Introduction: It is claimed that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on mental health. However, to date, prospective studies are lacking. Moreover, it is important to identify which factors modulate the stress response to the pandemic. Previously, sense of coherence (SOC) has emerged as a particularly important resistance factor. Objective: This prospective study aimed to assess the impact of the COVID-19 outbreak on mental health and to investigate the ability of pre-outbreak SOC levels to predict changes in psychopathological symptoms. Methods: This study assessed psychopathological symptoms and SOC before and after the COVID-19 outbreak as well as postoutbreak COVID-19-related traumatic distress in a Germanspeaking sample (n = 1,591). Bivariate latent change score (BLCS) modeling was used to analyze pre-to post-outbreak changes in psychopathological symptoms and the ability of SOC to predict symptom changes. Results: Overall, there was no change in psychopathological symptoms. However, on an individual-respondent level, 10% experienced a clinically significant increase in psychopathological symptoms and 15% met cutoff criteria for COVID-19-related traumatic distress. Using BLCS modeling, we identified a high-stress group experiencing an increase in psychopathological symptoms and a decrease in SOC and a low-stress group showing the reversed pattern. Changes in SOC and psychopathological symptoms were predicted by pre-outbreak SOC and psychopathological symptom levels. Conclusions: Although mental health was stable in most respondents, a small group of respondents characterized by low levels of SOC experienced increased psychopathological symptoms from pre-to post-outbreak. Thus, SOC training might be a promising approach to enhance the resistance to stressors.

Introduction. It is claimed that the COVID-19 pandemic has a negative impact on mental health. However, to date, prospective studies are lacking. Moreover, it is important to identify which factors modulate the stress response to the pandemic. Previously, sense of coherence (SOC) has emerged as a particularly important resistance factor. Objective. This prospective study aimed to assess the impact of the COVID-19 outbreak on mental health and to investigate the ability of pre-outbreak SOC levels to predict changes in psychopathological symptoms.Methods. The study assessed psychopathological symptoms and SOC before and after the COVID-19 outbreak as well as post-outbreak COVID-19-related traumatic distress in a German-speaking sample (N=1,591). Bivariate latent change score (BLCS) modelling was used to analyse pre-to-post outbreak changes in psychopathological symptoms and the ability of SOC to predict symptom changes.Results. Overall, there was no change in psychopathological symptoms. However, on individual-respondent level 10% experienced a clinically significant increase in psychopathological symptoms, and 15% met cut-off criteria for COVID-19-related traumatic distress. Using BLCS modelling, we identified a high-stress group experiencing an increase in psychopathological symptoms and a decrease in SOC and a low-stress group showing the reversed pattern. Changes in SOC and psychopathological symptoms were predicted by pre-outbreak SOC and psychopathological symptom levels. Conclusions. Although mental health was stable in most respondents, a relevant proportion of the sample experienced increased psychopathological symptoms due to COVID-19. Since higher SOC was predictive of smaller changes in symptom levels, SOC training might be a promising approach to enhance resistance to stressors.

Sense of coherence (SOC) constitutes the key component of salutogenesis theory. It reflects individuals' confidence that their environment is comprehensible and manageable and that their lives are meaningful. Research demonstrates a strong crosssectional relationship between SOC and mental health. However, little is known about SOC's temporal stability and its potential to predict changes in psychopatho

Background: To date, most research on aggression in mental disorders focused on active-aggressive behavior and found self-directed and other-directed active aggression to be a symptom and risk-factor of psychopathology. On the other hand, passive-aggressive behavior has been investigated less frequently and only in research on psychodynamic defense mechanisms, personality disorders, and dysfunctional self-control processes. This small number of studies primarily reflects a lack of a reliable and valid clinical assessment of passive-aggressive behavior. To address this gap, we developed the Test of Passive Aggression (TPA), a 24-item self-rating scale for the assessment of self-directed and other-directed passive-aggressive behavior.Method: Study 1 examined the internal consistency and factorial validity of the TPA in an inpatient sample (N = 307). Study 2 investigated the retest-reliability, internal consistency, and construct validity (active aggression, personality traits, impulsivity) of the TPA in a student sample (N = 180).Results: In line with our hypothesis, Exploratory Structural Equation Modeling revealed an acceptable to good fit of a bi-factorial structure of the TPA (Chi-square-df-ratio = 1.98; RMSR = 0.05, fit.off = 0.96). Both TPA scales showed good to excellent internal consistency (α = 0.83–0.90) and 4-week retest-reliability (rtt = 0.86). Correlations with well-established aggression scales, measures of personality, and impulsivity support discriminant and convergent validity of the TPA.Conclusions: The TPA is a reliable and valid instrument for the assessment of self-directed and other-directed passive-aggressive behavior.

Background : According to clinical guidelines, trauma-focused psychotherapies (TF-PT) such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are recommended as first-line treatments for posttraumatic stress disorder (PTSD). TF-CBT and EMDR are equally effective and have large effect sizes. However, many patients fail to respond or have comorbid symptoms or disorders that only partially decline with TF-PT. Thus, there is growing interest in augmenting TF-PT through adjuvant interventions. Objective : The current systematic review aims to assess whether adjuvant interventions improve outcome among adult PTSD patients receiving TF-PT. Methods : We searched the databases PubMed, PILOTS, Web of Science and the Cochrane Library for controlled clinical trials examining whether adjuvant interventions lead to more symptom reduction in adult PTSD patients receiving TF-PT. Thirteen randomized controlled trials fitted the inclusion criteria. These were evaluated for internal risk of bias using the Cochrane Handbook for Systematic Review of Interventions. Results : Most studies have a substantial risk for internal bias, mainly due to small sample sizes. Thus, no strong conclusion can be drawn from the current empirical evidence. Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction. Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction. Conclusions : Currently, it is not possible to formulate evidence-based clinical recommendations regarding adjuvants interventions. While several adjuvant interventions hold the potential to boost the effectiveness of TF-PT, the realization of sufficiently powered studies is crucial to separate plausible ideas from interventions proven to work in practice.