The Existential Concerns Questionnaire (ECQ)-Development and Initial Validation of a New Existential Anxiety Scale in a Nonclinical and Clinical Sample

Starving off death: Mortality salience impacts women's body image and disordered eating

From a Terror Management perspective, the pursuit of thinness that characterizes eating disorders (EDs) is arguably a culturally endorsed way to mitigate death anxiety. In the present studies, we used the mortality salience (MS) paradigm to examine whether priming death increases ED symptoms. We recruited two samples of women from undergraduate (Study 1, N = 120), and clinically relevant (Study 2, N = 154) populations. After priming, participants completed measures of potential confounds (e.g., neuroticism, affect). Next, we assessed ED attitudes and behavior using a portion size estimation task, and measures of body dissatisfaction and eating intention. Study 1 findings were inconsistent with the claimed role of death anxiety in ED related behavior. However, in Study 2, MS priming led to increased dissatisfaction with current thinness and smaller portion sizes for high-fat compared to low-fat food. Overall, the results suggest that death anxiety may, at least partially, drive ED symptoms.

A cross-sectional study of existential concerns and fear of progression in people with Rheumatoid Arthritis

OBJECTIVES

People with rheumatoid arthritis (RA) have higher levels of fear of disease progression (FOP) than cancer survivors. In cancer, FOP is inextricably linked with existential concerns. However, this has not been investigated in people with RA.

METHODS

We recruited 165 people with RA (96%F) who volunteered for a treatment trial of psychological intervention. Participants completed the Existential Concerns Questionnaire (ECQ) and questionnaires measuring constructs associated with FOP in cancer. We created groups of people with RA, with and without clinically significant levels of FOP (clinical and control groups) and compared their existential concerns. We hypothesized that existential concerns would add to the variance in FOP over and above pain, psychopathology, and disability.

RESULTS

Nearly two-thirds of people with RA scored in the clinical range for FOP. The clinical group had higher levels of all existential concerns than the control group. When subscales of the ECQ were entered into a multiple regression with FOP as the dependent variable, death anxiety, meaninglessness and guilt domains accounted for significant variance in FOP. Moreover, when added to a regression equation controlling all other variables, existential concerns continued to account for unique variance in FOP (t = 2.712, p = 0.007).

CONCLUSION

Existential concerns were strongly associated with FOP. While this cross-sectional study cannot determine whether existential concerns underlie FOP in RA, these results show robust relationships that warrant future investigation.

Journeying to Ixtlan: Ethics of Psychedelic Medicine and Research for Alzheimer's Disease and Related Dementias

In this paper, we examine the case of psychedelic medicine for Alzheimer's disease and related dementias (AD/ADRD). These "mind-altering" drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; the impact of "ego dissolution" on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards' orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations.

The Development of the Existential Empathy Questionnaire

Therapist empathy toward existential concerns might be a critical component of clinical practice. This study aims to explore the psychometric properties of the Existential Empathy Questionnaire (EEQ), a self-report instrument developed to measure levels of existential empathy among mental health professionals. The EEQ was completed by a sample of 393 therapists recruited in Belgium, along with measures of general empathy, experiential avoidance, and existential avoidance. To assess the test–retest reliability, 353 participants of the same sample completed the EEQ a second time 2 weeks later. Clinical experience and therapeutic theoretical background were assessed to inform professional characteristics. The results support the use of the EEQ as a unidimensional measure of existential empathy. It demonstrates good internal reliability and temporal stability. A principal components analysis indicates three components with small to moderate intercorrelations, labeled as “Communication,” “Avoidance and Overwhelming Feelings,” and “Resonance and Presence.” EEQ total scores show a moderate positive association with general empathy and a moderate negative association with experiential and existential avoidance. Furthermore, the EEQ significantly uniquely predicts experiential and existential avoidance after controlling for general empathy. Years of clinical practice and a humanistic-oriented therapeutic approach correlated moderately with high EEQ scores.

To be Scared or Scared to be: Existential Anxiety as a Mediator between Meaning Experience and Depression

Difficulty in the experience of meaning has been both theoretically and empirically linked with depression. This cross-sectional study first aimed to replicate the association between difficulty in meaning experience and depression in a sample of 77 psychotherapists and counselors (77.1% females; Mage: 49; SDage = 12.25). Second, this study wanted to extend the body of research findings by investigating whether existential anxiety, and focusing manner, that is, the ability to attend to one’s bodily felt experiences, mediated the relation between meaning experience and the severity of depression. Surprisingly, meaning experience did not show a significant association with severity of depression. Furthermore, existential anxiety mediated the association between meaning experience and severity of depression. Focusing manner showed no significant mediating role in the relationship between meaning experience and severity of depression. These findings suggest that existential anxiety might be an important underlying mechanism in depressive disorder. Addressing the anxiety evoked by existential questions in the patient’s life might be important in the psychotherapeutic treatment of depression. Future prospective research is needed to further disentangle the relationship between meaning experience, depression, focusing, and existential anxiety.

The Role of Existential Concerns in the Individual's Decisions regarding COVID-19 Vaccine Uptake: A Survey among Non-Vaccinated Italian Adults during the Third Wave of the Pandemic

Recent studies have suggested that health constructs embraced by the Terror Management Theory (TMT) and the Basic Psychological Needs Theory (BPNT) may drive individuals' COVID-19 health-related decisions. This study examines the relationships between existential concerns (ECs; within the TMT), basic psychological needs (BPNs; within the BPNT) and COVID-19 vaccine hesitancy (VH), as well as the mediating role of negative attitudes toward COVID-19 vaccines. A cross-sectional survey was carried out from April to May 2021 on a sample of two hundred and eighty-seven adults (Mage = 36.04 ± 12.07; 59.9% females). Participants provided information regarding existential concerns, basic psychological needs, attitudes toward COVID-19 vaccines and vaccine hesitancy for Pfizer-BioNTech and AstraZeneca vaccines separately. Higher vaccine hesitancy (32.1%) and vaccine resistance (32.8%) rates were found for AstraZeneca than for Pfizer-BioNTech COVID-19 vaccine (22.3% and 10.1%, respectively). Structural equation modeling showed that existential concerns were related to Pfizer-BioNTech and AstraZeneca vaccine hesitancy both directly and indirectly through negative attitudes toward potential side effects of COVID-19 vaccines. The findings of the study confirm that the TMT is efficient in explaining COVID-19 vaccine hesitancy. Targeted efforts are needed to increase the acceptance of COVID-19 vaccines.

Randomised controlled trial of cognitive behaviour therapy versus mindfulness for people with rheumatoid arthritis with and without a history of recurrent depression: study protocol and design

INTRODUCTION

Psychosocial treatments have been shown to benefit people with rheumatoid arthritis (RA) on various outcomes. Two evidence-based interventions are cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR). However, these interventions have been compared only once. Results showed that CBT outperformed MBSR on some outcomes, but MBSR was more effective for people with RA with a history of recurrent depression, with efficacy being moderated by history of depressive episodes. However, this was a post-hoc finding based on a small subsample. We aim to examine whether a history of recurrent depression will moderate the relative efficacy of these treatments when delivered online.

METHODS AND ANALYSIS

This study is a randomised controlled trial comparing CBT and MBSR delivered online with a waitlist control condition. History of recurrent depressive episodes will be assessed at baseline. The primary outcome will be pain interference. Secondary outcomes will include pain intensity, RA symptoms, depressive symptoms and anxiety symptoms. Outcome measures will be administered at baseline, post-treatment and at 6 months follow-up. We aim to recruit 300 participants, and an intention-to-treat analysis will be used. Linear mixed models will be used, with baseline levels of treatment outcomes as the covariate, and group and depressive status as fixed factors. The results will demonstrate whether online CBT and MBSR effectively improve outcomes among people with RA. Importantly, this trial will determine whether one intervention is more efficacious, and whether prior history of depression moderates this effect.

ETHICS AND DISSEMINATION

The trial has been approved by the Human Research Ethics Committee of the University of Sydney (2021/516). The findings will be subject to publication irrespective of the final results of the study, and based on the outcomes presented in this protocol.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12621000997853p).

Death education and photovoice at school: A workshop with Italian high school students

The study shows the effects of a death education workshop with Italian high school students. Students (N = 416) from 10 high schools throughout Italy participated: 212 in the experimental group and 204 in the control group. Four weekly, two-hour workshops about the themes of death, with theoretical lessons and an experiential artistic activity of photovoice. Results show that the students in the experimental group showed significantly increased self-efficacy levels and existential anxiety levels did not increase after death education intervention. Educating youth about death could give them the skills to improve the management of death-related events and cope with negative emotions.

Existential Meaninglessness Scale: Scale Development and Psychometric Properties

Grounded in a tripartite existential meaninglessness model, the authors developed the 18-item Existential Meaninglessness Scale (EMS) to assess one’s concern and anxiety of existential meaninglessness. Across three samples, the EMS’s factor structure and evidence of convergent, criterion-related, and incremental validity, internal consistency, and test–retest reliability were examined. Exploratory factor analyses demonstrated three dimensions of the EMS: incomprehension, purposelessness, and insignificance. Confirmatory factor analyses revealed that a bifactor model was a better fit to the data than other models. The bifactor model provided evidence for a general factor and measurement invariance. Ancillary bifactor indices indicated EMS’s unidimensionality. Findings of bivariate correlations and hierarchical regression analyses provided evidence for different aspects of construct validity and internal consistency. Both the Concern and Anxiety measures of the EMS positively predicted depressive symptoms and suicide ideation above and beyond the effects of general existential meaninglessness, general feelings of anxiety, and presence of meaning in life. Based on the findings, the authors discuss future research directions on existential meaninglessness using the EMS.

Help-Seeking as a Maladaptive Coping Style in the Pandemic Scenario: What Worked and What Did Not for Facing This New Stressor

The spread of COVID-19 and its related confinement measures were important stressors for a large part of the global population, with massive effects on both physical and mental health. Assessing how individuals coped with such a stressor and which strategies were effective is one of the main challenges for psychological research. In this study, we aimed to investigate the coping strategies implied during the COVID-19 lockdown and their effectiveness. We recruited 374 Italian participants through convenience sampling during the first pandemic wave (April 2020). We administered to our participants an online battery of questionnaires including the Brief COPE, the use of alternative coping strategies proposed by the WHO to help people facing lockdown stress, and a range of psychological symptoms. An exploratory factor analysis conducted on the subscales of the Brief COPE revealed a three-factor structure. Following the previous literature, we named these factors engagement, disengagement, and help-seeking coping styles. In the pandemic scenario, the engagement and disengagement styles revealed the typical correlation patterns with psychological symptoms (i.e., the engagement was adaptive while the disengagement was maladaptive). Instead, contrary to previous literature, help-seeking was positively related to psychological symptoms, suggesting a mismatch between searching for help and finding it during the lockdown. This result supports the importance of evaluating the effectiveness of coping strategies in the pandemic scenario, to give more compelling and precise advice to the population.

Pandemic reminders as psychological threat: thinking about COVID-19 lowers coping self-Efficacy among trauma-exposed adults

Reminders of COVID-related problems have been pervasive throughout the COVID-19 pandemic. Such reminders could have negative mental health impacts, especially among psychologically vulnerable people, including those with trauma-related problems. We experimentally examined the effects of pandemic reminders among trauma-exposed participants sampled from Prolific (N = 238). Participants were induced to think about health-related or social isolation-related aspects of COVID-19 or their favourite TV show and existential anxiety and coping self-efficacy (CSE) were then assessed. Posttraumatic stress symptoms (PTSS) related to a prior stressor and COVID-related functional impairment were assessed as potential moderators of reactions to pandemic reminders. Results showed that both types of pandemic reminders lowered CSE among participants with either higher PTSS or COVID-related functional impairment. Pandemic reminders did not significantly affect existential anxiety. These findings suggest that reminders of the COVID-19 pandemic may undermine the mental health of psychologically vulnerable populations.

The relationship between fear of COVID-19 and intention to get vaccinated. The serial mediation roles of existential anxiety and conspiracy beliefs

Today, we witness the progress toward global COVID-19 vaccinations organized by countries worldwide. Experts say a mass vaccination plan is the only effective antidote against the spread of SARS-COV-2. However, a part of the world population refuses vaccination. The present study aimed to understand the impact of some individual variables on the intention to get vaccinated. Through a serial mediation model, we tested the influence of fear of COVID-19 on the intention to get vaccinated and the serial mediating effect of existential anxiety and conspiracy beliefs. Via a cross-sectional design this research was conducted with the participation of 223 French adults (Female: 69.5%; Male: 30.5%; M_age = 30.26, SD = 13.24; range: 18–75 years) who responded to an online survey. The results showed a positive relationship between fear of COVID-19 and intention to get vaccinated; however, when this fear was associated with high levels of existential anxiety through conspiracy beliefs, the intention to get vaccinated decreased. Our findings were in line with Terror Management Health Model, which states that, in facing health threats, humans may strive to reduce their own perceived vulnerability not only by engaging in healthy behaviors but also denying or avoiding death anxiety, as anti-vaxxers do.

Mistrust and Beliefs in Conspiracy Theories Differently Mediate the Effects of Psychological Factors on Propensity for COVID-19 Vaccine

Vaccination is considered a key factor in the sanitary resolution of the COVID-19 pandemic. However, vaccine hesitancy can undermine its diffusion with severe consequences on global health. While beliefs in conspiracy theories, mistrust in science and in policymakers, and mistrust in official information channels may also increment vaccine hesitancy, understanding their psychological causes could improve our capacity to respond to the pandemic. Thus, we designed a cross-sectional study with the aim of probing vaccine propensity in the Italian population and explored its relationship with sociodemographic and psychological variables, and with misbeliefs in COVID-19. A battery of questionnaires was administered to a sample of 374 Italian adults during the first national lockdown (April 2020). The materials included an original instrument—Beliefs in COVID-19 Inventory—and questionnaires measuring perceived stress, anxiety, death anxiety, psychological distress, psychoticism, paranoia, anger, and somatization. The exploratory factor analysis (EFA) on Beliefs in COVID-19 suggested the existence of three factors: belief in conspiracy theories, mistrust in medical information, and mistrust in medicine and science. These factors were positively correlated with female sex, age, religious beliefs, psychiatric conditions, and psychological variables, while negatively correlated with education levels. We conducted a mediation analysis by means of a structural equation model, including psychological factors as predictors, beliefs in COVID-19 scales as mediators, and vaccine propensity as an outcome. The model showed that death anxiety had a direct positive effect on the propensity to get vaccinated. It also showed that death anxiety reduced the propensity to get vaccinated through a mediated path in believing in conspiracy theories, whereas paranoia was linked to a reduction in vaccination adherence with the mediation effect of mistrust in medical science. Psychological distress reduced vaccination propensity by increasing both conspiracy beliefs and mistrust. On the other hand, anxiety increased the propensity to get vaccinated through a decrease in both belief in conspiracy theories and mistrust in science. Our results suggest that psychological dimensions are differentially related to belief in conspiracy theories, to mistrust in science, and to the propensity to get vaccinated. Based on this result, we propose an original interpretation of how conspiracy beliefs build on a paranoid and suspicious attitude. We also discuss the possible clinical implications of treatment for such pathological beliefs.

Differences Between Health Workers and General Population in Risk Perception, Behaviors, and Psychological Distress Related to COVID-19 Spread in Italy

In this study, we investigated the perception of risk and the worries about COVID-19 infection in both healthcare workers and the general population in Italy. We studied the difference in risk perception in these two groups and how this related to demographic variables and psychological factors such as stress, anxiety, and death anxiety. To this aim, we administered an online questionnaire about COVID-19 together with other questionnaires assessing the psychological condition of participants. First, we found that the exposition to infection risk, due to living area or job, increased the perceived stress and anxiety (i.e., medical staff in North Italy was more stressed and anxious with respect to both medical- and non-medical participants from Center and South Italy). Then, we conducted hierarchical logistic regression models on our data to assess the response odds ratio relatively to each regressor on each dependent variable. We found that health workers reported higher risk perception, level of worry, and knowledge as related to COVID-19 infection compared to the general population. Psychological state, sex, and living area were less related to these factors. Instead, judgments about behaviors and containment rules were more linked to demographics, such as sex. We discussed these results in the light of risk factors for psychological distress and possible interventions to meet the psychological needs of healthcare workers.

What is good mental health? A scoping review

Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Disorders and Mental Health Promotion (ECNP TWG PMD-MHP), presents a critical review of the available operationalizations for good mental health. A pragmatic conceptual operationalisation of good mental health is a much-needed step towards more standardised research in this field. Good mental health can be defined as a state of well-being that allows individuals to cope with the normal stresses of life and function productively. Universal and selective interventions are suitable to promote mental health. Core domains that define good mental health encompass: (i) mental health literacy, (ii) attitude towards mental disorders, (iii) self-perceptions and values, (iv) cognitive skills, (v) academic/ occupational performance, (vi) emotions, (vii) behaviours, (viii) self-management strategies, (ix) social skills, (x) family and significant relationships (xi) physical health, (xii) sexual health, (xiii) meaning of life, (xiv) and quality of life. These domains should be widely traceable in the literature and can be used to conduct further empirical research in the field of good mental health. Such data can lead to more robust evidence to identify and establish the pathways to follow in order to improve mental health.

Psychodrama and Moviemaking in a Death Education Course to Work Through a Case of Suicide Among High School Students in Italy

This study describes the psychological effects of an experience of death education (DE) used to explore a case of suicide in an Italian high school. DE activities included philosophical and religious perspectives of the relationships between death and the meaning of life, a visit to a local hospice, and psychodrama activities, which culminated in the production of short movies. The intervention involved 268 high school students (138 in the experimental group). Pre-test and post-test measures assessed ontological representations of death, death anxiety, alexithymia, and meaning in life. Results confirmed that, in the experimental group, death anxiety was significantly reduced as much as the representation of death as annihilation and alexithymia, while a sense of spirituality and the meaning of life were more enhanced, compared to the No DE group. These improvements in the positive meaning of life and the reduction of anxiety confirmed that it is possible to manage trauma and grief at school with death education interventions that include religious discussion, psychodrama and movie making activities.