Dorčić, T. M., Živčić-Bećirević, I., & Smojver-Ažić, S. (2023). Anxiety in early adolescents during the Covid-19 pandemic: The role of intolerance of uncertainty and cognitive emotion regulation. European Journal of Psychology Open, 82(2), 45–55. https://doi.org/10.1024/2673-8627/a000035
Key Points
- The study examines the mediating role of intolerance of uncertainty and cognitive emotion-regulation strategies in the relationship between stress and anxiety symptoms in children and early adolescents during the COVID-19 pandemic.
- Stress directly and indirectly affects anxiety symptoms through intolerance of uncertainty and less adaptive cognitive emotion-regulation strategies.
- Intolerance of uncertainty and maladaptive cognitive emotion-regulation strategies are significant cognitive vulnerability factors for anxiety in children and adolescents.
- The findings can inform prevention and intervention programs for children and adolescents, focusing on correcting maladaptive cognitive emotion-regulation strategies and increasing tolerance of uncertainty.
- The COVID-19 pandemic has had significant effects on the mental health of children and adolescents, making this research particularly relevant.
Rationale
Anxiety is one of the most common psychological problems in children and adolescents, with an increasing trend during the COVID-19 pandemic (Meherali et al., 2021; Racine et al., 2021).
The cognitive model recognizes cognitive emotion regulation and intolerance of uncertainty as important vulnerability factors for anxiety (Caballero et al., 2023; Saraff et al., 2023).
Given the considerable uncertainty associated with the pandemic (Rettie & Daniels, 2021), these factors may be particularly salient in understanding anxiety symptoms in children and adolescents during this time (Korte et al., 2022).
This study addresses the knowledge gap regarding the combined effect of intolerance of uncertainty and emotional dysregulation on anxiety in children and adolescents during the pandemic (Akbari et al., 2021; Gullo et al., 2022).
Method
The study used a cross-sectional design with self-report questionnaires administered to a convenience sample of children and early adolescents.
Students from 5th to 8th grade completed online questionnaires on tablets during regular school hours, supervised by a school psychologist. Informed consent was obtained from the children and their parents.
Sample
The sample consisted of 234 students (128 females, 106 males) aged 11 to 15 years (M = 12.37, SD = 1.16) from an elementary school in Croatia.
Measures
- Revised Child Anxiety and Depression Scale (RCADS): Measures anxiety symptoms
- Intolerance of Uncertainty Scale for Children (IUSC): Measures reactions to uncertain, ambiguous situations and the future
- Cognitive Emotion Regulation Questionnaire (CERQ): Measures specific cognitive emotion-regulation strategies
- COVID-19 Related Stress Scale: Constructed for this study to measure stress related to the pandemic
Statistical measures
Descriptive statistics, zero-order correlations, and mediation analysis with gender as a covariate were conducted using SPSS and the Process macro extension.
Results
- The study hypothesized that stress would directly and indirectly affect anxiety symptoms through intolerance of uncertainty and cognitive emotion-regulation strategies.
- The results confirmed this hypothesis, showing that stress directly affects anxiety symptoms and indirectly through intolerance of uncertainty and less adaptive cognitive emotion-regulation strategies.
Insight
This study highlights the importance of intolerance of uncertainty and maladaptive cognitive emotion-regulation strategies as cognitive vulnerability factors for anxiety in children and adolescents during the COVID-19 pandemic.
These results suggest that intolerance of uncertainty and maladaptive cognitive emotion-regulation strategies partially mediate the relationship between stress and anxiety symptoms in children and early adolescents during the COVID-19 pandemic.
The findings extend previous research by demonstrating the combined effect of these factors in mediating the relationship between stress and anxiety.
Future research could explore the causal relationships between these variables and examine the effectiveness of interventions targeting these cognitive factors.
Strengths
- The use of well-established measures
- A diverse sample of children and early adolescents
- Advanced statistical analyses to test the hypothesized relationships
Limitations
- The study relied on self-report measures, which may be subject to bias
- The cross-sectional design limits the ability to draw causal conclusions
- The sample was from a single school in Croatia, which may limit generalizability to other populations
Clinical Implications
The study’s findings highlight the importance of developing effective prevention and intervention strategies for anxiety disorders in children and adolescents, as they are among the most common mental health problems in this age group and can have a significant impact on their current and future well-being.
The results suggest that intolerance of uncertainty and maladaptive cognitive strategies are key vulnerability factors for childhood anxiety, and targeting these factors in prevention and intervention programs could be beneficial.
Cognitive-behavioral interventions have strong empirical support for producing long-lasting positive outcomes in various domains and have been effective in modifying individual tolerance of uncertainty.
These interventions focus on teaching children and adolescents to plan their behavior and act thoughtfully and consciously, rather than simply learning desirable behaviors without addressing underlying cognitive processes. Treatment options may include psychoeducation, cognitive restructuring, and exposure experiments.
Emotional strategies that allow individuals to remain in challenging situations without needing to control them can help reduce negative cognitive, emotional, and behavioral responses to anxiety.
Gradually exposing children to uncertainty may help them develop a sense of safety, even in unpredictable situations. Preliminary evidence suggests that even brief, computer-assisted treatments targeting intolerance of uncertainty may effectively reduce fears of uncertainty.
Although adaptive and maladaptive emotion-regulation strategies are positively correlated, they have different roles in mediating the relationship between stress and anxiety.
While the use of “negative” strategies is associated with higher levels of anxiety symptoms, the use of “positive” strategies is not uniquely related to lower levels of anxiety symptoms.
Therefore, simply teaching children and adolescents adaptive emotion-regulation strategies may not be sufficient to help them cope with stress and alleviate anxiety.
Instead, it is crucial to focus on correcting the maladaptive strategies (self-blame, rumination, catastrophizing) they already use, especially in girls.
References
Primary reference
Dorčić, T. M., Živčić-Bećirević, I., & Smojver-Ažić, S. (2023). Anxiety in early adolescents during the Covid-19 pandemic: The role of intolerance of uncertainty and cognitive emotion regulation. European Journal of Psychology Open, 82(2), 45–55. https://doi.org/10.1024/2673-8627/a000035
Other references
Akbari, M., Spada, M. M., Nikčević, A. V., & Zamani, E. (2021). The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation. Clinical Psychology & Psychotherapy, 28(6), 1354–1366. https://doi.org/10.1002/cpp.2628
Caballero, C., Nook, E. C., & Gee, D. G. (2023). Managing fear and anxiety in development: A framework for understanding the neurodevelopment of emotion regulation capacity and tendency. Neuroscience and Biobehavioral Reviews, 145, Article 105002. https://doi.org/10.1016/j.neubiorev.2022.105002
Gullo, S., Gelo, O. C. G., Bassi, G., Lo Coco, G., Lagetto, G., Esposito, G., Pazzagli, C., Salcuni, S., Freda, M. F., Mazzeschi, C., Giordano, C., & Di Blasi, M. (2022). The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress. Current Psychology, 1–12. https://doi.org/10.1007/s12144-022-03071-5
Korte, C., Friedberg, R. D., Wilgenbusch, T., Paternostro, J. K., Brown, K., Kakolu, A., Tiller-Ormond, J., Baweja, R., Cassar, M., Barnowski, A., Movahedi, Y., Kohl, K., Martinez, W., Trafalis, S., & Leykin, Y. (2022). Intolerance of uncertainty and health-related anxiety in youth amid the COVID-19 pandemic: Understanding and weathering the continuing storm. Journal of Clinical Psychology in Medical Settings, 29(3), 645–653. https://doi.org/10.1007/s10880-021-09816-x
Meherali, S., Punjani, N., Louie-Poon, S., Abdul Rahim, K., Das, J. K., Salam, R. A., & Lassi, Z. S. (2021). Mental health of children and adolescents amidst COVID-19 and past pandemics: A rapid systematic review. International Journal of Environmental Research and Public Health, 18(7), Article 3432. https://doi.org/10.3390/ijerph18073432
Racine, N., McArthur, B. A., Cooke, J. E., Elrich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatrics, 175(11), 1142–1150. https://doi.org/10.1001/jamapediatrics.2021.2482
Rettie, H., & Daniels, J. (2021). Coping and tolerance of uncertainty: Predictors and mediators of mental health during the COVID-19 pandemic. American Psychologist, 76(3), 427–437. https://doi.org/10.1037/amp0000710
Saraff, P., Shikatani, B., Rogic, A. M., Dodig, E. F., Talluri, S., & Murray-Latin, H. (2023). Intolerance of uncertainty and social anxiety: An experimental investigation. Behaviour Change, 1–14. https://doi.org/10.1017/bec.2022.25
