Advising activity-knowledge, attitudes, beliefs, and behaviors regarding the recommendation of physical activity in clinical psychologists.

BACKGROUND: Regular physical activity comes with multiple benefits for physical but also mental health and can be a pivotal element in the prevention and treatment of mental disorders. Clinical psychologists play an important role in supporting their patients in increasing physical activity levels. Up to date, there is only little research on recommendation of physical activity in psychologists worldwide and no such research for psychologists in Germany. Aim of this study was to assess knowledge, attitudes, beliefs and behaviors regarding physical activity in psychologists in Germany. METHODS: We assessed knowledge, attitudes, beliefs and behaviors regarding physical activity among a sample of clinical psychologists in Germany using the "Exercise in Mental Illness Questionnaire-German" (EMIQ-G) in a cross-sectional online survey. RESULTS: 454 participants were included in the analysis. Participants reported moderate levels of knowledge and self-confidence in recommending physical activity. Only 14% of the participants received formal training regarding physical activity recommendation. Most participants recommended physical activity to their patients, primarily through personal discussions and referrals to exercise professionals. About one third did not give any recommendations regarding intensity. Strength training was only recommended by a minority. CONCLUSION: There is a need for greater integration of information and instructions regarding the recommendation of physical activity in the treatment of people with mental disorders in the training and further education of psychologists.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression.

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Viral Transmission? A Longitudinal Study of Media Use and Its Relation to Mental Strain During the First 2 Years of the COVID-19 Pandemic.

BACKGROUND: In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain. METHOD: The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany. RESULTS: Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later. CONCLUSION: Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage. TRIAL REGISTRATION: The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106 .

Tracking changes in physical activity during inpatient treatment in a psychiatric clinic in Germany by asking two simple questions.

Increasing physical activity is essential to improve psychiatric patients' physical and mental health. This study aimed to characterise the physical activity levels of inpatients in a general psychiatric clinic and to determine the feasibility of using a simple tool in everyday practice to assess physical activity levels in standard patient documentation. We assessed the level of physical activity undertaken by patients treated on an inpatient basis in a psychiatric hospital over 20 months. A total of 328 patients were included in the analysis. Physical activity was measured using a slightly altered version of the Exercise as a vital sign (EVS) questionnaire. All information was extracted from letters of discharge. During inpatient treatment, moderate to vigorous activity levels increased, and more patients engaged in physical activity. Patients with mood or anxiety disorders displayed the most considerable increase in physical activity. Patients with other diagnoses, such as schizophrenia, benefitted less or not at all. Factors associated with physical activity included-among others-history of substance use, education and month of admission. Investigating the feasibility of standardised documentation of physical activity showed fluctuation in documentation rates throughout the study. The level of physical activity performed by psychiatric patients can be increased during inpatient treatment. Implementing physical activity level as part of standard patient documentation is a first step in gathering data to assess the need for interventions to achieve an optimal physical activity in psychiatric patients throughout inpatient treatment.

[Sports psychiatry and psychotherapy]. / Sportpsychiatrie und -psychotherapie.

Sports psychiatry and psychotherapy is a relatively young field and is comprised of two key segments: the special features of the diagnostics and therapy of mental disorders in elite athletes and the use of exercise and sports in the development and treatment of mental disorders. Although all mental disorders can in principle also occur in (elite) athletes, there are additionally sport-specific mental disorders, such as anorexia athletica and other eating disorders, chronic traumatic encephalopathy, misuse of and dependency on performance-enhancing substances (doping) and muscle dysmorphia. Many high-quality clinical trials over the past two decades have been able to demonstrate a therapeutic efficacy of physical activity and sport in the treatment of various mental disorders. All clinicians active in psychiatry and psychotherapy should possess a basic knowledge of sports psychiatry.

Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany.

In context of the current COVID-19 pandemic the consumption of pandemic-related media coverage may be an important factor that is associated with anxiety and psychological distress. Aim of the study was to examine those associations in the general population in Germany. 6233 participants took part in an online-survey (March 27th-April 6th, 2020), which included demographic information and media exploitation in terms of duration, frequency and types of media. Symptoms of depression, unspecific anxiety and COVID-19 related anxiety were ascertained with standardized questionnaires. Frequency, duration and diversity of media exposure were positively associated with more symptoms of depression and unspecific and COVID-19 specific anxiety. We obtained the critical threshold of seven times per day and 2.5 h of media exposure to mark the difference between mild and moderate symptoms of (un)specific anxiety and depression. Particularly the usage of social media was associated with more pronounced psychological strain. Participants with pre-existing fears seem to be particularly vulnerable for mental distress related to more immoderate media consumption. Our findings provide some evidence for problematical associations of COVID-19 related media exposure with psychological strain and could serve as an orientation for recommendations-especially with regard to the thresholds of critical media usage.

Mental Health in Health Professionals in the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has posed enormous challenges to the healthcare systems worldwide, which are mainly shouldered by healthcare workers from all professions. This chapter outlines the potential stressors of the COVID-19 pandemic for health professionals and describes possible consequences for their mental health as well as potential interventions and coping strategies. The chapter is based on preliminary research on the psychosocial implications of the COVID-19 pandemic in health professionals and is complemented by findings from previous outbreaks of high-risk infectious diseases. High proportions of healthcare workers report acute symptoms of anxiety, depression, high psychological stress, and insomnia in the context of the COVID-19 pandemic. Coping strategies and self-care on an individual level, interventions on an institutional level such as specific training and institutional support, as well as social and psychological support can help to mitigate psychological strain. Further reliable and prospective studies regarding the mental health of health professionals, as well as further measures to protect their short- and long-term mental health, are required.

[Dealing with psychological distress by healthcare professionals during the COVID-19 pandemia]. / Umgang mit psychischer Belastung bei Gesundheitsfachkräften im Rahmen der Covid-19-Pandemie.

BACKGROUND: In the current COVID-19 pandemia, health workers from all professions are facing great challenges in coping with the crisis. In this situation health professionals are confronted with specific stressors and risks not only for the physical but also for the mental health. OBJECTIVE: This article summarizes the first recommendations for the reduction of stress and psychological burden in health professionals during the current COVID-19 pandemia. METHODS: The recommendations of the World Health Organization, the United Nations and the International Red Cross Society are summarized. Recommendations for the reduction of stress and psychological distress in health professionals as well as important factors that team leaders can consider in order to reduce psychological distress in employees are presented. RESULTS: The normalization of strong emotions and stress, the fulfillment of basic needs, social support, clear communication and distribution of tasks, flexible working hours and the utilization of psychosocial and psychological help without stigmatization seem to be particularly important measures. CONCLUSION: This article presents guidelines for health professionals and team leaders in healthcare that help to maintain mental health during the COVID-19 pandemia.

Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions.

INTRODUCTION: While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior. METHODS: N = 83 outpatients with MD (F1-F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention. RESULTS: Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change. CONCLUSIONS: MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.

Exercise as Treatment for "Stress-Related" Mental Disorders.

The beneficial impact of physical activity on preventing and treating mental disorders has captured growing (research) interest. This article aims to provide a concise overview of essential evidence regarding the effectiveness and underlying mechanisms of physical activity for individuals with mental disorders clustered as "stress-related" conditions. Empirical findings (e.g., longitudinalprospective studies, interventional randomized-controlled-trials, reviews, meta-analyses) regarding the effects of physical activity in the prevention and treatment of stress-related mental disorders are summarized. Furthermore, potential mechanisms underlying these effects are discussed, and recommendations regarding the use of physical activity are outlined. The majority of studies indicate good efficacy of physical activity in prospectively lowering the risk for the incidence of subsequent stress-related mental disorders as well as in the treatment of manifest disorders. Most evidence targets unipolar depressive disorder and, secondly, anxiety disorders. Research regarding posttraumatic stress disorder, obsessive-compulsive disorders, and somatoform disorders is promising but scarce. Physical activity seems to be useful as a stand-alone-treatment as well as in combination with other psychotherapeutic or pharmacological treatments. Multiple intertwined physiological, psychological, and social mechanisms are assumed to mediate the beneficial effects. Recommendations regarding physical activity can orientate on official guidelines but should consider the individual needs and circumstances of each subject. In summary, physical activity seems to be effective in the prevention and treatment of stressrelated mental disorders and, therefore, should be fostered in healthcare-settings. Future studies are needed to clarify partly inconsistent patterns of results and to close research gaps, e.g., concerning somatoform disorders.

Illness anxiety predicts higher mental strain and vaccine willingness-A nine-wave longitudinal study during the first 1.5 years of the COVID-19 pandemic in Germany.

Illness anxiety may amplify vulnerability to psychopathological symptoms during the COVID-19-pandemic-perhaps especially at the beginning of the pandemic and during high infection waves, but empirical evidence on this is lacking. In addition, considering a potentially functional facet of it, illness anxiety might be associated with higher vaccine willingness. We analyzed data of a nine-wave longitudinal online-survey (March 2020-October 2021) with 8148 non-probability sampled adults of the general population in Germany (clinicaltrials.gov: NCT04331106). Using multilevel analysis, we investigated longitudinal associations of dimensionally assessed illness anxiety (worry about illness, bodily preoccupation) with mental strain and vaccine willingness and considered the dynamic of the pandemic (i.e., duration and infection rates). Higher worry about illness and bodily preoccupation were associated with higher COVID-19-related fears, unspecific anxiety, depressive symptoms, and vaccine willingness. Vaccine willingness increased over time and in parallel to higher infection rates. Symptoms of mental strain decreased with continuing duration of the pandemic but increased when infection rates inclined. This decrease and increase, respectively, was steeper in individuals with higher illness anxiety. Our findings suggest that individuals with higher illness anxiety are more vulnerable to experience psychopathological symptoms during the ongoing pandemic, particularly at its beginning and during times of high infection rates. Thus, illness anxiety and associated symptoms should be targeted by adaptive measures. The fluctuation of symptoms parallel to the pandemic situation implies that support should be particularly issued at the beginning of extraordinary situations as well as during phases of high infection rates.

Psychological distress and anxiety in Arab refugees and migrants during the COVID-19 pandemic in Germany.

The COVID-19 pandemic is associated with various psychological stressors due to health-related, social, economic, and individual consequences, especially for minority groups such as refugees and other migrants who live in unstable conditions and have lost their social support groups. The aim of this study was to explore the impacts of the COVID-19 pandemic on this specific population in Germany.This study used a mixed-method approach. A total of 85 migrants took part in an online survey in Germany from April to July 2020. The questionnaire included demographic information and measures of psychological distress, anxiety and depressive symptoms, as well as risk and protective factors for psychological health during the COVID-19 pandemic. Semi-structured interviews with 10 refugees were conducted between May and June 2020. In our sample, 54.5% expressed fear of being infected with COVID-19. Participants spent several hours per day thinking about COVID-19 (M = 3.13 hours). Psychological and social determinants of mental health showed stronger associations with anxiety regarding COVID-19 than experiences with the disease. Interviews showed that especially for refugees with limited information regarding access to medical treatment, the pandemic increased already-existing psychological symptoms and worries about their families back home and reminded them of their flight from their home country to Europe. The COVID-19 pandemic is associated with psychological distress, anxiety, and depression in refugees and migrants in Germany. Information on where to get medical treatment, if needed, is of utmost importance to this population group, in addition to other strategies such as maintaining a healthy lifestyle and social contacts, and acceptance of strategies to cope with anxiety and negative emotions.

1.5 years pandemic - Psychological burden over the course of the COVID-19 pandemic in Germany: A nine-wave longitudinal community study.

BACKGROUND: The dynamic COVID-19 pandemic has been associated with mental strain. However, most studies focused primarily on the beginning of the pandemic and rarely took into account the long-term course. The aim of this prospective-longitudinal study was to investigate levels and changes of pandemic-related fears, unspecific anxiety, depressive symptoms, and psychosocial-behavioral factors over the first 1.5 years of the pandemic. METHODS: We conducted a nine-wave longitudinal online-survey from March 2020 to October 2021 with a total of 8148 participants of the adult general population in Germany. Descriptive examination and multilevel analysis were carried out to assess psychological burden, risk-bearing and protective psychosocial-behavioral factors, and associations with sociodemographics and the pandemic's duration and severity over the course of the pandemic. RESULTS: Symptoms of mental strain fluctuated across the pandemic and displayed a relative maximum at the pandemic's early beginning and during the second and third COVID-19 waves. Most participants (approximately 67.4 %-82.1 %) reported mild and transient symptoms, but a substantial portion (approximately 17.9 %-32.6 %) experienced pronounced mental health problems during the pandemic. Symptom severity was negatively associated with the duration of the pandemic and positively associated with the rate of new infections. LIMITATIONS: The observational study design, non-probability-sampling methods, and online self-report assessments limit the generalizability of our results. CONCLUSIONS: The fluctuating course of psychological burden during the pandemic emphasizes the relevance of continuous monitoring during this challenging time. Particularly individuals with pronounced subclinical symptoms or manifesting mental disorders should be targeted with adequate prevention and early intervention programs.

Problem drinking among university students in Berlin.

OBJECTIVE: Problem-drinking among university students is common and poses serious health-related risks. Therefore, identifying and addressing associated factors is important. PARTICIPANTS AND METHODS: A large cross-sectional online-survey with 12,914 university students from Berlin was conducted from November 2016 to August 2017. Relative-risk- and correlation-analysis was used to identify factors associated with problem-drinking and regular heavy-drinking. Independent t-tests compared impulsivity and personality traits, chi-square-tests compared drinking motives between risk- and non-risk-drinkers. RESULTS: Male gender, tobacco-smoking, illegal substance use, impulsivity and various sociodemographic and psychosocial variables were significantly related to problem/heavy-drinking. Extraversion was a risk, conscientiousness and agreeableness were protective factors. Drinking-motives did not differ significantly between risk- and non-risk-drinkers. Generally, the main drinking-motives were to feel elated, relax and social purposes. CONCLUSION: The identified markers and related problem behaviors may serve as a tool to enhance the identification of student subgroups at risk for problem/heavy-drinking, and hence improve targeted health-intervention-programs.

Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample.

Introduction: The COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures. Methods: The mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age. Results: Seventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p <0.0001; 0.39 < r <0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and a stress level, respectively. Reduced physical activity was significantly (p <0.0001) associated with higher PHQ-4 values in the general population sample. Discussion: Lower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population.

No party, no drugs? Use of stimulants, dissociative drugs, and GHB/GBL during the early COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic is presumably having an impact on the consumption of psychoactive substances. Social distancing and lockdown measures may particularly affect the use of "party drugs" (e.g., stimulants, dissociatives, and GHB/GBL) through the absence of typical use settings. We aimed to analyse the use patterns of those substances and underlying motivations before and during the pandemic. METHODS: A subsample of 1,231 users of stimulants (amphetamine, methamphetamine, MDMA/ecstasy, cocaine), dissociative drugs (ketamine, dextromethorphan, PCP), and GHB/GBL was assessed from 30th April to 4th August 2020 as part of the Corona Drug Survey, a cross-sectional international online survey in five languages that included a total of 5,049 participants. The reported use of distinct substances and the underlying motivations were ascertained before (retrospectively) and during the pandemic. Furthermore, associations between drug use as a coping mechanism, pandemic-related stressors, and substance use were examined. RESULTS: Regarding the reported frequency of use during the pandemic, 48.0-64.8% of the sample ceased or decreased, 11.9-25.5% maintained, and 23.6-29.1% increased their consumption. MDMA/ecstasy showed the strongest decrease and GHB/GBL and dissociatives the highest increase. Participants reported that price, quality, and supply were mostly unaffected by the pandemic. The most common motivations before and during the pandemic were mood-related factors, such as a desire to feel exhilarated, euphoric, high, or buzzed. The relevance of social purposes and mood-related motivators declined during the pandemic, whereas dealing with boredom increased. Overall, 16.4-35.6% perceived drug use as helpful for dealing with pandemic-related stressors, which were associated with an increased consumption frequency. CONCLUSION: The early stage of the COVID-19 pandemic was associated with major changes in the use of "party drugs". Those who increased their level of drug use and perceived it as a coping strategy in particular might be targeted with adaptive preventive and therapeutic measures.

COVID-19 vaccine hesitancy and related fears and anxiety.

BACKGROUND: Vaccination is crucial to limit the pandemic spread of SARS-CoV-2/COVID-19. Therefore, besides the development and supply of vaccines, it is essential that sufficient individuals are willing to get vaccinated, but concerning proportions of populations worldwide show vaccine hesitancy. This makes it important to determine factors that are associated with vaccine acceptance. METHODS: 1779 adults of a non-probability convenience sample in Germany were assessed with an online survey in a cross-sectional survey period from 1st to 11th January 2021 (a few days after the beginning of vaccinations in Germany). RESULTS: 64.5% of the sample stated that they absolutely would accept the vaccination, 13.8% would rather accept it, 10.4% were undecided, and 5.2% would rather not and 6.0% absolutely not get vaccinated. COVID-19-related anxiety, and fears of infection and health-related consequences correlated significantly positively with vaccine acceptance (all p < .001). In contrast, social (p = .006) and economic fears (p < .001) showed significant negative associations with vaccination willingness. The broader constructs of unspecific anxiety and depressive symptoms were not significantly associated with vaccine acceptance. Vaccine acceptance differed between users/non-users of social media and official websites to gain information about the pandemic (p < .001). CONCLUSIONS: COVID-19-related anxiety and health-related fears were associated with higher vaccine acceptance, whereas the fear of social and economic consequences showed the contrary direction. These findings highlight the need to differentiate between several types of fears and anxiety to predict their influence on vaccine acceptance, and provide important information and an essential base for future studies and interventions.

Step Away from Depression-Study protocol for a multicenter randomized clinical trial for a pedometer intervention during and after in-patient treatment of depression.

OBJECTIVES: Increasing the number of daily steps by using a pedometer and a diary leads to an activity increase and improved health outcomes in a variety of somatic disorders. Hence, for the inpatient treatment of depression, supervised exercise interventions are more widespread. We aim to examine if a self-managed pedometer intervention (PI) with the option of being proceeded after discharge leads to reduction of depression and to a physical activity (PA) increase. METHODS: The Step Away from Depression (SAD) study is a multicenter randomized controlled trial targeting 400 patients with major depressive disorder. Treatment as usual (TAU) is compared to TAU plus PI after 4 weeks, at discharge, and 6 months after hospital admission. Primary outcomes are clinically rated depression severity and accelerometer-measured step counts. Secondary outcomes include self-reported depression symptoms and PA level, psychiatric symptoms, health-related quality of life, self-efficacy, and components of the Motivation Volition Process Model. RESULTS: We report the design of the SAD study considering several methodological aspects for exercise studies, in general. CONCLUSIONS: Results of our study will provide information about efficacy of PI for inpatient treatment and about interrelating processes of change concerning depression, PA, and aspects of motivation and volition.

Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic is related to multiple stressors and therefore may be associated with psychological distress. The aim of this study was to longitudinally assess symptoms of (un-)specific anxiety and depression along different stages of the pandemic to generate knowledge about the progress of psychological consequences of the pandemic and to test the role of potential risk and resilience factors that were derived from cross-sectional studies and official recommendations. METHODS: The present study uses a longitudinal observational design with four waves of online data collection (from March 27 to June 15, 2020) in a convenience sample of the general population in Germany. A total of N = 2376 participants that completed at least two waves of the survey were included in the analyses. FINDINGS: Specific COVID-19-related anxiety and the average daily amount of preoccupation with the pandemic decreased continuously over the four waves. Unspecific worrying and depressive symptoms decreased on average but not on median level. Self-efficacy, normalization, maintaining social contacts, and knowledge, where to get medical support, were associated with fewer symptoms relative to baseline. Suppression, unhealthy habits, and a longer average daily time of thinking about the pandemic were correlated with a relative increase of symptoms. INTERPRETATION: Our findings provide insight into the longitudinal changes of symptoms of psychological distress along the first three months of the COVID-19 pandemic in Germany. Furthermore, we were able to reaffirm the anticipated protective and risk factors that were extracted from previous studies and recommendations.