Investigating the Mediating Role of Obsession and Ambiguity Intolerance in Predicting Coronary Anxiety Based on Metacognitive Beliefs in the Prevalence of Covid-19 Virus

Document Type : Research Paper

Authors

1 MA in General Psychology, Department of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran.

2 Associate Professor, Department Of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran.

3 PhD Student in Educational Psychology, Department Of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran.

4 MA in Clinical Psychology, Department of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran.

Abstract

Introduction: The aim of this study was to investigate the mediating role of obsession and intolerance of ambiguity in predicting coronary anxiety based on metacognitive beliefs in the prevalence of Covid-19 virus. Method: The present study was a descriptive correlation (path analysis). The statistical population of the study included all men and women who completed the questionnaires online. The statistical sample size was determined based on Morgan table equal to 330 people, which was done by available sampling method and online questionnaire. The instruments used in this study were Maudsley (1977) obsessive-compulsive disorder questionnaire, McLain ambiguity tolerance questionnaire (1993), Wells Metacognitive Beliefs (1997), and Alipour et al. (2000) coronavirus anxiety questionnaire. To analyze the research data, the path analysis method was used, which was performed using Lisrel 8.8 software.Results: The results of path analysis showed that in the hypothetical model, all indicators had a good fit and the model was approved. Path coefficients also showed that only the direct path of positive beliefs to tolerance of ambiguity and obsession was not significant and the other paths of metacognitive beliefs to obsession and tolerance of ambiguity as well as the path of obsession and ambiguity of tolerance to coronary anxiety were significant. Conclusion: Therefore, metacognitive beliefs, mediated by obsession and intolerance of ambiguity, predict the degree of coronary anxiety during the outbreak of Covid 19.

Keywords


احمدی، م؛ و نجفی، م. (1390). مقایسه باورهای فراشناختی و تحمل ابهام در افراد معتاد، سیگاری و عادی، روانشناسی بالینی، 3(4)، 59-67.
اصلی آزاد، م؛ منشیی، غ؛ و قمرانی، ا. (1398). تاثیر درمان ذهن آگاهی بر تحمل ابهام و درآمیختگی فکر و عمل مبتلایان به اختلال وسواس بی اختیاری. سلامت روان کودک، 6(1)، 83-94.
انجمن روان پزشکی آمریکا (2013). راهنمای تشخیصی و آماری اختلالات روانی. ترجمه یحیی سید محمدی (1396)، ویراست پنجم، تهران: نشر روان.
سلمانی، ب؛ و حسنی، ج. (1395). نقش عدم تحمّل ابهام و باورهای فراشناختی مثبت در اختلال‌های وسواس فکری عملی و افسردگی اساسی. مجله علوم پزشکی رازی، ۲۳ (۱۴۲): ۶۴-۷۲
شمالی احمدآبادی، م؛ برخورداری احمدآبادی، ع؛ و پورجانب الهی، م. (1400). نقش اضطراب کرونا، نگرانی و باورهای فراشناختی منفی در پیش‌بینی اضطراب یادگیری دانش‌آموزان در همه‌گیری کووید-19. رویکردی نو در علوم تربیتی، 1-10.
علی پور، ا؛ قدمی، ا؛ علی پور، ز؛ و عبداله زاده، ح. (1398). اعتباریابی مقدماتی مقیاس اضطراب بیماری کرونا (CDAS) در نمونه ایرانی. فصلنامه علمی- پژوهشی روانشناسی سلامت، (32)، 163-175
علیزاده فرد، س؛ و علی پور، ا. (۱۳۹۹). الگوی تحلیل مسیر پیش‌بینی کرونافوبیا بر اساس عدم تحمل بلاتکلیفی و اضطراب سلامتی، فصلنامه پژوهش در سلامت روانشناختی، ۱۴ (۱)، ۱۶-۲۷.
محمدخانی، ش و فرجاد، م. (1388). رابطه باورهای فراشناختی و راهبردهای کنترل فکر با علایم وسواسی در جمعیت غیربالینی. روان شناسی بالینی، 1(3), 35-51.
نریمانی، م؛ ابولقاسمی، ع. (1384). آزمون های روانشناختی. اردبیل: انتشارات باغ رضوان.
Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction, 1– 9. https://doi.org/10.1007/s11469-020-00270-8
Anderson, K. G., Dugas, M. J., Koerner, N., Radomsky, A. S., Savard, P., Turcotte, J. (2012). Interpretive style and intolerance of uncertainty in individual with anxiety disorders: A focus on generalized anxiety disorder. J Anxiety Disord, 26(8), 823-32.
Asmundson, G. J., & Taylor, S. (2020a). Coronaphobia: Fear and the 2019-nCoV outbreak. Journal of Anxiety Disorders, 70, 102196. http://doi.org/10.1016/j.janxdis.2020.102196
Asmundson, G. J., & Taylor, S. (2020b). How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders, 71, 102211. https://doi.org/10.1016/j.janxdis.2020.102211
Aydın, O., Balıkçı, K., Çökmüş, F. P., & Ünal Aydın, P. (2019). The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: Effects on symptoms and comparison with healthy control. Nordic Journal of Psychiatry, 73(4–5), 293– 301. https://doi.org/10.1080/08039488.2019.1623317
Bailey, R., & Wells, A. (2015). Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. Journal of Anxiety Disorders, 34, 8– 14. https://doi.org/10.1016/j.janxdis.2015.05.005
Banerjee, D. D. (2020). The other side of COVID19: Impact on obsessive compulsive disorder (OCD) and hoarding. Psychiatry Res. 2020, 288, 112966.
Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55(11), 1247– 1263. https://doi.org/10.1037/0003-066X.55.11.1247
Buhr, K., & Dugas, M. J. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour Research and Therapy, 47(3), 215– 223. https://doi.org/10.1016/j.brat.2008.12.004
Chakraborty, A., & Karmakar, S. (2020). Impact of COVID-19 on obsessive compulsive disorder (OCD). Iranian journal of psychiatry, 15(3), 256.
Chen, H., Wang, B., Cheng, Y., Muhammad, B., Li, S., Miao, Z., Wan, B., Abdul, M., Zhao, Z., Geng, D., & Xu, X. (2020). Prevalence of posttraumatic stress symptoms in health care workers after exposure to patients with COVID-19. Neurobiology of Stress, 100261. https://doi.org/10.1016/j.ynstr.2020.100261
Chong, M., Wang, W., Hsieh, W., Lee, C., Chiu, N., Yeh, W., Huang, T., Wen, J., & Chen, C. (2004). Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. British Journal of Psychiatry, 185, 127– 133. https://doi.org/10.1192/bjp.185.2.127
Conway, L. G., Woodard, S. R., & Zubrod, A. (2020). Social psychological measurements of COVID-19: Coronavirus perceived threat, government response, impacts, and experiences questionnaires. PsyArXiv. https://psyarxiv.com/z2x9a/
Fancourt, D., Steptoe, A., & Bu, F. (2020). Trajectories of depression and anxiety during enforced isolation due to COVID-19: Longitudinal analyses of 59,318 adults in the UK with and without diagnosed mental illness. medRxiv. Retrieved from https://www.medrxiv.org/content/10.1101/2020.06.03.20120923v1
Fergus, T. A., & Bardeen, J. R. (2013). Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. Personality and Individual Differences, 55(6), 640– 644. https://doi.org/10.1016/j.paid.2013.05.016
Fergus, T. A., & Valentiner, D. P. (2011). Intolerance of uncertainty moderates the relationship between catastrophic health appraisals and health anxiety. Cognitive Therapy and Research, 35(6), 560– 565. https://doi.org/10.1007/s10608-011-9392-9
Gentes, E. L., & Ruscio, A. M. (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clinical Psychology Review, 31(6), 923– 933. https://doi.org/10.1016/j.cpr.2011.05.001
Ghaderi, B., Mohammadkhani, S. H., & Hassanabadi, H. R. (2016). Cognitive and metacognitive predictors of anxiety in adolescents. Journal of Clinical Psychology, 7(4), 13– 26. https://doi.org/10.22075/JCP.2017.2214
Haig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2020). Practitioner review: Health anxiety in children and young people in the context of the COVID-19 pandemic. Behavioural and Cognitive Psychotherapy, 49, 1– 15. https://doi.org/10.1017/S1352465820000636
Holmes, E., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Silver, R. C., Everall, I., & Ford, T. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. The Lancet Psychiatry. Published online 15 April 2020
Idrissi, A. J., Lamkaddem, A., Benouajjit, A., El Bouaazzaoui, M. B., El Houari, F., Alami, M., Labyad, S., Chahidi, A., Benjelloun, M., Rabhi, S., Kissani, N., Zarhbouch, B., Ouazzani, R., Kadiri, F., Alouane, R., Elbiaze, M., Boujraf, S., El Fakir, S., & Souirti, Z. (2020). Sleep quality and mental health in the context of COVID-19 pandemic and lockdown in Morocco. Sleep Medicine, 74, 248– 253. https://doi.org/10.1016/j.sleep.2020.07.045
Landi, G., Pakenham, K. I., Boccolini, G., Grandi, S., & Tossani, E. (2020). Health anxiety and mental health outcome during COVID-19 lockdown in Italy: The mediating and moderating roles of psychological flexibility. Frontiers in Psychology, 11, 2195. https://doi.org/10.3389/fpsyg.2020.02195
Lee, S. A. (2020). Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Studies, 44, 393– 401. https://doi.org/10.1080/07481187.2020.1748481
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. https://doi.org/10.1016/j.janxdis.2020.102268
Lee, S. A., Mathis, A. A., Jobe, M. C., & Pappalardo, E. A. (2020). Clinically significant fear and anxiety of COVID-19: A psychometric examination of the Coronavirus Anxiety Scale. Psychiatry Research, 290, 113112. https://doi.org/10.1016/j.psychres.2020.113112
Lee, S. A., Mathis, A. A., Jobe, M. C., & Pappalardo, E. A. (2020). Clinically significant fear and anxiety of COVID-19: A psychometric examination of the coronavirus anxiety scale. Psychiatry Research, 290, 113112. https://doi.org/10.1016/j.psychres.2020.113112
Li, X., Li, S., Xiang, M., Fang, Y., Qian, K., Xu, J., Li, J., Zhang, Z., & Wang, B. (2020). The prevalence and risk factors of PTSD symptoms among medical assistance workers during the COVID-19 pandemic. Journal of Psychosomatic Research, 139, 110270. https://doi.org/10.1016/j.jpsychores.2020.110270
Mamun, M. A., Sakib, N., Gozal, D., Bhuiyan, A. I., Hossain, S., Bodrud-Doza, M., Al Mamun, F., Hosen, I., Safiq, M. B., Abdullah, A. H., Sarker, M. A., Rayhan, I., Sikder, M. T., Muhit, M., Lin, C.-Y., Griffiths, M. D., & Pakpour, A. H. (2020). The COVID-19 pandemic and serious psychological consequences in Bangladesh: A population-based nationwide study. Journal of Affective Disorders, 279, 462– 472. https://doi.org/10.1016/j.jad.2020.10.036
Massoni, S. (2014). Emotion as a boost to metacognition: How worry enhances the quality of confidence. Consciousness and Cognition, 29, 189– 198. https://doi.org/10.1016/j.concog.2014.08.006
McEvoy, P. M., Mahoney, A. E. J. (2013). Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediator of repetitive negative thinking in a clinical sample with anxiety disorders. J Anxiety Disord, 27(2), 216-24.
Melli, G., Bailey, R., Carraresi, C., & Poli, A. (2018). Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample. Clinical Psychology & Psychotherapy, 25(2), 263– 271. https://doi.org/10.1002/cpp.2159
Melli, G., Carraresi, C., Poli, A., & Bailey, R. (2016). The role of metacognitive beliefs in health anxiety. Personality and Individual Differences, 89, 80– 85. https://doi.org/10.1016/j.paid.2015.10.006
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. https://doi.org/10.1016/j.janxdis.2020.102258
Morriss, J., Christakou, A., & van Reekum, C. M. (2016). Nothing is safe: Intolerance of uncertainty is associated with compromised fear extinction learning. Biological Psychology, 121, 187– 193. https://doi.org/10.1016/j.biopsycho.2016.05.001
Nikčević, A. V., & Spada, M. M. (2020). The COVID-19 anxiety syndrome scale: Development and psychometric properties. Psychiatry Research, 292, 113322. https://doi.org/10.1016/j.psychres.2020.113322
Özdin, S., & Bayrak Özdin, Ş. (2020). Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. International Journal of Social Psychiatry, 66(5), 504– 511. https://doi.org/10.1177/0020764020927051
Parker, C., Shalev, D., Hsu, I., Shenoy, A., Cheung, S., Nash, S., Wiener, I., Fedoronko, D., Allen, N., & Shapiro, P. A. (2020). Depression, anxiety, and acute stress disorder among patients hospitalized with coronavirus disease 2019: A prospective cohort study. Psychosomatics, 62, 211– 219. https://doi.org/10.1016/j.psym.2020.10.001
Saricali, M., Satici, S. A., Satici, B., Gocet-Tekin, E., & Griffiths, M. D. (2020). Fear of COVID-19, mindfulness, humor, and hopelessness: A multiple mediation analysis. International Journal of Mental Health and Addiction, 1– 14. https://doi.org/10.1007/s11469-020-00419-5
Satici, B., Gocet-Tekin, E., Deniz, M. E., & Satici, S. A. (2020). Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. International Journal of Mental Health and Addiction, 1– 9. https://doi.org/10.1007/s11469-020-00294-0
Satici, B., Saricali, M., Satici, S. A., & Griffiths, M. D. (2020). Intolerance of uncertainty and mental wellbeing: Serial mediation by rumination and fear of COVID-19. International Journal of Mental Health and Addiction, 1– 12. https://doi.org/10.1007/s11469-020-00305-0
Spada, M. M., Caselli, G., Manfredi, C., Rebecchi, D., Rovetto, F., Ruggiero, G. M., Nikčević, A. V., & Sassaroli, S. (2012). Parental overprotection and metacognitions as predictors of worry and anxiety. Behavioural and Cognitive Psychotherapy, 40(3), 287– 296. https://doi.org/10.1017/S135246581100021X
Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., McKay, D., & Asmundson, G. J. G. (2020). Development and initial validation of the COVID stress scales. Journal of Anxiety Disorders, 72, 102232. https://doi.org/10.1016/j.janxdis.2020.102232
Tull, M. T., Barbano, A. C., Scamaldo, K. M., Richmond, J. R., Edmonds, K. A., Rose, J. P., & Gratz, K. L. (2020). The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety. Journal of Anxiety Disorders, 75, 102290. https://doi.org/10.1016/j.janxdis.2020.102290
Van der Heiden, C., Melchior, K., Muris, P., Bouwmeester, S., Bos, A. E. R., Van der Molen, H. T. (2010). A hierarchical model for relationship between general and specific vulnerability factor and symptom level of generalized anxiety disorder. J Anxiety Disord, 24(2), 284-89
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. https://doi.org/10.3390/ijerph17051729
Welch, P. G., Carleton, R. N., & Asmundson, G. J. (2009). Measuring health anxiety: Moving past the dichotomous response option of the original Whiteley index. Journal of Anxiety Disorders, 23(7), 1002– 1007. https://doi.org/10.1016/j.janxdis.2009.05.006
Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester, UK: Wiley.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.
Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Fabricant, L. E., & Olatunji, B. O. (2012). Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognitive Therapy and Research, 36, 210– 218. https://doi.org/10.1007/s10608-011-9353-3
Wright, K. D., Lebell, M. A. A., & Carleton, R. N. (2016). Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. Journal of Anxiety Disorders, 41, 35– 42. https://doi.org/10.1016/j.janxdis.2016.04.011
Wu, P., Fang, Y., Guan, Z., Fan, B., Kong, J., Yao, Z., Liu, X., Fuller, C. J., Susser, E., Lu, J., & Hoven, C. W. (2009). The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Canadian Journal of Psychiatry, 54, 301– 311.
Yang, Y., Zhu, J. F., Yang, S. Y., Lin, H. J., Chen, Y., Zhao, Q., & Fu, C. W. (2020). Prevalence and associated factors of poor sleep quality among Chinese returning workers during the COVID-19 pandemic. Sleep Medicine, 73, 47– 52. https://doi.org/10.1016/j.sleep.2020.06.034