Fear and Anxiety in COVID-19: Preexisting Anxiety Disorders

Probably not a substantial claim: may not pass S3 (load-bearing).

In March 2020, 49.6% of people in the United Kingdom reported high levels of anxiety.

“When the COVID-19 virus was spreading in March 2020, 49.6% of people in the U.K. reported high levels of anxiety (Office for National Statistics, 2020, Shevlin et al., 2020).”

• cites Office for National Statistics, 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Shevlin et al., 2020 sourceDisputed

  The Abstract (Method; page unavailable) places the UK survey in March 2020, but the Discussion (page unavailable) reports an anxiety prevalence of 21.63%, not 49.6%. The Measures section also defines its highest category of COVID-19-related anxiety as the upper quintile, not 49.6% of respondents. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

Virtual reality treatment for anxiety-related disorders is effective and particularly useful for social anxiety.

“The virtual reality method of treating anxiety-related disorders is effective and especially useful for tackling social anxiety.”

• cites Bouchard et al., 2017 sourceSupported
  Experimental — accuracy not yet measured
• cites Clark, 1999 sourceNot checked — no full text of the source

May combine two claims.

Exposures also alter cognition because the two are closely linked, and behavioral change can occur before cognitive change.

“It should also be noted that the exposures also change cognition as the two are very closely related (Hofmann, 2008, Woody et al., 2011) and behavior change can preempt cognitive change (Woody et al., 2011).”

• cites Hofmann, 2008 sourceSupported
• cites Woody et al., 2011 sourceNot checked — no full text of the source

May combine two claims.

During the COVID-19 pandemic, the general population experienced a marked increase in fear and anxiety, caused both by the virus itself and by preventive measures such as staying indoors and increased hand-washing.

“The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing.”

• cites Office for National Statistics, 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Shevlin et al., 2020 sourcePartly supported

  The Abstract Results report higher anxiety levels in a UK population sample than in previous population studies, but say the increase was not dramatic. The Discussion says the study could not establish how the pandemic threat or quarantine influenced mental health. The paper mentions stay-at-home restrictions, but does not support the claimed causal effect of staying indoors or increased hand-washing on fear and anxiety. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Rather than uncertainty being elevated in patients with preexisting anxiety disorders, the concept of uncertainty distress may be more applicable.

“It may not be the case that such uncertainty is elevated in patients with preexisting anxiety disorders (Rettie & Daniels, 2020) but instead the construct of “uncertainty distress” may be more relevant (Freeston et al., 2020).”

• cites Rettie & Daniels, 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Freeston et al., 2020 sourceSupported

Probably not a substantial claim: may not pass S2 (checkable).

Clarifying the differences among actual threat, perceived threat, actual uncertainty, perceived uncertainty, and intolerance of uncertainty can aid case formulation and guide whether treatment targets uncertainty tolerance, threat overestimation, or both.

“Understanding the distinction between these constructs and which, if any, applies to patients will help in the formulation of patients’ difficulties and determine whether treatment focuses on tolerance of uncertainty, overestimation of threat, or a hybrid of the two (Freeston et al., 2020).”

• cites Freeston et al., 2020 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Sally benefited from the shift to remote appointments.

“The transition to remote appointments was beneficial for Sally.”

Probably not a substantial claim: may not pass S3 (load-bearing).

For Lila, whose focus was illness anxiety, the move to remote treatment was relatively smooth.

“Given the illness anxiety focus for Lila, the switch to remote treatment was relatively seamless.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Angela's transition to videotherapy was straightforward.

“Similarly, the switch to videotherapy for Angela was straightforward.”

May combine two claims.

People with highly inflated responsibility fear inadvertently infecting others and are likely to experience intense anxiety.

“People with highly inflated responsibility dread inadvertently infecting others and are likely to experience intense anxiety.”

May combine two claims.

In that study, participants who sought reassurance reported feeling less responsible afterward, while those who did not seek reassurance reported feeling more responsible.

“those who sought reassurance felt less responsible after receiving it, whereas those who did not seek reassurance felt more responsible.”

• cites Leonhart & Radomsky, 2019 sourceNot checked — no full text of the source

The quote only partly states this claim.

COVID-19 creates a paradox: the primary infection-control strategy encourages avoiding close contact and exposures, which conflicts with exposure-based therapy.

“COVID-19 seemingly presents a paradox. The main strategy introduced to prevent the spread of coronavirus infections is to encourage everyone to avoid coming into close contact with other people and to avoid exposures.”

• AssumptionRests on an assumption: The primary strategy to curb coronavirus spread is to advise everyone to avoid close contact and exposures.

May combine two claims.

The primary psychological treatment for anxiety-related disorders is CBT, which comprises a cognitive analysis of the disorder and a structured series of behavioral exposures.

“The main psychological treatment for anxiety-related disorders is CBT, which has two components: a cognitive analysis of the person’s disorder and a planned series of behavioral exposures (Clark, 1986, Clark and Beck, 2010, Rachman, 2020).”

• cites Clark, 1986 sourceNot checked — no full text of the source
• cites Clark and Beck, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Rachman, 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Online video or audio connections can provide diverse socially based exposure opportunities.

“Additionally, for those who have the capability, connecting with others online via video or audio platforms can offer a wide variety of socially based exposures.”

Probably not a substantial claim: may not pass S2 (checkable).

Shorter, more frequent outings, alone or with a trusted companion, may help prevent worsening anxiety and avoidance in agoraphobia.

“shorter and more regular trips either alone or accompanied temporarily by a trusted other may prevent an exacerbation of anxiety and avoidance.”

May combine two claims.

In a study with 72 undergraduate participants, those randomly assigned to a high-responsibility condition sought more reassurance and had longer conversations with confederates than those in a low-responsibility condition.

“Seventy-two undergraduate student participants were randomly assigned to conditions of high or low responsibility before engaging in a dishwashing task with a confederate.”

• Also stated in: § Inflated Responsibility · plain

  “Not only did participants seek more reassurance (and have longer conversations with confederates) under conditions of high responsibility than under conditions of low responsibility”

• cites Leonhart & Radomsky, 2019 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

At the time of writing in February 2021, the global death rate from COVID-19 was 2.27% according to the World Health Organisation.

“At the time of writing in February 2021, according to the World Health Organisation (2020), the global death rate from COVID-19 is 2.27%.”

• cites World Health Organisation (2020)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Videotelehealth group sessions are well-suited for anxiety-related disorders and are widely available.

“Videotelehealth group sessions are well-suited for treating anxiety-related disorders and widely available (Lamb et al., 2019)”

• cites Lamb et al., 2019 sourceNot checked — no full text of the source

May combine two claims.

People with inflated responsibility may respond to COVID-19 with more mask wearing, more hand-washing, greater caution in interactions, and more care with possibly contaminated items entering the home.

“This could result in wearing masks more often, but also in more hand-washing, more caution about interacting with others (both those presumed to be vulnerable, and those of unknown status), and more care taken with possibly contaminated packages, groceries and other items which enter the home.”

Probably not a substantial claim: may not pass S2 (checkable).

Agoraphobia exposure treatment can proceed as long as public health guidelines are followed.

“Exposure-based treatment for agoraphobia could continue while ensuring compliance with public health guidelines.”

• AssumptionRests on an assumption: People are permitted short outings even under the strictest lockdowns.

Probably not a substantial claim: may not pass S3 (load-bearing).

In panic disorder, the threat is a heart attack, loss of consciousness, or death.

“For example, the threat in panic disorder is a heart attack, losing consciousness, or dying (Clark, 1986).”

• cites Clark, 1986 sourceNot checked — no full text of the source

May combine two claims.

While many effective cognitive behavioral therapies aim to reduce safety behaviors, certain judicious safety behaviors can promote cognitive change.

“Many effective cognitive behavioral therapies include the reduction of safety behavior, but judicious types of safety behavior can facilitate cognitive change (Rachman, 2020).”

• cites Rachman, 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Combining creative in-vivo exposure, videotelehealth, and virtual reality means therapy can and should continue for both preexisting anxiety and pandemic-related anxiety.

“Taken together, creative in-vivo exposure, videotelehealth and virtual reality mean that therapeutic interventions can and should continue to be provided both for the original anxiety-related difficulty but also for any additional anxiety that has been precipitated by the pandemic.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In social anxiety, the perceived threats are rejection or humiliation.

“The perceived threats in social anxiety are rejection or humiliation.”

May combine two claims.

Although advice and imposed actions are necessary to prevent COVID-19 spread, they might worsen problems for people with preexisting anxiety-related disorders.

“The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder.”

• AssumptionRests on an assumption: The advice and imposed actions, such as lockdown and staying home, are necessary to prevent the spread of COVID-19.

Probably not a substantial claim: may not pass S3 (load-bearing).

Clinical guidelines recommend CBT.

“and is recommended in clinical guidance (e.g., https://psychiatryonline.org/guidelines; NICE, 2019).”

• cites NICE, 2019Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Wearing a mask alone in a private car may count as a COVID-19 safety behavior and could paradoxically sustain an overestimation of threat and personal vulnerability.

“wearing a mask while driving a car alone that is not shared with others may be considered a COVID-19-related safety behavior and ironically may have deleterious consequences that include a continued overestimation of threat and personal vulnerability.”

May combine two claims.

COVID-19 may trigger both the worsening and the new onset of anxiety in people who are already vulnerable because of preexisting anxiety.

“We suggest that it is the case that COVID-19 may precipitate an exacerbation, as well as acquisition, of anxiety in those who are already vulnerable by virtue of their preexisting anxiety.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Remote treatment has drawbacks, but home-based sessions offer advantages such as easy access to exposure items for OCD contamination and opportunities for impromptu family conversations that can aid therapy.

“Although offering treatment remotely has its challenges (e.g., inconsistent wifi connection, perhaps missing emotional nuances, the lack of eye contact), seeing people in their home environment offers benefits that includes ease of access to potential items for exposure in the case of OCD contamination and the potential of an impromptu conversation with a parent or spouse to aid in treatment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Inflated responsibility is a primary cause of obsessive-compulsive disorder.

“Salkovskis (1985) proposed that inflated responsibility is a primary cause of OCD.”

• cites Salkovskis (1985) sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

People with anxiety-related disorders encounter many stimuli daily, but not all stimuli are equally able to trigger anxiety or allow summation.

“Of course, people with anxiety-related disorders confront a variety of stimuli on a daily basis, but not all stimuli have the same ability to trigger anxiety or present with the opportunity for summation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It is theoretically possible to treat housebound agoraphobia using a personalized virtual reality program that simulates increasing distances from home.

“In principle it is possible to overcome a person’s housebound agoraphobia by preparing a personalized virtual reality program (increasing distances from home).”