Transdiagnostic vulnerability factors for behavioral health problems during COVID-19

ABSTRACT

The novel 2019 SARS-2-CoV causing COVID-19 has had a devastating impact on the entire world. COVID-19 is a broad-based stressor, and research to date has documented increases in mental health problems, including anxiety, depression, and substance use, since the onset of COVID-19. By taking a transdiagnostic approach, scholars can help elucidate mechanisms and vulnerability as well as resiliency related to behavioral health problems in the context of COVID-19. The aim of the current special issue of Cognitive Behaviour Therapy was to showcase ongoing research focused on transdiagnostic factors in the context of COVID-19. The purpose of this issue is to highlight the significance of this work in the pandemic for research and practice; illustrate some of the many domains currently being explored via innovative approaches; and explicate fruitful areas for programmatic study. We hope that readers will recognize the important role of transdiagnostic models and their potential to offset the mental, addictive, and physical health disease burden of COVID-19.

KEYWORDS:

• COVID-19
• transdiagnostic
• health behaviors
• mental health

The novel 2019 SARS-2-CoV causing COVID-19 has had a devastating impact on the entire world. Along with causing hundreds of millions of infections and over 2 million deaths (World Health Organization, 2021), COVID-19 has had a significant physical health, mental health, economic, and social impact, among others (Cao et al., 2020; Guan et al., 2020; Pietromonaco, 2020; Sun et al., 2020; Zhou et al., 2020). Efforts to curb the spread of the virus, including social distancing measures, have been necessary to control the spread of the virus, but have decreased important social contacts usually relied upon for stress management (Armitage & Nellums, 2020). The full extent of the stress of COVID-19 is presently unknown, but COVID-19 presents a broad-based societal stressor. Indeed, studies consistently show that COVID-19 has been associated with elevated in mental health problems, including anxiety, depression, stress, and substance use (Gallagher et al., 2020; Pfefferbaum & North, 2020; Rajkumar, 2020; Rogers et al., 2020; Wang et al., 2020; Xiong et al., 2020; Zvolensky et al., 2020).

Exposure to COVID-19 stress likely influences the development, or exacerbation, of psychological and neurobiological processes that confer vulnerability to multiple types of psychopathology, including anxiety and depression (Pfefferbaum & North, 2020; Yao et al., 2020). A recent meta-analysis suggests that over 80% of people are experiencing increased stress, upwards of 50% increased anxiety, approximately 48% increased depression, and 38% reported increase in psychological distress generally (Xiong et al., 2020). We highlight the importance and potential of a transdiagnostic framework in efforts to better understand the link between COVID-19 stress and psychopathology (Dalgleish et al., 2020; Krueger & Eaton, 2015; Sauer-Zavala et al., 2012). Taking a transdiagnostic approach allows the identification of core psychological and neurobiological processes that underlie multiple forms of psychopathology (Nolen-Hoeksema & Watkins, 2011). COVID-19 stress burden (accumulated impact of stress) may have a particularly detrimental influence when it happens among persons already struggling with greater stress exposure and pre-existing psychopathology. Specifically, higher degrees of COVID-19 stress can influence patterns of social, emotional, and neurobiological development in ways that facilitate the rapid detection of potential threats (McLaughlin & Lambert, 2017), and by extension, may increase risk for multiple forms of psychopathology.

In general, adverse life events increase the risk of psychopathology, particularly disorders of emotion (Rogosch & Ciccheti, 2005; Roy et al., 2004; Shields et al., 1994). Indeed, alterations in stress- and threat-response systems may compromise emotion-and attention-regulatory systems (Brake et al., 2004). These data have often been used to explain the heightened risk for behavioral and affective disorders following exposure to adverse stressors in life (Heim & Nemeroff, 2001; Nemeroff, 2004). This transdiagnostic theoretical framework also is at the crux of the assertion that increased rates of emotional disorders are an inevitable consequence of the pandemic (Zvolensky et al., 2020). After repeated exposure, a threat processing system involving a rapid appraisal-response system develops that is capable of orchestrating rapid reactions with little processing (LeDoux & Phelps, 2008).

Little work has examined transdiagnostic factors in terms of COVID-19-specific mental health concerns and health behavior problems. However, non-COVID-19 work from a myriad of samples provides strong empirical support for the transdiagnostic theoretical framework in terms of mental health and health behavior problems. Considering the recent and ongoing nature of COVID-19, the extent to which these transdiagnostic factors affect mental health and health behaviors is currently unknown. However, it is likely that understanding the relationship between transdiagnostic factors and behavioral health outcomes as it pertains to COVID-19 will be fruitful in developing targeted, efficacious treatments for mental health and health behavior concerns. Therefore, the aim of the current special issue of Cognitive Behaviour Therapy was to showcase ongoing research focused on transdiagnostic factors in the context of COVID-19.

The studies included in this special issue generally examine the relationship of transdiagnostic risk factors and COVID-19 stress and mental health problems, health behaviors, and substance use. First, Paluszek et al. (2021) examined anxiety sensitivity, disgust, and intolerance of uncertainty as longitudinal transdiagnostic predictors of COVID-19-specific stress. Similarly, Warren et al. (2021) examined anxiety sensitivity as a transdiagnostic predictor of COVID-19 fear and mental health concerns among a U.S. population-based sample. Additionally, Fedorenko et al. (2021) conducted a survey in a COVID-19 hotspot and explored anxiety sensitivity, intolerance of uncertainty, and health anxiety as predictors of fears of contamination from the virus and fears of the negative consequences of social distancing. Gallagher et al. (2021) focused on hope as a longitudinal transdiagnostic resilience factor in terms of COVID-19 stress, anxiety, and well-being. In terms of health behaviors, Pizzonia et al. (2021) examined COVID-19 safety behaviors, worry, and depression as longitudinal transdiagnostic predictors of insomnia, while Wissemann et al. (2021) examined COVID-19 fear in terms of controlling parenting behaviors.

Five studies, among different populations, examined the relationship between transdiagnostic risk factors and substance use outcomes. Cho et al. (2021) examined anhedonia, distress intolerance, anxiety sensitivity, and negative urgency as longitudinal transdiagnostic predictors of substance use and substance use coping motives among a sample of adolescents. Relatedly, four additional studies focused on substance use during COVID-19. Vujanovic et al. (2021) explored COVID-19-specific worry as a transdiagnostic predictor of mental health and substance use concerns among a sample of first responders. Gold et al. (2021) examined COVID-19 fear as a transdiagnostic predictor of motivation to reduce smoking as well as actual smoking reduction among a sample of cigarette smokers. Shepherd et al. (2021) examined COVID-19-specific worry as a transdiagnostic predictor of coping motives and barriers to quit smoking among a sample of cigarette smokers. And finally, Buckner et al. (2021) examined emotion dysregulation as a transdiagnostic predictor of blood alcohol level and drinking to cope during COVID-19.

Overall, the present issue includes a set of articles that span major research and application areas in transdiagnostic processes in the context of COVID-19 and illustrative examples of cutting-edge work on theory, research methods, and clinical applications. The purpose of this issue is to highlight to readers of Cognitive Behaviour Therapy and others the significance of this work in the pandemic for research and practice; illustrate some of the many domains currently being explored via innovative approaches; and explicate fruitful areas for programmatic study. We hope that readers will recognize the important role of transdiagnostic models and their potential to offset the mental, addictive, and physical health disease burden of COVID-19.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) to the University of Houston under Award Number U54MD015946. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.