DISTRESS AS A COMPONENT OF PATHOGENESIS OF COVID-19 DURING THE FIRST WAVES OF PANDEMIC
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Keywords

distress
COVID-19
mental state
somatic symptoms
recovery

How to Cite

Kurovska, V., Podpalova, O., & Ohdanskyi, I. (2023). DISTRESS AS A COMPONENT OF PATHOGENESIS OF COVID-19 DURING THE FIRST WAVES OF PANDEMIC. PSYCHOLOGICAL JOURNAL, 9(6), 25–39. https://doi.org/10.31108/1.2023.9.6.3

Abstract

The need for psychological aid for a full recovery after COVID-19, primarily overcoming negative emotional consequences, anxiety disorders, which can increase the risk of developing fears, panic conditions, etc. relevant among the psychological research. The aim of our study was to investigate the self-assessment of the mental and somatic state of people who have had COVID-19. There are 104 respondents participated in the study, 81,7% of whom were women.

Before disease own emotional state was assessed as “good” or “very good” by 71,1% of respondents: 44,2% and 26,9%, respectively. During the height of the illness, this percentage decreases dramatically, becoming 14,3%. Indexes of assessing one's own emotional state at the time of the survey increase, but do not reach the level observed before illness: 54,7% of respondents rated their condition as “good” (26,9%) and “very good” (27,8%). At the same time, during the height of the disease, 59,6% of the respondents rated their emotional state as “very bad”, “bad”, or “moderate”. Of these, 19,2% rated their emotional state as "very bad", 18,2% - “bad”, and 22,1% - “moderate”. Among the mental disorders at the time of illness, anxiety (62,5%), depression (51%), fear (of the future, death, infecting others) (47,1%), apathy (45,2%), mood swings (34,6%), loss of willpower (33,6%) have been prevailed. On the moment of the survey, mood swings (30,7%), depression (29,8%), anxiety (28,8%), apathy (19,2%) sudden unpleasant memories (19,2%), loss of willpower (18,2%) have been dominated.

Among the somatic disorders which were present in participants during the disease increased tiredness (87,5%), physical weakness (86,5%), loss/changes in smell and/or taste (74%), sleep disorders (61,5%), deterioration of memory, attention, thinking, willpower (60,5%), loss of appetite (58,6%) had been prevailed. At the time of the survey, increased tiredness (50%), physical weakness (33,6%), deterioration of memory, attention, thinking, willpower (31,7%), and sleep disorders (26,9%) were still quite pronounced.

Among the factors that helped respondents to recover from the illness, the first places belong to the decrease in stress and having more rest (66,3%), emotional support from family and friends (64,4%), receiving the right information about the disease, to understand what was going on, and having awareness about the ways of the disease overcoming (50%). A significant part of the respondents was helped by self-control over own thoughts and emotions such as meditation and prayers (40,4%) and the experience of other people's recovery (40,4%). For a certain part of people (26%), work with a psychologist or psychotherapist was useful to overcome COVID-19. Physical and breathing exercises were useful for 44,2% of our responders. Surprisingly, the last place in the disease overcoming belongs to ways of somatic health restoration, such as the use of medicines (18,3%).

Our results suggest that the first waves of COVID-19 disease were characterized by a strong impact of distress which induced a high level of social tension, affected mental sphere, provoking anxiety and worries. Therefore, reduction in stress, support from friends and family, and receiving the right information about the disease played a greater role in recovery than medication.

 

https://doi.org/10.31108/1.2023.9.6.3
PDF 25-39

References

Ahmed M., Roy S., Iktidar M.A., Chowdhury S., Akter S., Islam A.M.K., & Hawlader M.D.H. (2022). Post COVID-19 memory complaints: prevalence and associated factors. Neurologia. https://doi.org/10.1016/j.nrl.2022.03.007

Al Dhaheri A. S., Bataineh M. F., Mohamad M. N., Ajab A., Al Marzouqi A., Jarrar A. H., Habib-Mourad C., Abu Jamous D. O., Ali H. I., Al Sabbah H., Hasan H., Stojanovska L., & Hashim M. (2021). Іmpact of COVID-19 on mental health and quality of life: Is there any effect? A crosssectional study of the MENA region. Plos One, 16 (3), e0249107. https://doi.org/10.1371/journal.pone.0249107

Alimoradi Z., Broström A., Tsang H.W.H., Griffiths M.D., Haghayegh S., Ohayon M.M., Lin C.Y., & Pakpour A. H. (2021). Sleep problems during COVID-19 pandemic and its’ association to psychological distress: a systematic review and meta-analysis. EClinical Medicine, 36, 100916. https://doi.org/10.1016/j.eclinm.2021.100916

Amat J., Paul E., Zarza C., Watkins L.R., & Maier S.F. (2006). Previous experience with behavioral control over stress blocks the behavioral and dorsal raphe nucleus activating effects of later uncontrollable stress: role of the ventral medial prefrontal cortex. J. Neurosci., 26,13264–13272. doi: 10.1523/JNEUROSCI.3630-06.2006

Andrews M.G., Mukhtar T., Eze U.C., Simoneau C.R., Ross J., Parikshak N., Wang S., Zhou L., Koontz M., Velmeshev D., Siebert C.V., Gemenes K.M., Tabata T., Perez Y., Wang L., Mostajo-Radji M.A., de Majo M., Donohue K.C., Shin D., Salma J., Pollen A.A., Nowakowski T.J., Ullian E., Kumar G.R., Winkler E.A., Crouch E.E., Ott M., & Kriegstein A.R. (2022). Tropism of SARS-CoV-2 for human cortical astrocytes. PNAS, 119(30), e2122236119. https://doi.org/10.1073/pnas.2122236119

Ans A.H., Anjum I., Satija V., Inayat A., Asghar Z., Akram I., & Shrestha B. (2018). Neurohormonal regulation of appetite and its relationship with stress: a mini literature review. Cureus, 10(7), e3032. doi: 10.7759/cureus.3032

Barsegyan A., Mackenzie S.M., Kurose B.D., McGaugh J.L., & Roozendaal B. (2010). Glucocorticoids in the prefrontal cortex enhance memory consolidation and impair working memory by a common neural mechanism. PNAS, 107(38), 16655–16660. https://doi.org/10.1073/pnas.1011975107

Bendau A., Plag J., Kunas S., Wyka S., Ströhle A., & Petzold M.B. (2021). 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. Brain and Behavior, 11, e01964. https://doi.org/10.1002/brb3.1964

Benjamin A., Kuperman Y., Eren N., Rotkopf R., Amitai M., Rossman H., Shilo S., Meir T., Keshet A., Nuttman-Shwartz O., Segal E., & Chen A. (2021). Stress-related emotional and behavioural impact following the first COVID-19 outbreak peak. Molecular Psychiatry, 26, 6149–6158. https://doi.org/10.1038/s41380-021-01219-6

Bhat S. & Chokroverty S. (2022). Sleep disorders and COVID-19. Sleep Medicine, 91, 253–261. https://doi.org/10.1016/j.sleep.2021.07.021

Birch J. N. & Vanderheyden W. M. (2022). The Molecular Relationship between Stress and Insomnia. Advanced biology, 6(11), 2101203. https://doi.org/10.1002/adbi.202101203

Bondarenko M., Kurovska V., Okhrei A., Podpalova O., & Reshetnik Y. (2021). Problems of distant learning of medical students during the COVID-19 pandemic. Science and education, 1, 19–26. https://doi.org/10.24195/2414-4665-2021-1-3

Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., & Rubin G.J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 395, 912–20. https://doi:org/10.1016/S0140-6736(20)30460-8

Buodo G.,T. Moretta, Santucci V.G., Chen S., & Potenza M.N. (2023). Using social media for social motives moderates the relationship between post-traumatic symptoms during a COVID-19-related lockdown and improvement of distress after lockdown. Behavioral sciences. 13(1), 53. https://doi.org/10.3390/bs13010053

Bzdok D. & Dunbar R. I.M. (2020). The neurobiology of social distance. Trends in Cognitive Sciences, 24 (9), 717–733. https://doi.org/10.1016/j.tics.2020.05.016

Cabib S., Campus P., Conversi D.,Orsini C., & Puglisi-Allegra S. (2020). Functional and dysfunctional neuroplasticity in learning to cope with stress. Brain. Sci., 10(2), 127. https://doi.org/10.3390/brainsci10020127

Chaaban N., Høier A. T. Z. B., & Vad Andersen B.A (2021). Detailed characterisation of appetite, sensory perceptional, and eating-behavioural effects of COVID-19: self-reports from the acute and post-acute phase of disease. Foods, 10(4), 892. https://doi.org/10.3390/foods10040892

Chen S. X., Ng J.C.K., Hui B. P.H., Au A.K.Y., Wu W.C.H., Lam B.C.P., Mak W.W.S., & Liu J.H. (2021). Dual impacts of coronavirus anxiety on mental health in 35 societies. Scientifc Reports, 11, 8925. https://doi.org/10.1038/s41598-021-87771-1

COVID-19 Mental Disorders Collaborators (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet, 398(10312), 1700–1712. doi: 10.1016/S0140-6736(21)02143-7

El Sayed S., Gomaa S., Shokry D., Kabil A., & Eiss A. (2021). Sleep in post-COVID-19 recovery period and its impact on diferent domains of quality of life. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 57(1), 172. https://doi.org/10.1186/s41983-021-00429-7

Gloster A.T., Lamnisos D., Lubenko J., Presti G., Squatrito V., Constantinou M., Nicolaou C., Papacostas S., Aydın G., Chong Y.Y., Chien W.T., Cheng H.Y., Ruiz F.J., Garcia-Martin M.B., Obando-Posada D.P., Segura-Vargas M.A., Vasiliou V.S., McHugh L., Höfer S., Baban A., Neto D.D.,Nunes da Silva A., Monestès J.L., Alvarez-Galvez J., Paez-Blarrina M., Montesinos F., Valdivia-Salas S.,Ori D., Kleszcz B., Lappalainen R., Ivanović I., Gosar D., Dionne F., Merwin R.M., Kassianos A.P., & Karekla M. (2020). Impact of COVID-19 pandemic on mental health: An international study. PLoS ONE, 15(12), e0244809. doi.org/10.1371/journal.pone.0244809

González-Sanguino C., Ausín B., Castellanos M. A., Saiz J., López-Gómez A., Ugidos C., & Muñoz M. (2020). Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, Behavior, and Immunity, 87: 172–176. https://doi: 10.1016/j.bbi.2020.05.040.

Goodwin R., Gaines S. O., Myers L., & Neto F. (2011). Initial Psychological Responses to Swine Flu. Int. J. Behav. Med, 18, 88–92. DOI 10.1007/s12529-010-9083-z

Gori A., Topino E., & Caretti V. (2022). The impact of COVID-19 lockdown on perceived stress: The role of defence mechanisms and coping strategies. Journal of contingencies and crisis management, 30(4), 379–390. https://doi.org/10.1111/1468-5973.12380

Grossman E. R., Benjamin-Neelon S. E., & Sonnenschein S. (2020). Alcohol consumption during the COVID-19 pandemic: a cross-sectional survey of US adults. Int. J. Environ. Res. Public Health, 17 (24), 9189. https://doi.org/10.3390/ijerph17249189

Hampton T. (2004). Stress and memory loss link. JAMA, 292(24), 2963. doi:10.1001/jama.292.24.2963-d

Han K. S., Kim L., & Shim I. (2012). Stress and sleep disorder. Experimental Neurobiology, 21(4), 141–150. doi: 10.5607/en.2012.21.4.141

Høier A. T. Z. B., Chaaban N., & Vad Andersen B. (2021). Possibilities for Maintaining Appetite in Recovering COVID-19 Patients. Foods, 10(2), 464. https://doi.org/10.3390/foods10020464

Hu Y., Ye B., & Tan J. (2021). Stress of COVID-19, Anxiety, economic insecurity, and mental health literacy: a structural equation modeling approach. Front Psychol, 12, 707079. https://doi.org/ 10.3389/fpsyg.2021.707079

Jahrami H.A., Alhaj O.A., Humood A.M., Alenezi A.F., Fekih-Romdhane F., AlRasheed M.M., Saif Z.Q., Bragazzi N.L., Pandi-Perumal S.R., BaHammam A.S., & Vitiello M.V. (2022). Sleep disturbances during the COVID-19 pandemic: a systematic review, meta-analysis, and meta-regression. Sleep Medicine Reviews, 62, 101591. https://doi.org/10.1016/j.smrv.2022.101591

Justice N.J., Yuan Z.F., Sawchenko P.E., & Vale W. (2008) Type 1 corticotropin-releasing factor receptor expression reported in BAC transgenic mice: implications for reconciling ligand-receptor mismatch in the central corticotropin-releasing factor system. J Comp Neurol, 511(4), 479–496. doi:10.1002/cne.21848

Killgore W.D.S., Cloonan S.A., Taylor E.C., & Dailey N. S. (2020). Loneliness: a signature mental health concern in the era of COVID-19. Psychiatry Research, 290, 113117. https://doi.org/10.1016/j.psychres.2020.113117

Kim E.J., Pellman B., & Kim J.J. (2015). Stress effects on the hippocampus: a critical review. Learning Memory, 22(9), 411–416. doi: 10.1101/lm.037291.114

Kimhi S., Marciano H., Eshel Y., & Adini B. (2020). Recovery from the COVID-19 pandemic: distress and resilience. International Journal of Disaster Risk Reduction, 50, 101843. https://doi.org/10.1016/j.ijdrr.2020.101843

Kimhi S., Marciano H., Eshel Y., & Adini B. (2020). Resilience and demographic characteristics predicting distress during the COVID-19 crisis. Social Science and Medicine, 265, 113389. https://doi.org/10.1016/j.socscimed.2020.113389

Li C., Cai H., Zhou Q., Zhang H., Wang M., & Kang H. (2023). Sleep disorders in the acute phase of coronavirus disease 2019: an overview and risk factor study. Annals of General Psychiatry, 22, 3. https://doi.org/10.1186/s12991-023-00431-8

Li S.B., Borniger J. C., Yamaguchi H., Hédou J., Gaudilliere B., & de Lecea L. (2020). Hypothalamic circuitry underlying stress-induced insomnia and peripheral immunosuppression. Science Advances, 6(37), eabc2590. DOI: 10.1126/sciadv.abc2590

Lin Y.N., Liu Z.R., Li S.Q., Li C.X., Zhang L., Li N., Sun X.W., Li H.P., Zhou J.P., & Li Q.Y. (2021). Burden of sleep disturbance during COVID-19 pandemic: a systematic review. Nature and Science of Sleep, 13, 933–966. https://doi.org/10.2147/NSS.S312037

Liyanage-Don N. A., Cornelius T., Sanchez J. E., Trainor A., Moise N., Wainberg M., & Kronish I. M. (2021). Psychological distress, persistent physical symptoms, and perceived recovery after COVID-19 illness. J. Gen. Intern. Med., 36(8), 2525–2527. https:// doi: 10.1007/s11606-021-06855-w

Lupien S. J., Gaudreau S., Tchiteya B. M., Maheu F., Sharma S., Nair N. P. V., Hauger R. L., McEwen B. S., & Meaney M. J. (1997). Stress-induced declarative memory impairment in healthy elderly subjects: relationship to cortisol reactivity. The Journal of Clinical Endocrinology & Metabolism, 82(7). 2070–2075. https://doi.org/10.1210/jcem.82.7.4075

Lyons D. M., Buckmaster P.S., Lee A.G., Wu C., Mitra R., Duffey L.M. Buckmaster C.L., Her S., Patel P. D., & Schatzberg A.F. (2010). Stress coping stimulates hippocampal neurogenesis in adult monkeys. PNAS, 107(33), 14823-14827. doi: 10.1073/pnas.0914568107

Manchia M., Gathier A.W., Yapici-Eser H., Schmidt M.V., de Quervain D., van Amelsvoort T., Bisson J.I., Cryan J.F., Howes O.D., Pinto L., van der Wee N.J., Domschke K., Branchi I., & Vinkers C. H. (2022). The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: a critical review across waves. Eur Neuropsychopharmacol, 55, 22–83. doi: 10.1016/j.euroneuro.2021.10.864

McEwen B. S. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological Review, 87(3), 873–904. doi: 10.1152/physrev.00041.2006

McEwen B. S., Nasca C., & Gray J. D. (2016). Stress effects on neuronal structure: Hippocampus, amygdala, and prefrontal cortex. Neuropsychopharmacology, 41, 3–23. doi:10.1038/npp.2015.171

Merrill R. M. (2022). Mental health conditions according to stress and sleep disorders. Int. J. Environ. Res. Public Health, 19(13), 7957. https://doi.org/10.3390/ijerph19137957

Minahan J., Falzarano F., Yazdani N., & Siedlecki K. L. (2021). The COVID-19 pandemic and psychosocial outcomes across age through the stress and coping framework. The Gerontologist, 61 (2). 228–239 https://doi.org/10.1093/geront/gnaa205

Newberg A. (2010). Principles of neurotheology. Farnham: Ashgate Publishing. ISBN 978-1-4094-0810-9

Nitschke J.P., Forbes P.A.G., Ali N., Cutler J., Apps M.A.J., Lockwood P.L., & Lamm C. (2021). Resilience during uncertainty? Greater social connectedness during COVID-19 lockdown is associated with reduced distress and fatigue. British Journal of Health Psychology, 26(2), 553–569. doi: 10.1111/bjhp.12485

Pandey K., Thurman M., Johnson S. D., Acharya A., Johnston M., Klug E.A., Olwenyi O. A., Rajaiah R., & Byrareddy S. N. (2021). Mental Health Issues During and After COVID-19 Vaccine Era. Brain Research Bulletin, 176, 161–173. https:// doi: 10.1016/j.brainresbull.2021.08.012

Pascual-Leone A., Amedi A., Fregni F., & Merabet L. B. (2005). The plastic human brain cortex. Annuual Review of Neuroscience, 28, 377–401. doi: 10.1146/annurev.neuro.27.070203.144216

Paz C G., Adana-Díaz L., Rodríguez-Lorenzana A., Simbaña-Rivera K., Gómez-Barreno L., Troya M., Páez M. I., Cárdenas J., Gerstner R. M., & Ortiz-Prado E. (2020). Anxiety and depression in patients with confirmed and suspected COVID-19 in Ecuador. Psychiatry Clin Neurosci, 74(10), 554–555. https://doi: 10.1111/pcn.13106

Pérez-Cano H.J., Moreno-Murguía M.B., Morales-López O., Crow-Buchanan O., English J. A., Lozano-Alcázar J., & Somilleda-Ventura S.A. (2020). Anxiety, depression, and stress in response to the coronavirus disease-19 pandemic. Cirugia y Cirujanos (English Edition), 88 (5), 562–568. https://doi.org/10.24875/ciru.20000561

Popoli M., Yan Z., McEwen B. S., & Sanacora G. (2011). The stressed synapse: the impact of stress and glucocorticoids on glutamate transmission. Nature Reviews Neuroscience, 13(1), 22–37. doi: 10.1038/nrn3138

Price R. B. & Duman R. (2020). Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model, Molecular Psychiatry, 25(3), 530–543. doi: 10.1038/s41380-019-0615-x

Prime H., Wade M., & Browne D. T. (2020). Risk and resilience in family well-being during the COVID-19 pandemic. American Psychologist, 75(5), 631–643. https://doi.org/10.1037/amp0000660

Rubin G. J. & S. Wessely (2020). The psychological effects of quarantining a city. BMJ, 368, m313. https://doi.org/10.1136/bmj.m313

Shan D., Li S., Xu R., Nie G., Xie Y., Han J., Gao X., Zheng Y., Xu Z., & Dai Z. (2022). Post-COVID-19 human memory impairment: a prisma-based systematic review of evidence from brain imaging studies. Frontiers in aging neuroscience, 14. https://doi.org/10.3389/fnagi.2022.1077384

Sheline Y. I., Sanghavi M., Mintun M.A., & Gado M. H. (1999). Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. The Journal of Neuroscience, 19(12), 5034–5043. doi: 10.1523/JNEUROSCI.19-12-05034.1999

Shin L. M., Wright C. I., Cannistrato P.A., Wedig M. M. , McMullin K., Martis B., Macklin M.I., Lasko N. B., Cavanagh S. R., Krangel T. S., Orr S. P., Pitman R.K., Whalen P.J., & Rauch S.L. (2005). A functional magnetic resonance imaging study of amygdala and medial prefrontal cortex responses to overtly presented fearful faces in posttraumatic stress disorder. Archives of General Psychiatry, 62(3), 273–281. doi: 10.1001/archpsyc.62.3.273

South J., Stansfield J., Amlôt R., & Weston D. (2020). Sustaining and strengthening community resilience throughout the COVID-19 pandemic and beyond. Perspect Public Health, 140(6), 305–308. doi: 10.1177/1757913920949582

Stoyanova S., Miteva S., & Ivantchev N. (2022). Perceived threat of COVID-19, self-assessment of physical health and mental resilience. Philosophical Psychology. https://doi.org/10.1080/09515089.2022.2086456

Taquet M., Luciano S., Geddes J.R., & Harrison P.J. (2021). Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62354 COVID-19 cases in the USA. Lancet Psychiatry, 8(2), 130–140. doi: 10.1016/S2215-0366(20)30462-4

Tavčar P., Potokar M., Kolenc M., Korva M., Avšič-Županc T., Zorec R., & Jorgačevski J. (2021). Neurotropic Viruses, Astrocytes, and COVID-19. Front. Cell. Neurosci, 15, 662578. https://doi.org/10.3389/fncel.2021.662578

Varga T. N., Bu F., Dissing A.S., Elsenburg L.K., Herranz Bustamante J.J., Matta J., van Zon S. K.R., Brouwer S., Bültmann U., Fancourt D., Hoeyer K., Goldberg M., Melchior M., Strandberg-Larsen K., Zins M., Clotworthy A., & Rod N.H. (2021). Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200,000 Western and Northern Europeans. The Lancet Regional Health Europe 2, 2, 100020. https://doi.org/10.1016/j.lanepe.2020.100020

Vgontzas A.N., Bixler E.O., Lin H.M., Prolo P., Mastorakos G., Vela-Bueno A., Kales A., & Chrousos G.P. (2001). Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. The Journal of Clinical Endocrinology & Metabolism, 86(8), 3787-3794. https://doi.org/10.1210/jcem.86.8.7778

Vyas A., Mitra R., Shankaranarayana Rao B.S., & Chattarji S. (2002). Chronic stress induces contrasting patterns of dendritic remodeling in hippocampal and amygdaloid neurons. The Journal of Neuroscience, 22(15), 6810–6818. doi: 10.1523/JNEUROSCI.22-15-06810.2002

Wang C., Pan R., Wan X., Tan Y., Xu L., Ho C. S., & Ho R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health, 17(5), 1729. https://doi.org/10.3390/ijerph17051729

Wang F., Pan F., Shapiro L.A., & Huang J. H. (2017). Stress induced neuroplasticity and mental disorders. Hindawi Neural Plasticity Volume, Article ID 9634501. https://doi.org/10.1155/2017/9634501

Wang S., Zhang Y., Ding W., Meng Y., Hu H., Liu Z., Zeng X., & Wang M. (2020). Psychological distress and sleep problems when people are under interpersonal isolation during an epidemic: a nationwide multicenter cross-sectional study. Eur Psychiatry, 63(1), e77. doi: 10.1192/j.eurpsy.2020.78

Widdett R. (2014). Neuroplasticity and mindfulness meditation. (Honors Theses, Paper 2469), Western Michigan University ScholarWorks, Western Michigan University. 2469. https://scholarworks.wmich.edu/honors_theses/2469

Yang L., Wu D., Hou Y., Wang X., Dai N., Wang G., Yang Q., Zhao W., Lou Z., Ji Y., & Ruan L. (2020). Analysis of psychological state and clinical psychological intervention model of patients with COVID-19. https://doi.org/10.1101/2020.03.22.20040899

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