Background: Physicians play a crucial frontline role in the COVID-19 pandemic, which may involve high levels of anxiety. We aimed to investigate the association between pandemic-related stress factors (PRSF) and anxiety and to evaluate the potential effect of resilience on anxiety among physicians. Methods: A self-report digital survey was completed by 1106 Israeli physicians (564 males and 542 females) during the COVID-19 outbreak. Anxiety was measured by the 8-item version of the Patient-Reported Outcomes Measurement Information System. Resilience was evaluated by the 10-item Connor-Davidson Resilience Scale. Stress was assessed using a PRSF inventory. Results: Physicians reported high levels of anxiety with a mean score of 59.20 ± 7.95. We found an inverse association between resilience and anxiety. Four salient PRSF (mental exhaustion, anxiety about being infected, anxiety infecting family members, and sleep difficulties) positively associated with anxiety scores. Conclusions: Our study identified specific PRSF including workload burden and fear of infection that are associated with increased anxiety and resilience that is associated with reduced anxiety among physicians.

Monitoring and deciding how to adjust an active regulatory strategy in order to maximize adaptive outcomes is an integral element of emotion regulation, yet existing evidence remains scarce. Filling this gap, the present study examined core factors that determine behavioral regulatory monitoring decisions and the neuro-affective consequences of these decisions. Using a novel paradigm, the initial implementation of central downregulation strategies (distraction, reappraisal) and the emotional intensity (high, low) were manipulated, prior to making a behavioral decision to maintain the initial implemented strategy or switch from it. Neuro-affective consequences of these behavioral decisions were evaluated using the Late Positive Potential (LPP), an electro-cortical measure of regulatory success. Confirming predictions, initial implementation of reappraisal in high intensity and distraction in low intensity (Strategy × Intensity combinations that were established in prior studies as non-preferred by individuals), resulted in increased behavioral switching frequency. Neurally, we expected and found that in high (but not low) emotional intensity, where distraction was more effective than reappraisal, maintaining distraction (relative to switching to reappraisal) and switching to distraction (relative to maintaining reappraisal) resulted in larger LPP modulation. These findings suggest that monitoring decisions are consistent with previously established regulatory preferences and are associated with adaptive short-term neural consequences.

Being able to resist temptation at a young age is crucial for successful functioning yet it can be challenging. According to the Selection, Optimization, and Compensation with Emotion Regulation (SOC-ER) framework, one central element of successful functioning is selection which involves choosing among regulatory options whose resource requirements fits with the amount of available resources an individual possesses. Although conceptually important, direct empirical evidence is lacking. Accordingly, the present study utilised performance based measures to examine the interactive effect of regulatory selection to resist temptation, and individual differences in executive resources, on functioning in young children. Specifically, 39 first grade children that varied in executive resources (working memory capacity, WMC), selected between two major regulatory strategies (reappraisal and distraction) to resist temptation, that varied in their resource demands, and were evaluated on successful functioning (via questionnaires completed by parents, that assess daily-life behaviours requiring executive functioning). Supporting SOC-ER predictions, we found that among children with low (but not high) WMC, choosing the less effortful distraction regulatory strategy was associated with adaptive functioning. Additionally, regulatory choice preferences previously obtained with adults were extended to children. Broad implications are discussed.