Psychological resilience factors and their association with weekly stressor reactivity during the COVID-19 outbreak in Europe (preprint)

Recently, cross-sectional relationships between psycho-social resilience factors (RFs) and resilience, operationalized as an outcome of low reactivity of mental health to stressor exposure (low ‘stressor reactivity’) during the first wave of the COVID-19 pandemic, were reported. Extending these findings, we here examine prospective relationships and weekly dynamics between the same RFs and stressor reactivity in a longitudinal sample during the aftermath of the first wave in several European countries. Over five weeks of app-based assessments, participants weekly reported stressor exposure, mental health problems, RFs, and demographic data, in one of six different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558) and longitudinally (N=200), using mixed effects models and mediation analyses. RFs at baseline, including positive appraisal style, optimism, self-efficacy, perceived good stress recovery, and perceived social support, were negatively associated with stressor reactivity (SR) scores, not only cross-sectionally (baseline SR scores) but also prospectively (average SR scores across subsequent weeks). In both analyses, positive appraisal style mediated the effects of perceived social support on SR. In the analyses of weekly RF-SR dynamics, RFs positive appraisal (of stressors generally and specifically of the Corona crisis) and general self-efficacy were negatively associated with SR in a contemporaneous, but not lagged fashion. We identify psychological RFs which prospectively predict resilience and co-fluctuate with weekly stressor reactivity within individuals. The prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood-congruency or other temporal bias effects. We further confirm an important role for positive appraisal in resilience.  

Psychological resilience factors and their association with weekly stressor reactivity during the COVID-19 outbreak in Europe (preprint)

Recently, cross-sectional relationships between psycho-social resilience factors (RFs) and resilience, operationalized as an outcome of low reactivity of mental health to stressor exposure (low ‘stressor reactivity’) during the first wave of the COVID-19 pandemic, were reported. Extending these findings, we here examine prospective relationships and weekly dynamics between the same RFs and stressor reactivity in a longitudinal sample during the aftermath of the first wave in several European countries. Over five weeks of app-based assessments, participants weekly reported stressor exposure, mental health problems, RFs, and demographic data, in one of six different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558) and longitudinally (N=200), using mixed effects models and mediation analyses. RFs at baseline, including positive appraisal style, optimism, self-efficacy, perceived good stress recovery, and perceived social support, were negatively associated with stressor reactivity (SR) scores, not only cross-sectionally (baseline SR scores) but also prospectively (average SR scores across subsequent weeks). In both analyses, positive appraisal style mediated the effects of perceived social support on SR. In the analyses of weekly RF-SR dynamics, RFs positive appraisal (of stressors generally and specifically of the Corona crisis) and general self-efficacy were negatively associated with SR in a contemporaneous, but not lagged fashion. We identify psychological RFs which prospectively predict resilience and co-fluctuate with weekly stressor reactivity within individuals. The prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood-congruency or other temporal bias effects. We further confirm an important role for positive appraisal in resilience.

Positive prospective mental imagery characteristics in young adults and their associations with depressive symptoms (preprint)

Background: Positive prospective mental imagery plays an important role in mental well-being, and depressive symptoms have been associated with difficulties in generating positive prospective mental images (PPMIs). We used a mobile app to gather PPMIs generated by young adults during the COVID-19 pandemic and analyzed content, characteristics, and associations with depressive symptoms. Methods: For this longitudinal study, 50 healthy students reported PPMIs at least three times per day for seven consecutive days using a mobile app inducing PPMI generation. We categorized entries into themes and applied linear mixed models to investigate associations between PPMI characteristics and depressive symptom outcomes. Results: We distinguished 25 PPMI themes. The most frequent were related to consuming food and drinks, watching TV/streaming platforms, and doing sports. More vivid PPMIs were easier to generate. Vividness and ease of generation of PPMIs, but not their anticipation or pleasure intensity, were associated with fewer depressive symptoms. Discussion: We identified PPMI themes in young adults and found significant negative associations between depressive symptoms and vividness and generation ease of PPMIs. These results may inform prevention and intervention science, including design of personalized interventions. We discuss implications for future studies and treatment development for individuals experiencing diminished PPMI.

Coping with COVID: Risk and Resilience Factors for Mental Health in a German Representative Panel Study (preprint)

Background: The COVID-19 pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. Methods: In a stratified random sample of the German household population (n=6,684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors with changes in psychological distress (PD; measured via PHQ-4) from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. Results: PHQ-4 in 2020 (M=2.45) and 2021 (M=2.21) was elevated compared to 2019 (M=1.79). Several risk factors (catastrophizing, neuroticism, asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. Conclusions: We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. Comparison to pre-pandemic data stress the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed.

Standalone smartphone CBT-based Ecological Momentary Interventions to increase mental health - a narrative review (preprint)

Introduction: A growing number of psychological interventions are delivered via smartphone with the aim to increase the efficacy and effectiveness of these treatments and provide scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioural therapy principles which are considered as a gold standard for the treatment of many mental health problems. Objective: This review aimed to investigate standalone smartphone-based ‘ecological momentary interventions’ (EMIs) to improve mental health, that were built based on principles derived from cognitive behavioural therapy (CBT). Methods: We searched MEDLINE, PsycINFO, Embase and PubMed databases for peer-reviewed studies published between 1st January 2007 and 15th January 2020. We included studies with a focus on standalone app-based approaches to improve mental health and their feasibility, and/or efficacy and/or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, e.g., app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, i.e., choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy and effectiveness. The latter was defined in terms of improvement in primary outcomes used in the studies. Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (m=70.8%), and outcomes were satisfying by users (m=72.6%). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, hence limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily life. Such EMIs provide readily available, scalable and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis, such as the COVID-19 pandemic, but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics.

Psycho-social factors associated with mental resilience in the Corona lockdown (preprint)

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. While increases in stress-related symptomatology and other adverse psycho-social outcomes as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. In order to gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (March 22nd to April 19th) in a convenience sample of N=15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p<0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p<0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics.