Meaning in life after cancer: Validation of the sources of meaning card method among participants in cancer rehabilitation.

Cancer survivors may be struggling to re-create meaning in life. Addressing their personal sources of meaning can support them in this process. The sources of meaning card method (SoMeCaM) aims to map and explore personal sources of meaning in a 1-h session. It includes 26 cards, each with a statement on a source of meaning. The purpose of this study was to validate the statements on the sources of meaning cards for use among participants in cancer rehabilitation by examining whether participants attribute the same meaning to the statements as intended. The three step test interview method was used to assess response processes to the sources of meaning cards among 12 participants in a 5-day cancer rehabilitation program in Denmark. The interviews were transcribed verbatim and analyzed using framework analysis. Nineteen of the 26 statements were interpreted congruently, that is, in line with the underlying theory, by all participants. Issues of incongruency, ambiguity and confusion were observed in participants' interpretations of the statements on religiosity (n = 6), spirituality (n = 10), and reason (n = 6). Minor issues were observed for the statements on practicality, achievement, knowledge, and attentiveness. In most statements, cancer survivors' interpretation aligned with the underlying theory. Problems were apparent regarding the sources of meaning religiosity, spirituality and reason, and a reconsideration of the wording of the statements is recommended. These problems may be due to cultural and linguistic interpretations rather than to being a cancer survivor. Future studies could focus on these issues in other target populations. Despite these minor issues, the SoMeCaM has proven useful in addressing the important topic of meaning in life in the cancer rehabilitation setting. Clinicians should pay attention to nuances in participants' understanding of the cards.

The Uncertain Certainty: A Mixed Methods Exploration of Personal Meanings of Death and Preliminary Insights Into Their Relationship With Worldview.

The present mixed methods study investigated personal meanings of death, i.e., concepts, views, and expectations associated with one's own death, and explored their relation to worldview. To this end, a sample of 202 young, German-speaking adults completed the Death Statements Test, a new qualitative assessment tool, as well as quantitative measures of religiosity, spirituality, atheism, and agnosticism. Qualitative data was transformed to enable quantitative analyses. Results indicated that the spectrum of personal meanings of death is generally broad and multifaceted. The most prevalent view on death was "death as source of motivation and meaning in life." The frequencies of emotionally positive and negative death meanings were relatively balanced, while neutral statements dominated. Relationships between participants' death meanings and worldview dimensions turned out to be small but existent. The Death Statements Test proved to be a valuable and economic assessment tool, eliciting rich qualitative material on personal meanings of death.

A Randomized Controlled Trial of the Sources of Meaning Card Method: A New Meaning-Oriented Approach Predicts Depression, Anxiety, Pain Acceptance, and Crisis of Meaning in Patients with Chronic Pain.

OBJECTIVE: Although considered the first-line psychological treatment for chronic pain, cognitive behavioral therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of patients with chronic pain. Moreover, important existential perspectives are sparsely or not at all integrated into cognitive behavioral therapy. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy. DESIGN: A randomized controlled trial was conducted with 42 patients with chronic pain. The trial compared an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline and at 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes. RESULTS: Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression, and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large. CONCLUSION: Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.

Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally.

BACKGROUND: Reactions to the COVID-19 pandemic are diverse, and both mental distress and existential crises can arise. The identification of protective and exacerbating factors and their progress over time is therefore highly relevant. The current study examined longitudinal protective effects of meaningfulness and exacerbating effects of crisis of meaning on general mental distress. METHODS: N = 431 participants from Germany and Austria (mean age: 42 years) completed an online survey in both April/May (T1) and July/August 2020 (T2). After determining temporal stability or changes in meaningfulness, crisis of meaning, and general mental distress (PHQ-4), we examined whether (i) meaningfulness and (ii) crisis of meaning, measured at T1, incrementally predicted PHQ-4 at T2, beyond baseline levels of PHQ-4. We further tested (iii) a within-subject mediation of temporal changes in PHQ-4 by changes in crisis of meaning. RESULTS: Meaningfulness prospectively predicted lower PHQ-4, and crisis of meaning predicted higher PHQ-4. From the first wave of the pandemic until a slowdown three months later, meaningfulness was stable, and crisis of meaning and PHQ-4 decreased. Changes in crisis of meaning mediated the changes in PHQ-4. CONCLUSIONS: Meaningfulness appears to have a protective, and crisis of meaning an exacerbating effect on psychological distress, as shown here for the time of the first pandemic wave until three months later. Attention to existential experiences of meaningfulness and loss of meaning thus proves relevant to the clinical and public health context. Measures that support meaningfulness will help coping with crises of meaning, which in turn supports overcoming general mental distress.

Effects of mortality awareness on attitudes toward dying and death and meaning in life-a randomized controlled trial.

A randomized controlled trial was carried out to investigate effects of heightened mortality awareness on meaning in life and attitudes toward dying and death. An intervention group (n = 51) completed questionnaires and participated in interventions to increase mortality awareness; a control group (n = 47) only completed the questionnaires. Longitudinal analyses revealed a decrease in the intervention group's fear of dying and an increase in their acceptance of dying, but no effects on attitudes toward death. Changes in meaningfulness were contingent on participants' religiousness. Unexpected cross-sectional results and the study's implications for theory and further empirical work are discussed.

The existential dimension of the pandemic: Death attitudes, personal worldview, and coronavirus anxiety.

A cross-sectional survey to investigate relationships between coronavirus anxiety, individual death attitudes, and personal worldview was conducted among 202 German-speaking adults in Central Europe. Results indicated that death anxiety significantly predicts coronavirus anxiety beyond sociodemographic variables. Women reported higher coronavirus anxiety than men. Against expectations, dimensions of personal worldview were hardly related to coronavirus anxiety. In contrast, we found evidence for a curvilinear relationship between religiosity as well as atheism and negative death attitudes. Our study contributes to recent discussions about death anxiety as a transdiagnostic factor in psychopathology and yields important implications for psychosocial support in the current pandemic.

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey.

BACKGROUND: An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic. METHODS: This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. RESULTS: The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress. CONCLUSIONS: The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.

Sense of coherence, mental well-being and perceived preoperative hospital and surgery related stress in surgical patients with malignant, benign, and no neoplasms.

BACKGROUND: This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative stress, and to test for a statistical mediation by mental well-being. METHOD: The sample consisted of 4918 patients from diverse surgical fields, of which 945 had malignant neoplasms, 333 benign neoplasms, and 3640 no neoplasms. For each subsample, we conducted simple mediation analyses to test an indirect effect of SOC on preoperative stress mediated by mental well-being. The models were adjusted for age, gender, and essential medical factors. RESULTS: Patient groups did not differ significantly regarding degrees of SOC and mental well-being (SOC, M [SD]: 12.31 [2.59], 12.02 [2.62], 12.18 [2.57]; mental well-being M [SD]: 59.26 [24.05], 56.89 [22.67], 57.31 [22.87], in patients with malignant, benign, and without neoplasms, respectively). Patients without neoplasms reported significantly lower stress (4.19 [2.86], M [SD]) than those with benign (5.02 [3.03], M [SD]) and malignant neoplasms (4.99 [2.93], M [SD]). In all three mediation models, SOC had significant direct effects on stress, with higher SOC being associated with lower stress (- 0.3170 [0.0407], - 0.3484 [0.0752], - 0.2919 [0.0206]; c' [SE], p < 0.001 in patients with malignant, benign, and without neoplasms, respectively). In patients with malignant neoplasms and without neoplasms, SOC showed small indirect effects on stress that were statistically mediated by well-being. Higher SOC was related to higher well-being, which in turn was related to lower stress. In patients with benign neoplasms, however, no significant indirect effects of SOC were found. CONCLUSIONS: SOC was directly associated with lower perceived hospital and surgery related stress, over and above the direct and mediation effects of mental well-being. Because the data are cross-sectional, conclusions implying causality cannot be drawn. Nevertheless, they indicate important relationships that can inform treatment approaches to reduce elevated preoperative stress by specifically addressing low SOC. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01357694 . Registered 18 May 2011.

Worldview Under Stress: Preliminary Findings on Cardiovascular and Cortisol Stress Responses Predicted by Secularity, Religiosity, Spirituality, and Existential Search.

This study reports preliminary findings on the hypothesis that worldview can predict cardiovascular and cortisol responses to social stress. Based on theory and previous findings, we assumed that worldview security would provide a basis for stress resilience. Accordingly, religious and atheist individuals were expected to show higher stress resilience than spiritual and agnostic participants. Likewise, dimensional measures of religiosity and atheism were hypothesized to predict decreased, and existential search-indicating worldview insecurity-was hypothesized to predict increased physiological stress responses. Subjects included 50 university students who completed online questionnaires and took part in a standardized social stress test (Trier Social Stress Test). Systolic and diastolic blood pressure (SBP/DBP), heart rate (HR), and salivary cortisol (SC) were assessed at baseline, immediately after stress testing, and during a forty-minute recovery period. Worldview comparisons revealed lower cardiovascular stress responses among religious than among atheist and spiritual participants and particularly high baseline SC among spiritual participants. Across the entire sample, existential search showed substantial positive correlations with SBP, HR, and SC stress parameters. The findings suggest that worldview security might partly explain the health benefits often associated with religion.

Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients.

PURPOSE: The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields. METHOD: Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure. RESULTS: Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS. CONCLUSION: Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes. TRIAL REGISTRATION: NCT01357694.

What brings meaning to life in a highly secular society? A study on sources of meaning among Danes.

This study presents psychometric properties of the Danish version of the Sources of Meaning and Meaning in Life Scale (SoMe-Da) and associations to socio-demographic and religious characteristics. Participants were 554 Danes, 66% women ranging in age between 15 and 91 years. Exploratory factor analysis (EFA) suggested a five factor structure for the 26 sources if meaning. Construct validity within the SoMe-Da and between mental health variables were established. Generativity associated most strongly with meaningfulness followed by spirituality, attentiveness, and explicit religiosity. We found religious characteristics to be more strongly associated with meaningfulness than socio-demographic variables. Finally, we found distinct patterns of preferred sources of meaning between Christians, agnostics, and atheists. Christians and agnostics seemed to be more motivated by self-transcendance, whereas atheists may be more motivated by self-actualization. Results indicate that the SoMe-Da appears to be a valid instrument for measuring the content and degree of personal meaning in life.

Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial.

BACKGROUND: Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care. METHODS: The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only. RESULTS: Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness. CONCLUSIONS: Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01357694.

When alienated from society, conspiracy theory belief gives meaning to life.

Background: Conspiracy theory belief - explaining the ultimate causes of social and political events with claims of secret conspiracies - is assumed to arise from a desire to make sense of uncertainty, especially in times of crisis. However, there is no compelling evidence that conspiracy theory belief actually fulfils this function, particularly in terms of evaluating one's life as meaningful. We posit that the adoption of conspiracy theory belief can be explained as a fluid compensation when a more proximal source of meaning, a sense of belonging to society, is threatened. Thus, a positive association between conspiracy theory belief and meaningfulness should emerge when people feel alienated from society. We therefore tested the hypotheses that alienation from society correlates negatively with meaningfulness (H1), and that it moderates the relationship between conspiracy theory belief and meaningfulness (H2). Method: Conspiracy theory belief related to the COVID-19 pandemic, meaningfulness (Meaning and Purpose Scales, MAPS), and perceived alienation from society were assessed in a representative sample of N = 974 German residents. Results: As expected, alienation from society was inversely related to meaningfulness and moderated the relationship between conspiracy theory belief and meaningfulness. According to the interaction, a positive association between belief in conspiracy theory and meaningfulness emerged when individuals experienced themselves as alienated from society. Conclusion: The results suggest that conspiracy theory belief might alleviate a lack of meaningfulness caused by experienced alienation from society. Individuals who felt discriminated against, treated unequally, or having their rights restricted were more likely to hold conspiracy theory belief, which was associated with a greater sense of meaning in their lives.

The Meaning and Purpose Scales (MAPS): development and multi-study validation of short measures of meaningfulness, crisis of meaning, and sources of purpose.

BACKGROUND: Meaning in life is multidimensional. It encompasses different qualities of meaning, such as meaningfulness, crisis of meaning, or existential indifference, as well as the sources from which people draw meaning, or purpose. For both research and practice, it is of high value to know not only the extent of meaningfulness, or its absence, but also its sources. How do these relate to meaningfulness and mental health? Are they accessible to people of different sociodemographic and economic backgrounds alike? For therapeutic and counseling practice, knowledge of experiences and sources of meaning is needed to support a clearer self-understanding in patients or clients and to encourage them to make authentic life choices. The Meaning and Purpose Scales (MAPS) presented here enable researchers and practitioners to gain insights into these dimensions of meaning in life, and, with only 23 items, to do so in a short time. METHODS: Using five independent and two follow-up samples with a total N of 7,500, this paper examined the MAPS' internal consistency, test-retest reliability, and convergent, divergent, criterion, factorial, and predictive validity. RESULTS: Principal axis factoring identified two meaning scales, Meaningfulness and Crisis of Meaning, and five purpose scales, Sustainability, Faith, Security, Community, and Personal Growth. The scales proved consistent, stable over four weeks and two months, and valid in multiple respects. In a representative German population sample, Personal Growth, Sustainability, and Community exhibited large, Faith and Security medium positive relationships with Meaningfulness, whereas Crisis of Meaning showed small to moderate negative correlations. Meaningfulness was positively, and Crisis of Meaning negatively predicted by age, partnership, parenthood, and religious affiliation. Financial hardship correlated positively with Crisis of Meaning and negatively with Meaningfulness, Community, and Personal Growth. Meaningfulness and Crisis of Meaning explained 21%, the sources of purpose 6% of additional variance in general mental distress (PHQ-4), beyond sociodemographics. Except for Faith (unrelated), all sources exhibited moderate negative correlations with the PHQ-4. CONCLUSION: As this series of studies demonstrates, the MAPS provide a highly economic and valid assessment of two qualities of meaning, Meaningfulness and Crisis of Meaning, and five sources of purpose: Sustainability, Faith, Security, Community, and Personal Growth.

Emotion regulation moderates the association between COVID-19 stress and mental distress: findings on buffering, exacerbation, and gender differences in a cross-sectional study from Norway.

Background: Maintaining good mental health is important during a crisis. However, little attention has been given to how people achieve this, or how they evaluate emotions associated with stressors, such as the COVID-19 pandemic. This study aims to (1) investigate whether emotion regulation, in particular cognitive reappraisal and suppression, moderates the relationship between COVID-19 stress and general mental distress and (2) examine gender differences in the interrelations between COVID-19 stress, emotion regulation, and mental distress. Methods: Data from a population in Norway (n = 1.225) were collected using a cross-sectional survey during the early months of the COVID-19 pandemic. Emotion regulation was measured using the Emotion Regulation Questionnaire Scale (ERQ), COVID-19 stress with the COVID-19 Stress Scale, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. Results: There was a strong association between COVID-19 stress and general mental distress (r = 0.61). The moderation analyses showed substantial moderation effects of cognitive reappraisal and suppression on the relationship between COVID-19 stress and mental distress. Cognitive reappraisal served as a buffer (p = 0.001) and suppression (p = 0.002) exacerbated the relation between COVID-19 stress and mental distress. Men had higher scores of suppression (p < 0.001), and women had higher scores of cognitive reappraisal (p = 0.025). The buffering effect of cognitive reappraisal presented itself only in women (p < 0.001), while the exacerbation effect of suppression appeared only in men (p < 0.001). Conclusion: The current study suggests that COVID-19 pandemic-related stress is easier to deal with for those who have the tendency to cognitively reappraise. In contrast, suppression is associated with symptoms of depression and anxiety. The prevention of mental distress can be supported by guiding people about the importance of using healthy emotion regulation strategies, as well as helping them to become more aware of the way they interpret and regulate their emotions. Gender differences in emotion regulation suggest gender awareness, e.g., tailored programs for men and women.

Have a good day! An experience-sampling study of daily meaningful and pleasant activities.

We organize our daily lives with a relatively high degree of freedom. Some things must be done; others are optional. Some we find meaningful, some pleasant, some both, and some neither. The present study looks at such evaluations of daily activities and how they relate to perceived meaning in life. Sixty-two students from an Austrian university first completed the meaningfulness scale from the Sources of Meaning and Meaning in Life Questionnaire (SoMe). They then participated in a 1-week experience-sampling assessment, wherein they completed a short questionnaire at five random time-points per day. They indicated their current activity and then reported, on a 6-point Likert scale, how pleasant and meaningful they perceived it to be. Activities could thus be categorized as meaningful, pleasant, both, or neither. Results reflected that activities grouped under culture/music, communication, intimacy, and sports are experienced as both highly meaningful and pleasant. A two-level hierarchical linear regression suggested that people with high trait meaningfulness experience their daily activities as more meaningful than people with lower trait meaningfulness if they also enjoy what they are doing. People with low trait meaningfulness, however, tended to experience their daily activities as rather meaningless, even if they enjoyed them very much. Thus, when looking for advice on how to have a good day, clarifying one's meaning in life seems to represent the best starting point.

Compliance with COVID-19 public health guidelines: an attitude-behaviour gap bridged by personal concern and distance to conspiracy ideation.

OBJECTIVE: This study examined predictors of compliance with public health guidelines to curb transmission of COVID-19. DESIGN: Applying an exploratory longitudinal design, participants (N = 431) from Germany and Austria completed surveys in April/May 2020 (T1) and July/August 2020 (T2). MEASURES: Three outcome measures operationalised compliance with public health guidelines at T2: self-reported adherence (behavioural), agreement and opposition (attitudinal). At T1, demographics, perceived distress (PHQ-4, crisis of meaning), resources (self-control, meaningfulness), locus of control, conspiracy mentality and social media use were assessed. At T2, situational variables were added (person at risk, infection of close person, fear of infection, COVID-19 stress). Temporal shifts from T1 to T2 were examined as complementary information. RESULTS: An attitude-behaviour gap at T2 was identified, as agreement with and opposition to the guidelines were only modestly correlated with adherence to them. Measures of personal concern (fear of infection, person at risk) were associated with both adherence and positive attitudes towards the measures. COVID-19 stress and conspiracy mentality predicted negative attitudes, but not adherence. Age predicted adherence positively, social media use negatively. CONCLUSION: The findings support the significance of personal concern for compliance with public health guidelines and suggest a critical impact of social media use and conspiracy mentality.

ME-Work: Development and Validation of a Modular Meaning in Work Inventory.

As research on meaning in work progresses, access to theoretically integrated, differentiated survey instruments becomes crucial. In response to this demand, the present article introduces ME-Work, a modular inventory to measure meaning in work. Derived from research findings on meaning in life, the ME-Work inventory offers three modules that can be used separately or jointly. Module 1 assesses four facets of meaning in work, i.e., coherence, significance, purpose and belonging; module 2 measures the subjective assessment of work as meaningful or meaningless, and module 3 records the extent to which work is perceived as a source of meaning. We report on the development of the instrument and the results of an exploratory factor analysis in a pilot study of 115 working adults. A further study with 278 working adults provided evidence for construct and incremental validity. Relationships with meaning in life, mental health, job satisfaction, socio-moral climate, burnout and work as meaning were investigated. Confirmatory factor analysis supported the factor structure. Gender-specific analyses of the four facets of meaning's differential predictive power provided additional insights. Practical implications and further research needs are discussed.

Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress.

BACKGROUND: As evidenced by several studies, mental distress increased substantially during the COVID-19 pandemic. In this period, citizens were asked to exercise a high degree of self-control with regard to personal and social health behavior. At the same time, we witnessed an increase of prosocial acts and shared creative expressions, which are known to serve as sources of meaning. Meaning in life and self-control are acknowledged psychological resources. Especially in times of crisis, meaning in life has been shown to be a crucial factor for resilience and coping. However, threatening and stressful situations can also jeopardize existential security and trigger crises of meaning. The present study aimed to document levels of acute COVID-19 stress and general mental distress in Germany and Austria during the lockdown and in the weeks thereafter. In order to identify potential risk factors related to demographics and living conditions, their associations with COVID-19 stress were analyzed exploratively. The primary objective of the study, however, was to investigate the buffering effect of two psychological resources-meaningfulness and self-control-with regard to the relation between acute COVID-19 stress and general mental distress. Finally, a potential aggravation of mental distress due to the occurrence of crises of meaning was examined. METHOD: A cross-sectional survey was conducted online during lockdown (survey group 1) and the subsequent weeks characterized by eased restrictions (survey group 2). A total of N = 1,538 German-speaking participants completed a questionnaire battery including a novel measure of acute COVID-19 stress, meaningfulness and crisis of meaning (SoMe), self-control (SCS-KD), and a screening of general mental distress, measured by core symptoms of depression and anxiety (PHQ-4). In a first step, associations between living conditions, demographics, and COVID-19 stress were explored. Second, a moderation and a mediation model were tested. Meaningfulness, a measure of presence of meaning in life, as well as self-control were proposed to serve as buffers in a time of crisis, thus moderating the relation between acute COVID-19 stress and general mental distress (double moderation). Crisis of meaning, operationalizing an experienced lack of meaning in life, was proposed to mediate the relationship between acute COVID-19 stress and general mental distress, with an assumed moderation of the association between COVID-19 stress and crisis of meaning by survey group (lockdown versus eased restrictions after lockdown), and a hypothesized moderation of the link between crisis of meaning and general mental distress by self-control (dual moderated mediation). RESULTS: COVID-19 stress was slightly right-skewed. Scores were higher during lockdown than in the weeks thereafter. The rate of clinically significant general mental distress was high, exceeding prevalence rates from both the general population and clinical samples of the time before the pandemic. In the weeks following the lockdown (group 2), general mental distress and crisis of meaning were significantly higher than during lockdown (group 1), whereas meaningfulness and self-control were significantly lower. Demographically, age had the strongest association with COVID-19 stress, with older participants perceiving less acute stress (r = -.21). People who were partnered or married suffered less from COVID-19 stress (η2 = .01). Living alone (η2 = .006), living in a room versus a flat or house (η2 = .008), and being unemployed due to the pandemic (η2 = .008) were related to higher experience of COVID-19 stress. COVID-19 stress and general mental distress were strongly related (r = .53). Both meaningfulness and self-control were negatively associated with general mental distress (r = -.40 and -.36, respectively). They also moderated the relationship between COVID-19 stress and general mental distress: When meaningfulness was high, high COVID-19 stress was related to substantially lower PHQ-4 scores than when meaningfulness was low. The same held for self-control: High scores of self-control were associated with lower PHQ-4 scores especially when COVID-19 stress was high. Crisis of meaning mediated the relationship between COVID-19 stress and PHQ-4. There was a higher likelihood of crises of meaning occurring when COVID-19 stress was high; crisis of meaning, in turn, was associated with general mental distress. Survey group moderated the first path of this mediation, i.e., the relationship between COVID-19 stress and crisis of meaning: High scores of COVID-19 stress were associated more strongly with crisis of meaning in the second survey group (after the lockdown). Self-control moderated the second path, i.e., the relationship between crisis of meaning and PHQ-4: When a crisis of meaning was present, self-control could buffer its effect on general mental distress. CONCLUSIONS: Also in the present study among German-speaking participants, general mental distress was high. Scores were higher after than during the lockdown, indicating an ongoing destabilization for a significant part of the population. People who saw a meaning in their lives and who were capable of self-control reported substantially less mental distress. Meaningfulness and self-control also served as buffers between COVID-19 stress and general mental distress: When COVID-19 stress was high, the presence of meaningfulness and self-control accounted for lower general mental distress. Moreover, people who suffered strongly from COVID-19 stress were more likely to develop a crisis of meaning which, in turn, was associated with higher general mental distress. This suggests that ongoing anxiety and depression might (also) be based on existential struggles. Again here, self-control buffered the impact of crisis of meaning on general mental health. We conclude from these findings that public health policies can support citizens in coping with large-scale crises by enabling experiences of meaningfulness, e.g., through transparent and reliable modes of communicating goals and necessary intermediate steps. Moreover, health professionals are well advised to invite individuals to confront existential questions and struggles, and to encourage them to exercise self-control. The latter can be boosted by keeping higher-order goals salient-which again is inherently linked to an understanding of their meaning.

[Allowing, accepting, releasing: A philosophical-psychological approach to an active concept of suffering]. / Einlassen, Zulassen, Loslassen: Über ein konstruktives Leidensverständnis.

Pain or misery strike us - but it is up to us how to deal with them. Suffering is a verb; this underlines the active nature of suffering. The present paper develops a constructive concept of suffering by taking up approaches from existential philosophy and psychology. It suggests that suffering, if allowed and accepted, has the potential to facilitate transformation and, subsequently, to release from pain. The text ends with reflections on how a transformative understanding of suffering can be opened up in the accompaniment of suffering or dying.