Comparison of Referral Thinking and Cognitive Emotion Regulation Strategies in People with Generalized Anxiety Disorder that Improved from Corona and Normal Group

Covid-19 is a new and unknown type of disease originating from the virus of the covid family, which causes the death of about 2% of patients with acute respiratory symptoms. The main symptoms of this virus are fever, cough, shortness of breath, extreme fatigue, etc. (1). In the meantime, generalized anxiety disorder is a type of general anxiety from the set of anxiety disorders in DSM-5, which makes people with this disorder constantly worry about future events; So that this chronic worry causes disturbance in the daily functioning process of a person and makes him suffer a lot (4). Despite the mentioned content, it is difficult to separate people with generalized anxiety disorder from normal people, and for this reason, several views have been presented about the cause of morbid anxiety (5). Cognitive theorists believe that false beliefs cause anxiety. For example, Ellis states that external factors cannot make a person anxious and it is the feeling of incompetence to deal with threatening risks that makes him anxious (6). Also, researches about generalized anxiety show that one of the main characteristics of people with generalized anxiety is referential thinking, which is one of the metadiagnostic processes that has a high correlation with emotional disorders, and in general, it can be said that it is the same characteristic in most mental disorders (8).On the other hand, people with general anxiety also have difficulty organizing their emotional experiences and find them annoying. So, these people do not use the positive skills of cognitive emotion regulation (15). Cognitive regulation of emotion is one of the most important criteria for diagnosing the level of mental health. Because people in stressful situations use various strategies such as magnifying the event, positive evaluation, acceptance, and planning (16). The cognitive regulation of emotion is an internal and external conflict. Any damage in the cognitive regulation of emotion makes people more vulnerable to depression and anxiety disorders (17). According to the above material, the researcher is trying to answer the question, is there a difference between referential thinking and cognitive emotion regulation strategies of people with generalized anxiety who have recovered from Corona and the normal group?

The current research is descriptive and causal-comparative based on the objectives and method of data collection. The statistical population of the present study was composed of people who visited one of the health centers of Alborz province in November and December 2019 (about 300 people). Among them, 50 people whose corona test was positive and after 2-3 weeks their test was negative and based on Spitzer's generalized anxiety questionnaire, they were diagnosed with corona anxiety disorder. Available and targeted sampling method after completing the consent form and observing the ethical principles of the research by the researcher (confidentiality and the least possibility of harm or risk) as a sample in the group recovered from Corona and 50 people who were tested from the beginning was negative and the score of anxiety questionnaire of generalized disorder was not significant, they were selected as healthy group. And after explaining the purpose of the research, they completed questionnaires of referential thinking (Ehring et al., 2010), generalized anxiety (Spitzer et al., 2006) and cognitive regulation of emotion (Garnefsky et al., 2001). Finally, descriptive statistics (mean and standard deviation) and Kalmogorov Smirnov tests to check the normal distribution of data, Levine's test to check the homogeneity of variances and multivariate variance analysis using spss software version 25 for analysis Data statistics were used.

The demographic and descriptive results showed that the average age of the subjects in the normal group was 34.77 and the group with general anxiety recovered from Corona was 35.33 years old. The highest number of subjects was 33 years old (26 subjects: 53.8% married and 46.2% single) and the least number of subjects was 40 years old (7 subjects: 42.9% married and 57.1% single). Also, the largest number of subjects had undergraduate education.It was also found that the mean and standard deviation of referential thinking in the group with general anxiety recovered from Corona was higher than the normal group, but the scores of the normal group were higher in the variable of cognitive regulation of emotion.The results of the multivariate analysis of variance test showed that there is a significant difference between the referential thinking and the cognitive emotion regulation strategies of the normal group and the group with general anxiety recovered from Corona (P < 0.001). On the other hand, by observing the effect size calculated in Table 2, it seems that referential thinking explains 7.2% and cognitive emotion regulation strategies explain 45.2% of the variance of this difference.

This research was conducted with the aim of comparing referential thinking and cognitive emotion regulation strategies in people with general anxiety recovered from Corona with the normal group. The results showed that there is a significant difference between the average scores of the two groups of normal people and people with general anxiety recovered from Corona in reference thinking variables, so that the scores of people with generalized anxiety recovered from Corona are higher than healthy people. In the explanation of the obtained findings, it can be said that referential thinking increases a person's worry by creating repetitive negative thoughts and mental rumination, and since the structure of worry is one of the main characteristics of generalized anxiety disorder (24), it can be said that it is one of the causes of the disorder Pervasive anxiety is the presence of referential thoughts, and after that, people who have faced a lot of life and financial losses due to the corona situation show the diagnostic criteria of generalized anxiety disorder with symptoms of referential thoughts.Another finding of the current research showed that there is a significant difference between people with generalized anxiety who have recovered from Corona and healthy people in using cognitive emotion regulation strategies; So that people withgeneralized anxiety recovered from Corona use negative strategies in the cognitive regulation of emotion far more than healthy people. In explaining the results of the data, it can be mentioned that human emotions play an important role in his life, especially in adapting to life changes and unpleasant environmental and stressful events, especially when a person has a negative emotional experience such as Chronic diseases or a threatening event are encountered. Research results show that people who use incompatible strategies are more vulnerable to emotional problems (18). On the other hand, it seems that people who use non-adaptive strategies in the stressful conditions of the outbreak of the Corona virus show far more symptoms of generalized anxiety disorder.The findings of this research showed that there is a difference between referential thinking and cognitive emotion regulation strategies between two groups of people with generalized anxiety who recovered from Corona and the normal group. In this way, in addition to the problems and complications related to their disease, people with corona are also involved in some psychological problems. These issues and problems can cause the aggravation and continuation of the symptoms and complications of the Covid-19 disease. Therefore, it is necessary for specialists in this field to pay special attention to the psychological aspects of patients. Timely psychological examinations of these patients can play an important role in preventing the exacerbation and continuation of symptoms and complications.