expectations as Matter for the Believing Process. Front. Psychol. 2017,8, 772. [CrossRef]
22.
Seitz, R.J.; Angel, H.F. Processes of Believing—A Review and Conceptual Account. Rev. Neurosci.
2012
,23, 303–309. [CrossRef] [PubMed]
23. Seitz, R.J.; Angel, H.F. Belief Formation—A Driving Force for Brain Evolution. Brain Cogn. 2020,140, 105548. [CrossRef]
24.
Iriki, A.; Taoka, M. Triadic (Ecological, Neural, Cognitive) Niche Construction: A Scenario of Human Brain Evolution Extrapolating Tool
use and Language from the Control of Reaching Actions. Philos. Trans. R. Soc. B Biol. Sci. 2012,367, 10–23. [CrossRef] [PubMed]
25. Seitz, R.J. Believing and Beliefs-Neurophysiological Underpinnings. Front. Behav. Neurosci. 2022,16, 880504. [CrossRef]
26.
Aguilar-Raab, C.; Grevenstein, D.; Gotthardt, L.; Jarczok, M.N.; Hunger, C.; Ditzen, B.; Schweitzer, J. Changing Me, Changing Us:
Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy. Fam. Process
2018
,57, 342–358. [CrossRef]
27.
Seitz, R.J.; Paloutzian, R.F.; Angel, H.F. Believing is Representation Mediated by the Dopamine Brain System. Eur. J. Neurosci.
2019,49, 1212–1214. [CrossRef]
28.
Bongelli, R.; Canestrari, C.; Fermani, A.; Muzi, M.; Riccioni, I.; Bertolazzi, A.; Burro, R. Associations between Personality Traits,
Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19
Pandemic-A Multi-Group Path-Analysis. Healthcare 2021,9, 1086. [CrossRef]
29.
Nussmayr, K. 15 Grafiken, Die Die Verbreitung des Coronavirus in Österreich und der Welt erklären. Die Presse. 2020. Available
online: https://www.diepresse.com/5785804/15-grafiken-die-die-verbreitung-des-coronavirusin-osterreich-und-der-welt-
erklaren (accessed on 8 June 2022).
30.
Dalkner, N.; Ratzenhofer, M.; Fleischmann, E.; Fellendorf, F.T.; Bengesser, S.; Birner, A.; Maget, A.; Großschädl, K.; Lenger, M.;
Platzer, M.; et al. Psychological and Behavioral Response on the COVID-19 Pandemic in Individuals with Bipolar Disorder: A
Multicenter Study. Psychiatry Res. 2022,310, 114451. [CrossRef]
Int. J. Environ. Res. Public Health 2022,19, 11997 13 of 13
31.
Derogatis, L.R.; Fitzpatrick, M. The SCL-90-R, the Brief Symptom Inventory (BSI), and the BSI-18. In The Use of Psychological
Testing for Treatment Planning and Outcomes Assessment: Instruments for Adults, 3rd ed.; Lawrence Erlbaum Associates Publishers:
Mahwah, NJ, USA, 2004; Volume 3, pp. 1–41.
32.
Derogatis, L.R.; Unger, R. Symptom Checklist-90-Revised. In The Corsini Encyclopedia of Psychology; John Wiley & Sons, Ltd.:
Hoboken, NJ, USA, 2010; pp. 1–2.
33.
Spitzer, C.; Hammer, S.; Löwe, B.; Grabe, H.J.; Barnow, S.; Rose, M.; Wingenfeld, K.; Freyberger, H.J.; Franke, G.H. The Short
Version of the Brief Symptom Inventory (BSI -18): Preliminary Psychometric Properties of the German Translation. Fortschr.
Neurol. 2011,79, 517–523. [CrossRef]
34.
Buysse, D.J.; Reynolds, C.F.; Monk, T.H.; Berman, S.R.; Kupfer, D.J. The Pittsburgh Sleep Quality Index: A New Instrument for
Psychiatric Practice and Research. Psychiatry Res. 1989,28, 193–213. [CrossRef]
35. Ekman, P. An Argument for Basic Emotions. Cogn. Emot. 1992,6, 169–200. [CrossRef]
36.
VERBI Software. MAXQDA 2020 [Computer-Software]. 2019. Available online: https://www.maxqda.de (accessed on
5 January 2022).
37. Lazarus, R.S.; Folkman, S. Stress, Appraisal, and Coping; Springer Publishing Company: New York, NY, USA, 1984.
38.
Bonanno, G.A.; Burton, C.L. Regulatory Flexibility: An Individual Differences Perspective on Coping and Emotion Regulation.
Perspect. Psychol. Sci. 2013,8, 591–612. [CrossRef]
39.
McLelland, V.C.; Devitt, A.L.; Schacter, D.L.; Addis, D.R. Making the Future Memorable: The Phenomenology of Remembered
Future Events. Memory 2015,23, 1255–1263. [CrossRef]
40. Burgdorf, J.; Panksepp, J. The Neurobiology of Positive Emotions. Neurosci. Biobehav. Rev. 2006,30, 173–187. [CrossRef]
41. Garces, M.; Finkel, L. Emotional Theory of Rationality. Front. Integr. Neurosci. 2019,13, 11. [CrossRef]
42.
Stavros, M. Lehrbuch Der Psychodynamik: Die Funktion Der Dysfunktionalität Psychischer Störungen, 8th ed.; Vandenhoeck & Ruprecht:
Göttingen, Germany, 2017.
43. Panksepp, J. Behavior. Empathy and the Laws of Affect. Science 2011,334, 1358–1359. [CrossRef]
44.
Seligman, M.E.; Steen, T.A.; Park, N.; Peterson, C. Positive Psychology Progress: Empirical Validation of Interventions. Am.
Psychol. 2005,60, 410–421. [CrossRef]
45. Sedgwick, P. Michel Foucault: The Anti-History of Psychiatry. Psychol. Med. 1981,11, 235–248. [CrossRef] [PubMed]
46.
Oglesby, M.E.; Short, N.A.; Albanese, B.J.; Portero, A.K.; Schmidt, N.B. Negative Interpretations of Distress-Related Information:
A Novel Assessment Tool for Distress Tolerance. J. Anxiety Disord. 2018,60, 20–25. [CrossRef] [PubMed]
47.
Compas, B.E.; Jaser, S.S.; Bettis, A.H.; Watson, K.H.; Gruhn, M.A.; Dunbar, J.P.; Williams, E.; Thigpen, J.C. Coping, Emotion
Regulation, and Psychopathology in Childhood and Adolescence: A Meta-Analysis and Narrative Review. Psychol. Bull.
2017
,
143, 939–991. [CrossRef]
48.
Kernberg, O.F. An Ego Psychology Object Relations Theory of the Structure and Treatment of Pathologic Narcissism. An Overview.
Psychiatr. Clin. N. Am. 1989,12, 723–729. [CrossRef]
49. Newen, A. The Embodied Self, the Pattern Theory of Self, and the Predictive Mind. Front. Psychol. 2018,9, 2270. [CrossRef]
50.
Solms, M.; Panksepp, J. The “Id” Knows More than the “Ego” Admits: Neuropsychoanalytic and Primal Consciousness
Perspectives on the Interface between Affective and Cognitive Neuroscience. Brain Sci. 2012,2, 147–175. [CrossRef]
51.
Frings, C.; Wentura, D. Self-Priorization Processes in Action and Perception. J. Exp. Psychol. Hum. Percept. Perform.
2014
,40,
1737–1740. [CrossRef]
52.
Aldao, A.; Nolen-Hoeksema, S.; Schweizer, S. Emotion-Regulation Strategies across Psychopathology: A Meta-Analytic Review.
Clin. Psychol. Rev. 2010,30, 217–237. [CrossRef]
53. Drubach, D.A. The Purpose and Neurobiology of Theory of Mind Functions. J. Relig. Health 2008,47, 354–365. [CrossRef]
54.
Fonagy, P.; Allison, E. The Role of Mentalizing and Epistemic Trust in the Therapeutic Relationship. Psychotherapy
2014
,51,
372–380. [CrossRef]
