Emotion Regulation Strategies, COVID-19 Induced Psychological Distress, and Psychological Well-being in Pakistan

Main Article Content

Sahira Zaman
Fatima Abid
Yumna Bilal

Abstract


The world is not the same after the COVID-19 pandemic hit in December 2019. The present study investigated the role of emotion regulation (ER) strategies (expressive suppression and cognitive reappraisal) between COVID-19-induced psychological distress and psychological well-being among students during the lockdown. This study hypothesized that COVID-19-induced psychological distress reduces the student’s psychological well-being, and ER strategies mediate this association. A quantitative survey research design was used for collecting data from 300 students in different departments of a public university in Pakistan. The results indicated that COVID-19-induced psychological distress significantly decrease students' psychological well-being (b= -.38, t = -15.02, p < .001) during the lockdown period in Pakistan. Both ER strategies found a complete statistically significant mediation between this distress and students' psychological well-being. Cognitive reappraisal had a slightly more positive indirect effect (a*b = .08, Bootstrap CI95 = .03 and .12) on COVID-19 induced psychological distress and psychological well-being than expressive suppression (a*b = .07, Bootstrap CI95 = .01 and .04). It is concluded that mental health can be better looked after by using better emotion regulation strategies. Thus, this study contributes to the behavioral sciences knowledge by iterating that emotional regulation improves the mental health of individuals in these difficult circumstances. The strength of using thought restructuring through cognitive reappraisal is a better strategy for dealing with distress in the pandemic. These findings contribute to behavioral science knowledge and understanding of emotion regulation in mitigating psychological distress and enhancing well-being during this pandemic and beyond.



Article Details

How to Cite
Zaman, S., Abid, F., & Bilal, Y. (2021). Emotion Regulation Strategies, COVID-19 Induced Psychological Distress, and Psychological Well-being in Pakistan. The Journal of Behavioral Science, 16(3), 27-41. Retrieved from https://so06.tci-thaijo.org/index.php/IJBS/article/view/251637
Section
Research Articles

References

Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality, 64(4), 899-922. https://doi.org/10.1111/j.1467-6494.1996.
tb00948.x
Allahverdipour, H., Karimzadeh, Z., Alizadeh, N., Asghari Jafarabadi, M., & Javadivala, Z. (2021). Psychological well-being and happiness among middle-aged women: A cross-sectional study. Health Care for Women International, 42(1), 28-42. https://doi.org/10.1080/07399332.2019.1703990
Asghar, N., Kobyzev, I., Hoey, J., Poupart, P., & Sheikh, M. B. (2020). Generating emotionally aligned responses in dialogues using affect control theory. Cornell University. https://arxiv.org/abs/2003.03645
Bauman, N. J. (2016). The stigma of mental health in athletes: Are mental toughness and mental health seen as contradictory in elite sport? British Journal of Sports Medicine, 50, 135-136. http://dx.doi.org/10.1136/bjsports-2015-095570
Bericat, E. (2016). The sociology of emotions: Four decades of progress. Current Sociology, 64(3), 491-513. https://doi.org/10.1177%2F00113921
15588355
Bjelajac, Ž., & Filipović, A. (2020). Lack of security culture in facing the COVID-19 pandemic. The Culture of Polis, 17(42), 383-399.
Blair, C., & Raver, C. C. (2012). Individual development and evolution: experiential canalization of self-regulation. Developmental psychology, 48(3), 647–657. https://doi.org/10.1037/a0026472
Bohlmeijer, E. T., & Westerhof, G. J. (2021). A new model for sustainable mental health: Integrating well-being into psychological treatment. In Kirby, J. N., & Gilbert, P. (Eds.), Making an Impact on Mental Health: The Applications of Psychological Research (pp. 153–188). Routledge/Taylor & Francis Group.
Brüggen, E. C., Hogreve, J., Holmlund, M., Kabadayi, S., & Löfgren, M. (2017). Financial well-being: A conceptualization and research agenda. Journal of Business Research, 79, 228-237. https://doi.org/10.1016/j.jbusres.2017.03.013
Carter, M. J., & Fuller, C. (2016). Symbols, meaning, and action: The past, present, and future of symbolic interactionism. Current Sociology, 64(6), 931-961. https://doi.org/10.1177/0011392116638396
Cole, P. M., Dennis, T. A., Martin, S. E., & Hall, S. E. (2008). Emotion Regulation and the Early Development of Psychopathology. In Vandekerckhove, M., von Scheve, C., Ismer, S., Jung, S., & Kronast, S. (Eds.), Regulating Emotions. https://doi.org/10.1002/97814443
01786.ch7
Cherland, E. (2012). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(4), 313.
Cheung, L. H., Callaghan, P., & Chang, A. M. (2003). A controlled trial of psycho-educational interventions in preparing Chinese women for elective hysterectomy. International Journal of Nursing Studies, 40(2), 207-216. https://doi.org/10.1016/S0020-7489(02)00080-9
Chirico, F., & Magnavita, N. (2020). The crucial role of occupational health surveillance for health-care workers during the COVID-19 pandemic. Workplace Health & Safety, 69(1), 5-6. https://doi.org/10.1177/2165079920950161
Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75(2), 561–574. https://doi.org/10.1037//0022-3514.75.2.561
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4. https://doi.org/10.11648/j.ajtas.20160501.11
Ford, B. Q., & Gross, J. J. (2019). Why beliefs about emotion matter: An emotion-regulation perspective. Current Directions in Psychological Science, 28(1), 74-81. https://doi.org/10.1177/0963721418806697
Ford, B. Q., Lwi, S. J., Gentzler, A. L., Hankin, B., & Mauss, I. B. (2018). The cost of believing emotions are uncontrollable: Youths’ beliefs about emotion predict emotion regulation and depressive symptoms. Journal of Experimental Psychology: General, 147(8), 1170. https://psycnet.apa.org/doi/10.1037/xge0000396
Ghebreyesus, T. A. (2020). Safeguard research in the time of COVID-19. Nature Medicine, 26(4), 443. https://doi.org/10.1038/s41591-020-0852-1
Gordon, S. L. (1990). Social Structural Effects on Emotions. In Kemper, T. D. (Ed.), Research Agendas in The Sociology of Emotions (pp. 145–179). State University of New York Press.
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1-26. https://doi.org/10.1038/
s41591-020-0852-1
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348-362. https://doi.org/10.1037/0022-3514.85.2.348
Hayes, A. F. (2017). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Publications.
Ho, C. S., Lim, L. J., Lim, A. Q., Chan, N. H., Tan, R. S., Lee, S. H., & Ho, R. (2020). Diagnostic and predictive applications of functional near-infrared spectroscopy for major depressive disorder: A systematic review. Frontiers in Psychiatry, 11, 378. https://doi.org/10.3389/
fpsyt.2020.00378
Hochschild, A. (1983). Comment on Kemper's "Social constructionist and positivist approaches to the sociology of emotions." American Journal of Sociology, 89(2), 432–434. https://doi.org/10.1086/227874
Husain, S. F., Tang, T., Yu, R., Tam, W. W., Tran, B., Quek, T. T., Hwang, S., Chang, C. W., Ho, C. S., & Ho, R. C. (2020). Cortical haemodynamic response measured by functional near infrared spectroscopy during a verbal fluency task in patients with major depression and borderline personality disorder. EBioMedicine, 51, 102586. https://doi.org/10.1016/j.ebiom.2019.11.047
Husain, S. F., Yu, R., Tang, T., Tam, W. W., Tran, B., Quek, T. T., Hwang, S., Chang, C. W., Ho, C. S., & Ho, R. C. (2020). Validating a functional near-infrared spectroscopy diagnostic paradigm for major depressive disorder. Scientific Reports, 10(1), 1-9. https://doi.org/10.1038/s41598-020-66784-2
Idris, I., Khairani, A. Z., & Shamsuddin, H. (2019). The influence of resilience on psychological well-being of Malaysian university undergraduates. International Journal of Higher Education, 8(4), 153-163.
Isaac, M. M., Weng, C., Chen, C.-Y., & Phuong Khanh, T.-N. (2021). Effects of an Online Community Intervention on Taiwanese Sugar Intake Behavior. The Journal of Behavioral Science, 16(2), 16-27. https://so06.tcithaijo.org/
index.php/IJBS/article/view/249235
Jarymowicz, M. T., & Imbir, K. K. (2015). Toward a human emotions taxonomy (based on their automatic vs. reflective origin). Emotion Review, 7(2), 183–188. https://doi.org/10.1177/
1754073914555923
Jung, C. G. (2017). Mandala Symbolism:(From vol. 9 collected works). Princeton University Press.
Jurist, E. L. (2005). Mentalized affectivity. Psychoanalytic Psychology, 22(3), 426–444. https://doi.org/10.1037/0736-9735.22.3.426
Kamper-DeMarco, K. E., Shankman, J., Fearey, E., Lawrence, H. R., & Schwartz-Mette, R. A. (2020). Linking social skills and adjustment. In Social Skills Across the Life Span (pp. 47-66). Elsevier.
Katana, M., Röcke, C., Spain, S. M., & Allemand, M. (2019). Emotion regulation, subjective well-being, and perceived stress in daily life of geriatric nurses. Frontiers in Psychology, 10, 1097. https://doi.org/10.3389/fpsyg.2019.01097
Kessler, R. C. (2003). Epidemiology of women and depression. Journal of Affective Disorders, 74(1), 5-13. https://doi.org/10.1016/S0165-0327(02)00426-3
Khairani, A. Z., Shamsuddin, H., & Idris, I. (2019). Improving psychological well-being among undergraduates: How creativity in learning can contribute? Jurnal Komunikasi: Malaysian Journal of Communication, 35(2), 346-360. http://journalarticle.ukm.my/13208/
King, L. A., & Miner, K. N. (2000). Writing about the perceived benefits of traumatic events: Implications for physical health. Personality and Social Psychology Bulletin, 26(2), 220-230. https://doi.org/10.1177/0146167200264008
Le, H. T., Lai, A. J. X., Sun, J., Hoang, M. T., Vu Linh, G., Pham, H. Q., Nguyen, T. H., Tran, B. X., Latkin, C. A., Le Xuan, T. T., Nguyen, T. T., Pham, Q. T., Ta, N. T. K., Nguyen, Q. T., Ho, R. C. M., & Ho, C. S. H. (2020). Anxiety and depression among people under the nationwide partial lockdown in Vietnam. Frontiers in Public Health, 8, 656. https://doi.org/10.3389/fpubh.2020.589359
Lee, Y., Lui, L. M., Chen-Li, D., Liao, Y., Mansur, R. B., Brietzke, E., Rosenblat, J. D., Ho, R., Rodrigues, N. B., & Lipsitz, O. (2021). Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries. Journal of Affective Disorders, 290, 364-377. https://doi.org/10.1016/j.jad.2021.04.050
Li, Y., Wang, Y., Jiang, J., Valdimarsdóttir, U. A., Fall, K., Fang, F., Song, H., Lu, D., & Zhang, W. (2020). Psychological distress among health professional students during the COVID-19 outbreak. Psychological Medicine, 51(11), 1960-1960. https://doi.org/10.1017/S003329
1721000714
Liu, C. H., Zhang, E., Wong, G. T. F., & Hyun, S. (2020). Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for US young adult mental health. Psychiatry Research, 290, Article 113172. https://doi.org/10.1016/j.psychres.2020.113172
Ma, Z., Zhao, J., Li, Y., Chen, D., Wang, T., Zhang, Z., Chen, Z., Yu, Q., Jiang, J., & Fan, F. (2020). Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in china. Epidemiology and Psychiatric Sciences, 29, E181. http://doi.org/10.1017/S2045796020000931
Manzano-García, G., & Ayala, J. C. (2017). Relationship between psychological capital and psychological well-being of direct support staff of specialist autism services. The mediator role of burnout. Frontiers in psychology, 8, 2277. https://doi.org/10.3389/fpsyg.2017.02277
Martino, G., Caputo, A., Vicario, C. M., Feldt-Rasmussen, U., Watt, T., Quattropani, M. C., Benvenga, S., & Vita, R. (2021). Alexithymia, emotional distress, and perceived quality of life in patients with hashimoto’s thyroiditis. Frontiers in Psychology, 12, 1295. https://doi.org/10.3389/fpsyg.2021.667237
Maslow, A. (1968). Some educational implications of the humanistic psychologies. Harvard Educational Review, 38(4), 685-696. https://doi.org/10.17763/haer.38.4.j07288786v86w660
Nicola, M., Alsafi, Z., Sohrabi, C., Kerwan, A., Al-Jabir, A., Iosifidis, C., Agha, M., & Agha, R. (2020). The socio-economic implications of the coronavirus pandemic (COVID-19): A review. International journal of surgery, 78, 185-193. https://doi.org/10.1016/j.ijsu.2020.04.018
Nezlek, J. B., & Kuppens, P. (2008). Regulating positive and negative emotions in daily life. Journal of Personality, 76(3), 561-580. https://doi.org/10.1111/j.1467-6494.2008.
00496.x
Olszewska-Guizzo, A., Mukoyama, A., Naganawa, S., Dan, I., Husain, S. F., Ho, C. S., & Ho, R. (2021). Hemodynamic response to three types of urban spaces before and after lockdown during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(11), 6118. https://doi.org/10.3390/ijerph18116118
Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in Psychology, 9, 798. https://doi.org/10.3389/fpsyg.2018.00798
Proctor, C., Tweed, R., & Morris, D. (2016). The Rogerian fully functioning person: A positive psychology perspective. Journal of Humanistic Psychology, 56(5), 503-529. https://doi.org/10.1177%2F0022167815605936
Putnam, R. D. (2000). Bowling Alone: The Collapse and Revival of American Community. Simon and Schuster.
Ran, R. M., & Deci, E. L. (2011). A self-determination theory perspective on social, institutional, cultural, and economic supports for autonomy and their importance for well-being. Human Autonomy in Cross-Cultural Context (pp. 45-64). https://doi.org/10.1007/
978-90-481-9667-8_3
Ren, Z., Xin, Y., Ge, J., Zhao, Z., Liu, D., Ho, R., & Ho, C. S. (2021). Psychological impact of COVID-19 on college students after school reopening: A cross-sectional study based on machine learning. Frontiers in Psychology, 12, 1346. https://doi.org/10.3389/fpsyg.2021.
641806
Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics, 83(1), 10-28. https://doi.org/10.1159/000353263
Sharma, S. (2020). Life Adjustment During COVID-19. In S. Z. H. Zaidi, S. S. H. Kazmi, K. Hasan, & N. Sharma (Eds)., COVID-19: Biopsychosocial Perspectives. https://books.google.com.pk/books?id=0XbpDwAAQBAJ&lpg=PT248&ots=U9RpyYITNj&lr&pg=PT253#v=onepage&q&f=false
Shi, L., Lu, Z. A., Que, J. Y., Huang, X. L., Liu, L., Ran, M. S., Gong, Y., Yuan, K., Yan, W., Sun, Y., Shi, J., Bao, Y., & Lu, L. (2020). Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Network Open, 3(7), http://doi.org10.1001/jamanetworkopen.2020.14053
Shipman, K. L., & Zeman, J. (2001). Socialization of children's emotion regulation in mother–child dyads: A developmental psychopathology perspective. Development and Psychopathology, 13(2), 317-336. https://doi.org/10.1017/S0954579401002073
Singh, G. (2014). Mental health of adolescents in relation to emotional maturity and parent child relationship. Voice of Research, 3(2), 4-6.
Sledge Jr, G. W., Hu, P., Falkson, G., Tormey, D., Abeloff, M., & Eastern Cooperative Oncology Group. (2000). Comparison of chemotherapy with chemohormonal therapy as first-line therapy for metastatic, hormone-sensitive breast cancer: An eastern cooperative oncology group study. Journal of Clinical Oncology, 18(2), 262. https://doi.org/10.1200/JCO.2000.
18.2.262
Soh, H. L., Ho, R. C., Ho, C. S., & Tam, W. W. (2020). Efficacy of digital cognitive behavioural therapy for insomnia: A meta-analysis of randomised controlled trials. Sleep Medicine, 75, 315-325. https://doi.org/10.1016/j.sleep.2020.08.020
Srivastava, S., Purkayastha, N., Chaurasia, H., & Muhammad, T. (2021). Socioeconomic inequality in psychological distress among older adults in India: A decomposition analysis. BMC Psychiatry, 21(1), 1-15. https://doi.org/10.1186/s12888-021-03231-0
Tee, M., Wang, C., Tee, C., Pan, R., Reyes, P. W., Wan, X., Anlacan, J., Tan, Y., Xu, L., & Harijanto, C. (2020). Impact of the COVID-19 pandemic on physical and mental health in lower and upper middle-income Asian countries: A comparison between the Philippines and China. Frontiers in Psychiatry, 11, Article 568929. https://doi.org/10.3389/fpsyt.2020.568929
Tran, B. X., Nguyen, H. T., Le, H. T., Latkin, C. A., Pham, H. Q., Vu, L. G., Le, X. T. T., Nguyen, T. T., Pham, Q. T., & Ta, N. T. K. (2020). Impact of COVID-19 on economic well-being and quality of life of the Vietnamese during the national social distancing. Frontiers in Psychology, 11, Article 565153. https://doi.org/10.3389/fpsyg.2020.565153
Tran, B. X., Vo, L. H., Phan, H. T., Pham, H. Q., Vu, G. T., Le, H. T., Latkin, C. A., Ho, C. S., & Ho, R. C. (2020). Mobilizing medical students for COVID-19 responses: Experience of Vietnam. Journal of Global Health, 10(2), Article 020319. https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC7559422/
Verzeletti, C., Zammuner, V. L., Galli, C., & Agnoli, S. (2016). Emotion regulation strategies and psychosocial well being in adolescence. Null, 3(1), 1199294. https://doi.org/10.1080/23311908.2016.1199294
Wang, C., Chudzicka-Czupała, A., Grabowski, D., Pan, R., Adamus, K., Wan, X., Hetnał, M., Tan, Y., Olszewska-Guizzo, A., & Xu, L. (2020). The association between physical and mental health and face mask use during the COVID-19 pandemic: A comparison of two countries with different views and practices. Frontiers in Psychiatry, 11, Article 569981. https://doi.org/10.3389/fpsyt.2020.569981
Wang, C., Chudzicka-Czupała, A., Tee, M. L., Núñez, M. I. L., Tripp, C., Fardin, M. A., Habib, H. A., Tran, B. X., Adamus, K., & Anlacan, J. (2021). A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans. Scientific Reports, 11(1), 1-12. https://doi.org/10.1038/s41598-021-85943-7
Wang, C., Fardin, M. A., Shirazi, M., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., Tran, B., & Quek, T. T. (2021). Mental health of the general population during the 2019 coronavirus disease (COVID-19) pandemic: A tale of two developing countries. Psychiatry International, 2(1), 71-84. https://doi.org/10.3390/psychiatryint2010006
Wang, C., López-Núñez, M. I., Pan, R., Wan, X., Tan, Y., Xu, L., Choo, F., Ho, R., Ho, C., & ME, A. G. (2021). The impact of 2019 coronavirus disease (COVID-19) pandemic on physical and mental health: A comparison between China and Spain. JMIR Formative Research, 5(5), e27818. https://doi.org/10.2196/27818
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. International Journal of Environmental Research and Public Health, 17(5), 1729. https://doi.org/10.3390/ijerph17051729
Wang, C., Tee, M., Roy, A. E., Fardin, M. A., Srichokchatchawan, W., Habib, H. A., Tran, B. X., Hussain, S., Hoang, M. T., & Le, X. T. (2021). The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia. PloS One, 16(2), e0246824. https://doi.org/10.1371/journal.pone.0246824
Wang, C., Tripp, C., Sears, S. F., Xu, L., Tan, Y., Zhou, D., Ma, W., Xu, Z., Chan, N. A., & Ho, C. (2021). The impact of the COVID-19 pandemic on physical and mental health in the two largest economies in the world: A comparison between the united states and china. Journal of Behavioral Medicine. https://doi.org/10.1007/s10865-021-00237-7
Wang, Y., Di, Y., Ye, J., & Wei, W. (2021). Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychology, Health & Medicine, 26(1), 13-22. https://doi.org/10.1080/13548506.
2020.1746817
Ward, C., Bochner, S., & Furnham, A. (2020). The Psychology of Culture Shock. Routledge.
Watson, J. C., & Greenberg, L. S. (2017). Emotion-focused therapy for generalized anxiety. American Psychological Association. https://doi.org/10.1037/0000018-000
Watters, E. R., Aloe, A. M., & Wojciak, A. S. (2021). Examining the associations between childhood trauma, resilience, and depression: A multivariate meta-analysis. Trauma, Violence, & Abuse. https://doi.org/10.1177/1524838021
1029397
Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin, 138(4), 775–808. https://doi.org/10.1037/a0027600
Werner, K., & Gross, J. J. (2010). Emotion regulation and psychopathology: A conceptual framework. In A. M. Kring & D. M. Sloan (Eds.), Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment (pp. 13–37). The Guilford Press.
Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., Curtis, H. J., Mehrkar, A., Evans, D., & Inglesby, P. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature, 584(7821), 430-436. https://doi.org/10.1038/s41586-020-2521-4
World Health Organization [WHO]. (2019). Advice for public. https://www.who.int/emergencies/
diseases/novel-coronavirus-2019/advice-for-public
World Health Organization [WHO]. (1998). The WHO-5 well-being index. https://www.psykiatri-regionh.dk/who-5/Documents/WHO-5%20questionaire%20-%20English.pdf
Yu, H., Li, M., Li, Z., Xiang, W., Yuan, Y., Liu, Y., Li, Z., & Xiong, Z. (2020). Coping style, social support and psychological distress in the general Chinese population in the early stages of the COVID-19 epidemic. BMC Psychiatry, 20(1), 1-11. https://doi.org/10.1186/s12888-020-02826-3
Zhang, J., Lu, H., Zeng, H., Zhang, S., Du, Q., Jiang, T., & Du, B. (2020). The differential psychological distress of populations affected by the COVID-19 pandemic. Brain, Behavior, and Immunity, 87, 49-50. https://doi.org/10.1016/j.bbi.2020.04.031