Understanding anxiety: the role of psychological flexibility, intolerance of uncertainty and death anxiety as transdiagnostic mechanisms

Abstract

Anxiety disorders are among the most common mental health conditions globally and cause significant impairment in psychosocial functioning. Transdiagnostic processes such as psychological flexibility, intolerance of uncertainty and death anxiety have shown to be important in the development and maintenance of anxiety. This thesis aims to explore how these processes operate across populations, and more specifically, among healthcare professionals (HCPs). To explore these processes, a systematic review and empirical study were undertaken. A systematic review and meta-analysis examined the association between psychological flexibility and anxiety. The meta-analysis of 29 studies found a moderate negative association between PF and anxiety, however effect sizes varied by PF measure used, anxiety construct measured and sample size. Alongside this, a cross-sectional, mixed-methods study explored health anxiety among HCPs working in inpatient oncology, neurorehabilitation and mental health acute/psychiatric intensive care units. Psychological flexibility, intolerance of uncertainty and death anxiety were explored as predictors of HA. Quantitative findings found no significant differences between staff groups and HA. Death anxiety and psychological flexibility emerged as significant predictors of HA. Thematic analysis of qualitative data generated three overarching themes: (1) health consciousness; (2) shifting values, perspectives and acceptance; and (3) workplace stressors and coping. These findings contribute to the current literature on transdiagnostic mechanisms in anxiety. The meta-analysis identifies key moderators which may account for the inconsistencies in the literature. Additionally, the empirical study offers novel insights into how transdiagnostic processes are associated with health anxiety among HCPs, and the qualitative findings offer a nuanced understanding of the impact of clinical exposure (e.g. death, illness) on HCPs lifestyle choices and perspectives on life. This thesis may help to inform the development of more targeted interventions and highlights important areas for future research.

Keywords: anxiety, anxiety disorders, healthcare workers, health anxiety, psychological flexibility, death anxiety, intolerance of uncertainty

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Identifiers

ORCID for Juliana Figueiredo: orcid.org/0009-0005-9921-9006

ORCID for Warren Dunger: orcid.org/0000-0002-3213-5175

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