COVID-19 pandemic is a global calamity posing an unprecedented opportunity to study resilience. We developed a brief resilience survey probing self-reliance, emotion-regulation, interpersonal-relationship patterns and neighborhood-environment, and applied it online during the acute COVID-19 outbreak (April 6-15, 2020), on a crowdsourcing research website (www.covid19resilience.org) advertised through social media. We evaluated level of stress (worries) regarding COVID-19: (1) contracting, (2) dying from, (3) currently having, (4) family member contracting, (5) unknowingly infecting others with (6) experiencing significant financial burden following. Anxiety (GAD7) and depression (PHQ2) were measured. Totally, 3042 participants (n = 1964 females, age range 18-79, mean age = 39) completed the resilience and COVID-19-related stress survey and 1350 of them (mean age = 41, SD = 13; n = 997 females) completed GAD7 and PHQ2. Participants significantly endorsed more distress about family contracting COVID-19 (48.5%) and unknowingly infecting others (36%), than getting COVID-19 themselves (19.9%), p < 0.0005 covarying for demographics and proxy COVID-19 exposures like getting tested and knowing infected individuals. Patterns of COVID-19 related worries, rates of anxiety (GAD7 > 10, 22.2%) and depression (PHQ2 > 2, 16.1%) did not differ between healthcare providers and non-healthcare providers. Higher resilience scores were associated with lower COVID-19 related worries (main effect F 1,3054 = 134.9; p < 0.00001, covarying for confounders). Increase in 1 SD on resilience score was associated with reduced rate of anxiety (65%) and depression (69%), across healthcare and nonhealthcare professionals. Findings provide empirical evidence on mental health associated with COVID-19 outbreak in a large convenience sample, setting a stage for longitudinal studies evaluating mental health trajectories following COVID-19 pandemic.

While many researchers have largely focused on principles of systematic desensitization and habituation in explaining fear extinction, these processes have mixed evidence at best. In particular, these models do not account for spontaneous recovery or reinstatement of fear, nor do they explain the context dependency of extinction or rapid reacquisition. This may in part account for the significant number of patients who fail to respond to our available treatments which rely on these principles in designing exposure sessions. However, recent research is converging to suggest that an inhibitory model of fear reduction, in which the original feared association (CS-US) remains but is inhibited by a newly formed association (CS-noUS) representing safety, holds promise in explaining the long-term attenuation of fear and anxiety. This paper reviews research in a number of areas, including neuroimaging, psychophysiology, and psychopharmacology that all provide support for the inhibition model of anxiety. Limitations to this body of research are discussed, along with recommendations for future research and suggestions for improving exposure therapy for fear and anxiety disorders. Clinical implications discussed in this paper include incorporating random and variable practice in exposure sessions, multiple contexts, and pharmacological aides, among others.

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Background. The COVID-19 pandemic has major ramifications for global health and the economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between COVID-19 pandemic-related income loss with financial strain and mental health trajectories over a 1-month course.Methods. Two independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; N = 4 171) and at a 1-month follow-up (T2; N = 1 559). Mixedeffects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income.Findings. In both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income.Worsening of income loss was associated with exacerbation of depression at T2 in both studies.Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US).Interpretation. Income loss and financial strain were uniquely associated with depressive symptoms and the exacerbation of symptoms over time, above and beyond pandemic-related anxiety.Considering the painful dilemma of lockdown versus reopening, with the tradeoff between public health and economic wellbeing, our findings provide evidence that the economic impact of COVID-19 has negative implications for mental health.

Prolonged exposure therapy (PE) is a highly efficacious and effective treatment for posttraumatic stress disorder (PTSD). In addition to reducing PTSD symptoms, PE ameliorates a wide-variety of related symptoms, including anxiety, depression, functional impairment, mild suicidal ideation, and anger. Furthermore, PE is effective in patients with comorbid conditions, including dissociation, substance use, borderline personality disorder and psychosis. How does PE achieve these outcomes? Emotional processing theory (EPT) is the conceptual model from which PE was derived. Three key concepts were originally proposed as indicators that emotional processing, the mechanism underlying symptom reduction via exposure therapy, including PE, had occurred. The three indicators are fear activation, within-session habituation, and between-session habituation, all of which were proposed to reduce symptoms of PTSD. In addition to these indicators, EPT posits that changes in cognitive evaluations about the self and the world are also involved in successful emotional processing, the mechanism underlying symptom reduction. Since its emergence in 1986, EPT has been updated and modified to incorporate emerging empirical findings and conceptual developments. We first review recent empirical support for, and refutation of, various hypotheses derived from EPT, including the importance of fear activation, betweensession habituation, and cognitive change. We then provide a clinical case study to highlight strategies to promote emotional processing and the resultant long-term symptom reduction. This case example highlights three common obstacles to success in PE: namely underengagement, insufficient homework compliance, and the presence of PTSD-related negative cognitions.

Many university students suffer from test anxiety that is severe enough to impair performance. Given mixed efficacy results of previous cognitive-behavior therapy (CBT) trials and a theoretically driven rationale, an acceptance-based behavior therapy (ABBT) approach was compared to traditional CBT (i.e., Beckian cognitive therapy; CT) for the treatment of test anxiety. In this pilot study, 16 university students with test anxiety were randomly assigned to receive either a CT or ABBT 2-hr group workshop. The two treatments produced markedly different effects on test performance (measured by exam scores), with those receiving ABBT experiencing improvements in performance, whereas those receiving CT exhibited reduced performance. In addition, there was a suggestion that ABBT might have been more effective at reducing subjectively experienced test anxiety (i.e., a nonsignificant but medium-sized group by time interaction effect). Implications of these results for the treatment of test anxiety and for theoretical notions related to cognitive change strategies are discussed.

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Objective While self-efficacy (SE) and outcome-expectancy (OE) have been well researched as predictors of outcome, few studies have investigated changes in these variables across treatments. We evaluated changes in OE and SE throughout treatment as predictors of outcomes in a large sample with panic disorder, generalized anxiety disorder, social anxiety disorder, or post-traumatic stress disorder. We hypothesized that increases in SE and OE would predict reductions in anxiety and depression as well as improvement in functioning. Method Participants (mean age = 43.3, SD=13.2, 71.1% female, 55.5% white) were recruited from primary care centers throughout the US and were randomized to receive either Coordinated Anxiety Learning and Management (CALM) treatment, comprised of cognitive-behavioral therapy, psychotropic medication, or both, or to usual care. SE and OE ratings were collected at each session for participants in the CALM treatment (n=482) and were entered into a structural equation model as predictors of changes in Brief Symptom Inventory, Anxiety Sensitivity Index, Patient Health Questionnaire, and Sheehan Disability Scale outcomes at 6, 12, and 18 months after baseline. Results The best fitting models predict symptom levels from OE and SE and not vice versa. The slopes and intercept of OE significantly predicted change in each outcome variable except PHQ-8. The slope and intercept of SE significantly predicted change in each outcome variable. Conclusion Over and above absolute level, increases in SE and OE were significant predictors of decreases in symptoms and increases in functioning. Implications for treatment are discussed, as well as future directions of research.