Risk perception as a motivational resource during the COVID-19 pandemic: the role of vaccination status and emerging variants.

BACKGROUND: People's perceived risk of being infected and having severe illness was conceived as a motivational source of adherence to behavioral measures during the COVID-19 crisis. METHODS: We used online self-reported data, spanning 20 months of the COVID-19 crisis in Belgium (n = 221,791; 34.4% vaccinated; July 2020 - March 2022) to study the association between risk perception and motivation. RESULTS: Both perceived infection probability and severity fluctuated across time as a function of the characteristics of emerging variants, with unvaccinated persons perceiving decreasingly less risk compared to vaccinated ones. Perceived severity (and not perceived probability) was the most critical predictor of autonomous motivation for adherence to health-protective measures, a pattern observed at both the between-day and between-person level among both vaccinated and unvaccinated individuals. An integrated process model further indicated that on days with higher hospitalization load, participants reported being more adherent because risk severity and autonomous motivation for adherence were more elevated on these days. CONCLUSIONS: These findings suggest that risk severity served as a critical and dynamic resource for adherence to behavioral measures because it fostered greater autonomous regulation.

Psychological need fulfillment as a source of resilience: Its protective role in concerns and symptoms of anxiety and depression during the COVID-19 pandemic.

The essential role of the psychological needs for autonomy, competence, and relatedness in well-being has been demonstrated convincingly. Yet whether their fulfillment also serves as a source of resilience in the face of adversity has received limited attention. A longitudinal sample of Belgian citizens (N = 1869; Mage = 56.23, 68% female) completed an online questionnaire on 13 occasions between April 2020 and April 2022 during the COVID-19 crisis. Multilevel analyses showed that need fulfillment, both at the between- and within-person level, related negatively to concerns, even after controlling for exposure to personal risks. Further, the association between concerns and changes in symptoms of depression and anxiety was dampened when people reported higher need fulfillment compared with others (i.e. between-person level) or when they reported periodically more need fulfillment than usual (i.e. within-person level). This moderation effect occurred on top of the systematic negative main effect of need fulfillment on symptoms of anxiety and depression. Psychological need fulfillment serves as a resilience factor (a) by reducing concerns in the face of adverse events (i.e. an appraisal effect) and (b) by mobilizing resources that help individuals to deal better with concerns (i.e. a coping effect). Theoretical and practical implications of the resilience effect of need fulfillment are discussed.

Predictors and outcomes of sports coaches' athlete-invested contingent self-worth.

Some sports coaches not only invest considerable time and energy in their athletes, but also attach their self-worth to the successes and failures of their athletes. Grounded in Self-Determination Theory, the present study aimed to examine the theoretical predictors and outcomes of such Athlete-Invested Contingent Self-worth (AICS). Results from a cross-sectional study (Study 1; N = 740, Mage = 34.37 years) and an experimental vignette-based study among youth sports coaches (Study 2; N = 318, Mage = 38.94 years) indicated that AICS was positively related to a controlling coaching style and negatively related to a structuring style. Study 1 showed that a perceived evaluative club board was positively related to AICS, and Study 2 further demonstrated that poor performance was negatively associated with AICS and that an evaluative climate was related to AICS through experiences of need frustration. The discussion focuses on the pitfalls of coaches' contingent self-worth for the development of their athletes.

How Do Late Adults Experience Meaning During the COVID-19 Lockdown? The Role of Intrinsic Goals.

Late adults differ in the degree to which their mental health is impacted by the COVID-19 crisis, with interindividual differences in their capacity to mobilize coping resources playing an important role. Therefore, the search for inner sources of resilience is important to understand late adults' adaptation to this crisis. Based on Goal Content Theory, a mini-theory within the broader Self-Determination Theory, this study aimed to examine whether older adults' valuation and attainment of intrinsic goals represent such a source of resilience. Intrinsic goals would form a solid foundation to experience a sense of meaning during this crisis, which, in turn, relates to higher well-being (i.e., life satisfaction and vitality) and lower ill-being (i.e., symptoms of depression, anxiety, and loneliness). During the second month of the lockdown period in Belgium, 693 older adults (Mage = 70.06, SD = 4.48, range: 65-89 years, 62.1% female) filled out online questionnaires concerning the study variables. Structural equation modeling showed that intrinsic goal attainment and goal importance related positively to experiences of meaning in life which, in turn, were related to higher levels of well-being and lower levels of ill-being. No evidence was found for an interaction effect between intrinsic goal attainment and goal importance. Supporting late adults' pursuit and attainment of meaningful intrinsic goals relates to their well-being and may potentially strengthen their resilience in times of crisis.

A moment of autonomy support brightens adolescents' mood: Autonomy support, psychological control and adolescent affect in everyday life.

This experience sampling study examined whether autonomy-supportive and psychologically controlling interactions with parents are intertwined with adolescents' momentary affect. For 7 days (in 2020), 143 adolescents (Mage = 15.82; SDage = 1.75; 64% girls; 95% European, 1% African, 3% unknown) reported 5 or 6 times a day how they felt and how interactions with parents were experienced. Preregistered dynamic structural equation models on 1439 (including 532 adjacent) parent-adolescent interactions revealed significant within-family associations: Adolescents experienced more positive affect during and following autonomy-supportive interactions, and vice versa. Adolescents felt more negative affect during and 3 h before psychologically controlling interactions. Between-family associations showed significant linkages between parenting and affect. These findings show that a moment of autonomy support can alter adolescents' everyday well-being.

Who is motivated to accept a booster and annual dose? A dimensional and person-centered approach.

The transmissibility of new COVID-19 variants and decreasing efficacy of vaccines led authorities to recommend a booster and even an annual dose. However, people's willingness to accept new doses varied considerably. Using two independent longitudinal samples of 4596 (Mean age = 53.6) and 514 (Mean age = 55.9) vaccinated participants, we examined how people's (lack of) vaccination motivation for their first dose was associated with their intention to get a booster (Sample 1) and an annual dose (Sample 2) several months later (Aim 1). We also aimed to capture the impact of the motivational heterogeneity on these intentions by capitalizing on participants' different motivational profiles collected at baseline (Aim 2). Across both samples, autonomous motivation, controlled motivation, and distrust-based amotivation were uniquely related to, respectively, higher, lower, and even lower booster and annual dose intentions. Further, a two-step clustering procedure revealed five profiles, with the profiles characterized by higher autonomous motivation (i.e. Good Quality and High Quantity profiles) reporting the highest vaccination intentions and the profile characterized by the highest number of obstacles (i.e. Global Amotivated profile) yielding the lowest vaccination intentions. These results stress the critical need to support citizens' volitional endorsement of vaccination to harvest long-term benefits with respect to COVID-19.

An examination of the reciprocal associations between physical activity and anxiety, depressive symptoms, and sleep quality during the first 9 weeks of the COVID-19 pandemic in Belgium.

During the initial outbreak of the global COVID-19 pandemic, many countries imposed a total lockdown (containment at home). Although it was still allowed in Belgium to be physically active or exercise with people from your household in the vicinity of your home, engaging in sports or physical activity in a group or club context was no longer permitted. To examine whether a lack of physical activity was potentially threatening to the mental well-being of citizens and vice versa, the present study examined concurrent and reciprocal relationships between physical activity and anxiety, depressive symptoms, and sleep quality during the COVID-19 lockdown in a 9-week longitudinal design. In a sample of 983 Belgian adults (75.1% female; M age = 43.78, range = 18-82 years), we explored these relationships at both the between- and within-person levels through random intercept cross-lagged panel models. The findings indicate that more physical activity was associated with lower symptoms of anxiety and depression and better sleep quality, a finding observed both at the between-person (across weeks; ßanxiety = -0.25, ßdepression = -0.30, ßsleep quality = 0.24, p < .001) and within-person level (within weeks; ßanxiety = -0.10, ßdepression = -0.14, ßsleep quality = 0.11, p < .05). Moreover, at the within-person level, an increase in feelings of anxiety and depression at one moment predicted lower levels of physical activity one week later (ßanxiety = -0.04, ßdepression = -0.06, p < .05). Since poor mental health poses a threat to the maintenance of physical activity, the current findings suggest that it is critical to invest in the mental health of individuals during distressing times.

The role of emotion regulation in mental health during the COVID-19 outbreak: A 10-wave longitudinal study.

The COVID-19 pandemic elicited a lot of concerns among citizens, thereby potentially compromising their well-being. This study sought to examine the role of individuals' emotion regulation styles (i.e., emotional dysregulation, emotional suppression, and emotional integration) in handling these concerns and their experiences of well-being (i.e., satisfaction with life and sleep quality) and ill-being (i.e., anxiety and depressive symptoms). The study had a unique 10-wave longitudinal design (N = 986; Mage  = 41.28; 76% female) and was conducted during the outbreak of the pandemic in March-May 2020. Multilevel analyses showed, first, that weekly variation in COVID-19 related concerns related negatively to weekly variation in well-being and positively to weekly variation in ill-being. Second, at the between-person level, emotional dysregulation and suppression related positively to between-person vulnerability in ill-being and lower well-being (across all waves). Third, between-person differences in emotional dysregulation amplified the strength of the within-person association between concerns and depressive complaints and lowered life satisfaction. Unexpectedly, integrative emotion regulation amplified the strength of the within-person association between concerns and anxiety. The discussion focuses on the critical role of emotion regulation in handling the uncertainty elicited by the pandemic and provides directions for further research.

How do vaccination intentions change over time? The role of motivational growth.

OBJECTIVE: Across nationwide rollout of COVID-19 vaccination, people in Belgium differed widely in their vaccination intention. In the present study, we examined (a) how people's vaccination intentions changed during the vaccination rollout and (b) whether changes in motivation (i.e., autonomous, controlled, and distrust-based (a)motivation) predicted changes in vaccination intention, thereby taking into account people's vaccination intention at baseline. METHOD: Using 4 subsamples of participants who were vaccinated at different time points (ntotal = 10,799) between December 2020 and June 2021; we used latent change modeling and latent growth curve modeling to examine the associations among initial levels and changes in vaccination motivation and vaccination intention. RESULTS: Across subsamples, changes in vaccination intention were found to be qualified by changes in motivation. An increase in autonomous motivation was related to a positive shift in vaccination intention, while an increase in both controlled motivation and distrust-based amotivation was related to a negative shift in vaccination intention. Moreover, autonomous motivation predicted especially an increase in vaccination intention among those initially low in vaccination intention, whereas an increase in either controlled motivation or distrust-based amotivation especially predicted a decrease in vaccination intention among those initially high in vaccination intention. CONCLUSIONS: Findings suggest that a growing sense of ownership and a reduction in distrust is critical for individuals to develop a stronger intention to get vaccinated, particularly when people had initially low vaccination intentions. We discuss conceptual, methodological, and practical implications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Role of Communication Style and External Motivators in Predicting Vaccination Experiences and Intentions: An Experimental Vignette Study.

This vignette-based study examined in a sample of unvaccinated Belgian citizens (N = 1918; Mage = 45.99) how health care workers could foster reflection about and intentions to get vaccinated against COVID-19 by experimentally varying their communication style (i.e., autonomy-supportive vs. controlling) and the reference to external motivators (i.e., use of a monetary voucher or corona pass vs. the lack thereof). Each participant was randomly assigned to one of six conditions and rated a vignette in terms of anticipated autonomy satisfaction, perceived effectiveness, reflection, and vaccination intention. An autonomy-supportive, relative to a controlling, communication style predicted greater autonomy need satisfaction, which in turn related positively to perceived effectiveness, reflection, and vaccination intention. External motivators failed to generate positive effects compared to the control condition. The findings highlight the critical role of autonomy support in promoting a self-endorsed decision to get vaccinated.

How the Stringency of the COVID-19 Restrictions Influences Motivation for Adherence and Well-Being: The Critical Role of Proportionality.

BACKGROUND: The stringency of the measures taken by governments to combat the COVID-19 pandemic varied considerably across countries and time. In the present study, we examined how the proportionality to the epidemiological situation is related to citizens'behavior, motivation and mental health. METHODS: Across 421 days between March 2020 and March 2022, 273,722 Belgian participants (Mage = 49.47; 63.9% female; 33% single) completed an online questionnaire. Multiple linear mixed regression modeling was used to examine the interaction between the epidemiological situation, as indicated by the actual hospitalization numbers, and the stringency index to predict day-to-day variation in the variables of interest. RESULTS: Systematic evidence emerged showing that disproportional situations, as opposed to proportional situations, were associated with a clear pattern of maladaptive outcomes. Specifically, when either strict or lenient measures were disproportional in relation to the epidemiological situation, people reported lower autonomous motivation, more controlled motivation and amotivation, less adherence to sanitary rules, higher perceived risk of infection, lower need satisfaction, and higher anxiety and depressive symptoms. Perceived risk severity especially covaried with the stringency of the measures. At the absolute level, citizens reported the highest need satisfaction and mental health during days with proportional lenient measures. CONCLUSION: Stringent measures are not per se demotivating or compromising of people's well-being, nor are lenient measures as such motivating or enhancing well-being. Only proportional measures, that is, measures with a level of stringency that is aligned with the actual epidemiological situation, are associated with the greatest motivational, behavioral, and mental health benefits.

Saliva testing among teachers during the COVID-19 pandemic: Effects on health concerns, well-being, and precautionary behavior.

RATIONALE: At the start of 2021, several SARS-CoV-2 cluster outbreaks in schools threatened in-person education and created a fairly chaotic and frightening environment for school personnel. To keep the schools open while preventing COVID-19 outbreaks, intensive diagnostic testing in teachers and school personnel was strongly recommended but missing at the time. OBJECTIVES: A project was launched in Belgian schools to weekly analyze the morning saliva of school personnel using PCR-testing to detect and prevent COVID-19 positive cases. In this quasi-experimental study, we aimed to examine whether the implementation of this saliva testing project impacted school personnel's pandemic-related health concerns, well-being, and adherence to the health-protective measures, contrasting experimental with control schools. METHODS: The data were collected during the third wave (Alpha-wave, February-March 2021) of the pandemic. The sample consisted of 435 participants from 34 different schools across Flanders (Belgium) (78.8% female; M age = 43.87 years, range = 21-67) of which 82% participated in the weekly saliva tests (i.e., experimental group) and 18% took part in the control group. RESULTS: Results from a series of linear mixed regression models showed that saliva testing buffered against an increase in health concerns among tested school personnel but did not affect participants' general well-being. Slight declines in adherence to the health-protective behaviors were observed, yet this was only the case for participants who felt less supported by their school principal. High degrees of principals' support also fostered the sharpest decreases in school staff's pandemic-related health concerns. CONCLUSIONS: When keeping the schools open in unstable pandemic times, weekly saliva testing is a promising strategy to prevent cluster outbreaks while simultaneously safeguarding health concerns among school personnel. School principals appear to play a critical role in the implementation of saliva testing to secure positive effects.

Personal and contextual determinants of COVID-19 vaccination intention: a vignette study.

BACKGROUND: This vignette study explores which factors contribute to higher COVID-19 vaccination intentions. METHODS: Between the 4th-11 January 2021, we recruited 15,901 Belgian citizens (Mage = 50.11 years, range 18-100) through convenience sampling to participate in a vignette study. In each vignette, we manipulated contextual determinants consisting of different factors. Each participant rated six vignettes in terms of the outcomes 'vaccination intention' and 'recommendation to others.' Finally, we explored the benefits of tailored communication by examining whether these ratings depended upon citizens' initial motives for vaccination. RESULTS: Participants are most likely to accept a vaccine when they expect no or only small side effects, when the vaccine offers a 95% protection, and when people can no longer infect others (p < 0.001). The possibility to receive the vaccine at home or at the GP's office, highlighting that most citizens are willing to get vaccinated, and emphasizing the protective benefits for others yielded additional positive effects (p < 0.001). Results showed that tailored communication has a small but significant effect, especially for individuals high on distrust-based amotivation (p < 0.01). CONCLUSION: In addition to vaccine characteristics, there is room for policymakers to respond to those determinants that fall under their control and can thus be highlighted within communication campaigns.

The relation between conspiracism, government trust, and COVID-19 vaccination intentions: The key role of motivation.

RATIONALE: Vaccination willingness is a critical step in the effort to reach herd immunity and control the COVID-19 pandemic. Nevertheless, many people remain reluctant to be vaccinated. OBJECTIVE: Integrating the literature on Self-Determination Theory, trust in authorities, and conspiracy theories, this research examines (a) the direct and indirect effect of government trust and conspiracism via underlying forms of motivations for (not) getting vaccinated against COVID-19 and (b) whether these associations differ across the two largely politically independent Belgian linguistic groups. METHODS: Using Structural Equation Modeling, we tested our models in two independent samples, in February 2021 (T1) and April 2021 (T2) (Total N = 8264). RESULTS: At T1 and T2, Government trust and conspiracism both predict COVID-19 vaccination intention, respectively positively and negatively. These relations are fully mediated by motivational factors, with identified motivations having a larger positive contribution. Looking at linguistic context, differences emerge at T2, with French-speaking Belgians showing lower levels of government trust and higher levels of conspiracism than Dutch speakers. CONCLUSIONS: Results highlight the importance of integrating distal (trust in government, conspiracism) and proximal (motivational) variables to understand vaccination intentions.

Emotion regulation in times of COVID-19: A person-centered approach based on self-determination theory.

Although the COVID-19 crisis is a worldwide threat to individuals' physical health and psychological well-being, not all people are equally susceptible to increased ill-being. One potentially important factor in individuals' vulnerability (versus resilience) to ill-being in the face of stress is emotion regulation. On the basis of Self-Determination Theory, this study examined the role of three emotion regulation styles in individuals' mental health during the COVID-19 crisis, that is, integration, suppression, and dysregulation. Participants were 6584 adults (77% female, M age = 45.16 years) who filled out well-validated measures of emotion regulation, depression, anxiety, life satisfaction, and sleep quality. To examine naturally occurring combinations of emotion regulation strategies, hierarchical k-means clustering was performed, yielding 3 profiles: (a) low scores on all strategies (indicating rather low overall levels of worry; 27%), (b) high scores on integration only (41%), and (c) high scores on suppression and dysregulation (32%). Participants in the profiles scoring high on suppression and dysregulation displayed a less favorable pattern of outcomes (high ill-being, low life satisfaction, and poorer sleep quality) compared to the other two groups. Between-cluster differences remained significant even when taking into account the corona-related worries experienced by people. Overall, the findings underscore the important role of emotion regulation in individuals' mental health during mentally challenging periods such as the COVID-19 crisis. Practical implications and directions for future research are discussed.

Predicting vaccine uptake during COVID-19 crisis: A motivational approach.

The present research examined which motivational factors contribute to individuals' intention to take a vaccine that protects against SARS-CoV-2-virus and their self-reported vaccine uptake several months later. The role of different types of motivation was investigated (i.e., autonomous and controlled regulation) as well as vaccine distrust and effort to obtain a vaccine. Across two large-scale cross-sectional (N = 8887) and longitudinal (N = 6996) studies and controlling for various covariates, autonomous motivation and distrust-based amotivation contributed positively and negatively, respectively, to a) concurrent vaccination intentions, b) self-reported vaccination and c) subsequent subscription to a waitlist to obtain a vaccine. Participants' infection-related risk perception predicted more positive vaccination outcomes through fostering greater autonomous motivation for vaccination and lower distrust, whereas pandemic-related health concerns failed to yield such adaptive effects. The results emphasize the importance of fostering autonomous motivation for vaccination and handling distrust.

The role of ego integrity and despair in older adults' well-being during the COVID-19 crisis: the mediating role of need-based experiences.

The COVID-19 pandemic has affected people across the world, with important heterogeneity among older adults in how they respond to the challenges associated with this crisis. Relying on a cross-fertilization between Erikson's personality theory and self-determination theory, this study aimed to examine possible sources of resilience (i.e., ego integrity and need satisfaction) and vulnerability (i.e., despair) in older adults' (mal) adjustment, thereby additionally considering the role of multiple risk and protective factors (e.g., gender and marital status). During the second month of the lockdown period in Belgium, 693 older adults (M age = 70.06, SD = 4.48, range: 65-89 years, 62.1% female) filled out online questionnaires concerning the study variables, while also completing assessments of several important sociodemographic factors. Structural equation modeling suggested that both ego integrity and despair related to indicators of well-being and psychological distress through experienced need satisfaction. Additionally, we found several factors to protect (e.g., higher perceived income) or diminish (e.g., being widowed) older adults' well-being during these challenging times, with little evidence for a moderating role of these factors in associations between the psychological variables. Theoretical and practical implications of these results are discussed.

Do Psychological Needs Play a Role in Times of Uncertainty? Associations with Well-Being During the COVID-19 Crisis.

Across the world, measures were taken to contain the spreading of the COVID-19 virus. Many of these measures caused a sudden rupture in people's daily routines, thereby eliciting considerable uncertainty and potentially also hampering the satisfaction of individuals' psychological needs for autonomy, relatedness, and competence. Drawing upon Maslow's Hierarchical Need Theory and Self-Determination Theory, this study examined the unique role of felt insecurity and the psychological needs, as well as their dynamic interplay, in the prediction of mental health. A large and heterogeneous sample of adults (N = 5118; Mage = 43.45 years) was collected during the first ten days of the lockdown period in Flanders, Belgium. A subsample (N = 835, Mage = 41.39) participated during a second wave one week later. Hierarchical regression analyses indicated that felt insecurity, need satisfaction and need frustration all independently predicted various positive (life satisfaction, sleep quality) and negative indicators depressive symptoms, anxiety) of mental health, with little systematic evidence for interactions between the predictors. The pattern of findings obtained concurrently largely held in the longitudinal analyses. Finally, results showed that associations between felt insecurity and lower concurrent and prospective mental health were partially mediated by need satisfaction and frustration, with especially psychological need frustration predicting changes in mental health over time. Overall, the findings suggest that satisfaction of the psychological needs for autonomy, competence, and relatedness is not just a 'luxury good'. Satisfaction of these needs is important also in times of insecurity, while need frustration represents a risk factor for maladjustment during such times.

Mental Health Outcomes Among Parents of Children With a Chronic Disease During the COVID-19 Pandemic: The Role of Parental Burn-Out.

OBJECTIVE: The COVID-19 pandemic and associated quarantine measures highly impacted parental psychological well-being. Parents of children with chronic diseases might be specifically vulnerable as they already face multiple challenges to provide adequate care for their child. The research questions of the current study were twofold: (a) to examine whether parents of children with a chronic disease experienced more anxiety and depression compared to parents of healthy children and (b) to examine a series of risk factors for worsened well-being (i.e., depression, anxiety, and sleep problems), such as sociodemographic variables, COVID-19-specific variables (i.e., financial worries, living space, and perceived quality of health care), and parental psychological experiences (i.e., parental burn-out and less positive parenting experiences). METHODS: Parents of children with a chronic disease (i.e., the clinical sample; N = 599 and 507 for Research Questions 1 and 2, respectively) and parents of healthy children (i.e., the reference sample: N = 417) filled out an online survey. RESULTS: Findings demonstrated that the parents in the clinical sample reported higher levels of anxiety than parents in the reference sample. Analyses within the clinical sample indicated that COVID-19-specific stressors and parental psychological experiences were associated with higher levels of anxiety, depression, and sleep problems. Mediation analyses furthermore indicated that the association of COVID-19-specific stressors with all outcome measures was mediated by parental burn-out. CONCLUSIONS: Parents of children with a chronic disease constitute a vulnerable group for worse well-being during the current pandemic. Findings suggest interventions directly targeting parental burn-out are warranted.

Parental identity as a resource for parental adaptation during the COVID-19 lockdown.

The lockdown measures that were taken to contain the worldwide outbreak of COVID-19 caused many parents to stay at home with their children. This unusual situation created both risks and opportunities for families. In the present study, we examined the role of parental identity as a resource for parental adaptation during this challenging period, thereby considering both parenthood experiences and parents' general mental health while also taking into account the cumulative risk to which parents were exposed (e.g., single parenthood). Furthermore, to shed light on the mechanisms behind the effects of parental identity, this study addressed the mediating role of parental satisfaction of their basic psychological needs for autonomy, competence, and relatedness. During the lockdown period in Belgium, 492 parents (88% mothers, Mage = 44 years, 63.7% in intact family, 31.2% with a university degree) completed online questionnaires on parental identity, need-based experiences, positive and negative parenthood experiences, and mental health. Several weeks earlier, these participants also rated their mental health and a variety of risks they were exposed to as part of a larger study. Results showed that a clear and self-endorsed parental identity was related to better parental adaptation, with parental need satisfaction playing a mediating role in these associations. Moreover, these associations remained significant after controlling for the prior levels of parental mental health and for cumulative risk. Overall, findings suggest that parental identity serves as a source of resilience in an uncertain period such as the COVID-19 pandemic. Practical implications and directions for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).