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Original article
Coping strategies in obsessive-compulsive patients during Covid-19 lockdown
Estrategias de afrontamiento en pacientes con Trastorno obsesivo-compulsivo durante el confinamiento por COVID-19
Ángel Rosa-Alcázara, María Dolores García-Hernándezb, José Luis Parada-Navasc, Pablo J. Olivares-Olivaresb, Sergio Martínez-Murillob, Ana I. Rosa-Alcázarb,
Corresponding author
airosa@um.es

Corresponding author: Dept. Personality, Assessment & Psychological Treatment, University of Murcia, Spain, Faculty of Psychology, Espinardo Campus, University of Murcia, 30100 Murcia, Spain.
a Department of Psychology, Catholic University of Murcia, Spain
b Department of Personality, Assessment & Psychological Treatment, University of Murcia, Spain
c Faculty of Education, University of Murcia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Coronavirus disease 2019 &#40;COVID-19&#41; will have an impact on various spheres of life such as the economy&#44; human health&#44; health care&#44; politics&#44; etc&#46; The World Health Organization has also reported the impact of the pandemic on mental health and psycho-social consequences&#46; Quarantine has affected people&#8217;s usual activities&#44; routines&#44; and livelihoods and this may lead to an increase in loneliness&#44; anxiety&#44; depression&#44; insomnia and harmful alcohol and drug use &#40;<a class="elsevierStyleCrossRef" href="#bib0190">World Health Organization&#44; 2020</a>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The psychological repercussions in both general and clinical populations is causing serious mental health problems&#44; highlighting severe anxiety and depressive symptoms&#44; severe stress levels&#44; posttraumatic stress&#44; etc&#46; &#40;<a class="elsevierStyleCrossRefs" href="#bib0030">Brailovskaia &#38; Margraf&#44; 2020&#59; Bueno-Notivol et al&#46;&#44; 2021&#59; Inchausti et al&#46;&#44; 2020&#59; Li et al&#46;&#44; 2020&#59; Mazza et al&#46;&#44; 2020&#59; Pfefferbaum &#38; North&#44; 2020&#59; Xiang et al&#46;&#44; 2020</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Fear of disease and contagion together with prevention and safety behaviors&#44; such as hand washing&#44; physical distancing&#44; avoidance of stimuli and situations&#44; hypervigilance to somatic sensations&#44; economic problems&#44; reductions in social interaction may increase the risk of serious and disabling mental health conditions&#44; such as anxiety disorders&#44; post-traumatic stress disorder&#44; obsessive- compulsive disorder &#40;OCD&#41; &#40;<a class="elsevierStyleCrossRefs" href="#bib0055">Fiorillo &#38; Gorwood&#44; 2020&#59; Fontenelle &#38; Miguel&#44; 2020&#59; Pozza et al&#46;&#44; 2020&#59; Silva et al&#46;&#44; 2020</a>&#41;&#46; The uncontrollable and unpredictable nature of COVID-19 has likely led to extraordinary stress in the general population&#46; Previous studies have reported that controllable or uncontrollable stressful experiences may provoke or exacerbate psychological and physical pathologies &#40;<a class="elsevierStyleCrossRefs" href="#bib0110">Matheson &#38; Anisman 2003&#59; Slavich&#44; 2016</a>&#41;&#46; It is important to take into account variables both of the stressor itself &#40;frequency&#44; duration&#44; type&#44; number&#44; control&#41; and the individual&#39;s abilities to cope &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Monroe et al&#46;&#44; 2007</a>&#41;&#46; Focusing on OCD&#44; the elements of containment of the pandemic will produce reinforcement of obsessive thinking and compulsive behavior and exacerbation of symptoms &#40;<a class="elsevierStyleCrossRefs" href="#bib0050">Fineberg et al&#46;&#44; 2020&#59; Rivera &#38; Carballea&#44; 2020&#59; Silva et al&#46;&#44; 2020</a>&#41;&#46; These symptoms have been reported following previous epidemics such as SARS&#44; MERS&#44; etc&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib0085">Kumar &#38; Somani&#44; 2020</a>&#41;&#46; The increase in symptoms might not be immediate and depends on various factors such as the need to keep hands clean each time a person comes from outside&#44; the constant checking for information from various media sources about the virus&#44; the stocking up of masks&#44; soaps&#44; sanitizers and disinfectants all of which can lead to hoarding and panic shopping&#44; etc&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib0015">Banerjee&#44; 2020</a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic is also causing an increase in obsession and compulsion severity&#46; Some variables have been associated with more elevated worsening&#44; such as presenting contamination symptoms&#44; poor personal hygiene and higher severity &#40;<a class="elsevierStyleCrossRef" href="#bib0045">Davide et al&#46;&#44; 2020</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#bib0025">Benatti et al&#46; &#40;2020&#41;</a> have reported a significant emergence of new obsessions and compulsions&#44; increased suicidal ideation&#44; Internet checking&#44; sleep disturbances&#44; avoidance behaviors&#44; and work difficulties&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">One factor that plays a significant role in the psychological and psychosocial control is coping strategies&#46; <a class="elsevierStyleCrossRef" href="#bib0100">Lazarus and Folkman &#40;1986&#41;</a> defined these &#8220;coping strategies&#8221; as constantly changing cognitive and behavioral efforts&#44; which are developed to handle specific demands that are valued as situations that exceed a person&#39;s resources&#46; Coping modulates the differences that exist between individuals in stressful situations&#44; as a result of trying to change these situations or regulate emotional reactions &#40;<a class="elsevierStyleCrossRef" href="#bib0125">Mor&#225;n et al&#46;&#44; 2010</a>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#bib0145">Ravindran et al&#46; &#40;2002&#41;</a> showed that depression has been associated with excessive use of emotion-focused coping&#44; particularly emotional containment and rumination&#46; <a class="elsevierStyleCrossRef" href="#bib0090">Ladouceur et al&#46; &#40;2000&#41;</a> carried out a study analyzing different coping strategies in OCD patients versus anxious and healthy participants&#46; Results showed that the clinical groups used a greater number of strategies but did so ineffectively&#46; The OCD group reported a significantly higher proportion of strategies specifically linked to the thought content&#44; highlighting such things as convincing oneself&#44; distracting activity&#44; seeking reassurance&#44; saying stop&#44; analyzing&#46; The OCD group presented excessive importance of thoughts and hyper-responsibility&#46; <a class="elsevierStyleCrossRef" href="#bib0130">Moritz et al&#46; &#40;2018&#41;</a> also found that adaptive coping in OCD patients was worse relative to healthy controls and to clinical controls with depression&#46; Moreover&#44; the depressive group presented greater acceptance&#44; reevaluation of problems as opportunities and keeping one&#8217;s cool&#44; while the OCD group showed greater catastrophizing&#46; Recently&#44; <a class="elsevierStyleCrossRef" href="#bib0040">Damirchi et al&#46; &#40;2020&#41;</a> in a community sample found a significant negative relationship between self-talk and emotional coping style&#44; death anxiety&#44; and obsessive-compulsive disorder during COVID-19&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We have not found any study analyzing coping strategies in OCD patients during COVID-19&#46; It is important to know what have been used by OCD patients during COVID-19 lockdown and their relationship with anxiety and depression level&#44; both to study their status and to be able to use prevention and treatment strategies&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore&#44; the aim of the present study was to examine differences in coping strategies in OCD patients and a healthy control group in relation to COVID-19&#46; Specifically&#44; the study aimed to&#58; &#40;1&#41; study coping strategies in OCD patients and a healthy control group during lockdown&#59; &#40;2&#41; examine coping strategies controlling level of anxiety and depression&#59; &#40;3&#41; assess differences in coping strategies in the OCD group due to comorbidity and OCD subtypes&#59; &#40;4&#41; assess the relationship between coping strategies and anxiety and depression levels in the OCD group&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Method</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Participants</span><p id="par0045" class="elsevierStylePara elsevierViewall">There were 237 participants aged between 13-58 years &#40;<span class="elsevierStyleItalic">M</span>&#8239;&#61;&#8239;34&#46;60&#44; S<span class="elsevierStyleItalic">D</span>&#8239;&#61;&#8239;10&#46;41&#41; diagnosed with OCD &#40;<a class="elsevierStyleCrossRef" href="#bib0005">American Psychiatric Association APA&#44; 2013</a>&#41; and a healthy control group&#46; Women comprised 55&#46;70&#37; of the sample&#46; Primary obsessions before COVID-19 were aggressive &#40;21&#46;30&#37;&#41;&#44; miscellaneous &#40;18&#46;10&#37;&#41; and somatic &#40;14&#46;80&#37;&#41;&#46; Primary compulsions were checking &#40;41&#46;80&#37;&#41;&#44; cleaning&#47;washing &#40;23&#46;80&#37;&#41;&#44; and miscellaneous &#40;17&#46;20&#37;&#41;&#46; During COVID-19 lockdown&#44; 36&#46;80&#37; showed new obsessions related to contamination &#40;42&#46;30&#37;&#41;&#44; somatic &#40;33&#46;30&#37;&#41;&#44; aggressive &#40;14&#46;30&#37;&#41;&#44; religious &#40;6&#46;10&#37;&#41;&#44; dysmorphic &#40;4&#37;&#41;&#44; accumulation&#44; sexual and symmetric&#47;ordering &#40;2&#37;&#41;&#46; The new compulsions were cleaning&#47;washing &#40;57&#46;80&#37;&#41;&#44; checking &#40;11&#46;10&#37;&#41;&#44; ordering &#40;8&#46;90&#37;&#41;&#44; repeating &#40;11&#46;10&#37;&#41;&#44; hoarding &#40;6&#46;70&#37;&#41; and miscellaneous &#40;4&#46;40&#37;&#41;&#46; The average duration of OCD was 10&#46;06 years &#40;<span class="elsevierStyleItalic">SD</span>&#8239;&#61;&#8239;10&#46;79&#41;&#46; 36&#46;10&#37; patients suffer comorbidity&#46; 67&#37; OCD patients received pharmacological treatments &#40;antidepressant&#8239;&#61;&#8239;69&#46;50&#37;&#44; antipsychotic&#8239;&#43;&#8239;antidepressant&#8239;&#61;&#8239;30&#46;50&#37;&#41; and 100&#37; were under psychological treatment&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Inclusion criteria for participants in the clinical group included a diagnosis of OCD according to DSM criteria&#46; The Control group &#40;CG&#41; could not present any current psychopathological disorder&#46; All participants had to be in lockdown due to COVID-19 &#40;April 2020&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Participants in the clinical group were excluded if they presented a current psychopathology with Bipolar Disorder&#44; Schizophrenic Spectrum Disorders and other Psychotic Disorders&#44; Personality Disorders&#44; Anorexia&#44; Bulimia&#44; disorders related to substance and addictive dependence and Neurocognitive Disorders&#46; Sample characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure</span><p id="par0060" class="elsevierStylePara elsevierViewall">The study met the ethical standards of the Declaration of Helsinki and has been approved by the Ethics Committee of the University of Murcia &#40;Spain&#41;&#46; All families provided written informed consent&#46; The sample was recruited from two contexts&#58; clinical and community&#46; Once clinical group was formed&#44; the non-clinical group was recruited in order to be equal in age and sex&#46; The procedure was as follows&#58; a&#41; Contact some associations&#47;public and private clinics&#47;university workers of Murcia &#40;Spain&#44; April 2020&#41;&#44; and b&#41; complete the anonymous online survey during 20&#8239;minutes&#46; Responses were saved on a secured server at the Universtiy of Murcia&#46;The test presentation order was the same for all participants&#46; Participation was voluntary and free&#46; Recruitment is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measures</span><p id="par0065" class="elsevierStylePara elsevierViewall">Yale Brown Obsessive Compulsive Scale &#40;Y-BOCS&#59; <a class="elsevierStyleCrossRef" href="#bib0075">Goodman et al&#46;&#44; 1989</a>&#41;&#46; Comprising 10 items assessing OCD severity&#46; It contains two subscales&#44; Obsessions &#40;range&#8239;&#61;&#8239;0-20&#41; and Compulsions &#40;range&#8239;&#61;&#8239;0-20&#41; and a Total score &#40;range&#8239;&#61;&#8239;0-40&#41;&#46; The scale has a high internal consistency &#40;&#945;&#8239;&#61;&#8239;&#46;87-&#46;90&#41;&#44; and good convergent validity &#40;<span class="elsevierStyleItalic">r</span>&#8239;&#61;&#8239;&#46;74 - <span class="elsevierStyleItalic">r</span>&#8239;&#61;&#8239;&#46;47&#41;&#46; A total average greater than or equal to 16 is considered of clinical significance&#46; Evaluation was carried out by the psychologists who treated the patients&#44; reporting data before and during the lockdown&#46; OCD patients also completed this instrument&#44; with the percentage of agreement being very high regarding the type of obsessions and compulsions &#40;97&#37; and 98&#44; respectively&#41;&#46; The severity data were taken from those reported by clinicians before and during lockdown&#46; Cronbach&#39;s alpha in this study was &#46;87 &#40;clinician&#41; and &#46;86 &#40;participants OCD&#41;&#46; This instrument was only applied to clinical participants&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Hospital Anxiety and Depression Scale &#40;HADS&#59; <a class="elsevierStyleCrossRef" href="#bib0200">Zigmond &#38; Snaith&#44; 1983</a>&#41;&#46; Self-report measure of anxiety and depression of 14 items rated on a 4 point Likert scale &#40;0 a 3&#41;&#46; It was divided into Anxiety &#40;HADS-A&#41; and Depression &#40;HADS-D&#41; subscales both containing seven items&#46; Cronbach&#39;s alpha in this study was &#46;77 and &#46;79 &#40;depression non-clinical and clinical group&#41;&#44; &#46;75 and &#46;77 &#40;anxiety non-clinical and clinical group&#41;&#44; &#46;82 and &#46;84 &#40;total non-clinical and clinical group&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Spanish Version of the Brief COPE &#40;COPE-28&#59; <a class="elsevierStyleCrossRef" href="#bib0125">Mor&#225;n et al&#46;&#44; 2010</a>&#41;&#46; 28 items and 14 subscales answered on a Likert-type ordinal scale of 4 response alternatives &#40;from 0 to 3&#41;&#46; Coping dimensions are&#58; &#40;1&#41; Active coping &#40;initiate direct actions&#44; increase your own efforts&#44; eliminate or reduce the stressor&#41;&#59; &#40;2&#41; Planning &#40;thinking about how to deal with the stressor and planning action strategies&#41;&#59; &#40;3&#41; Instrumental support &#40;seeking help&#44; advice&#44; and information from competent people&#41;&#59; &#40;4&#41; Use of emotional support &#40;receiving emotional support of sympathy and understanding&#41;&#59; &#40;5&#41; Self-distraction &#40;concentrating on other projects&#44; trying to distract oneself with other activities&#44; trying not to concentrate on the stressor&#41;&#59; &#40;6&#41; Relief &#40;increased awareness of one&#39;s emotional distress&#44; accompanied by a tendency to express or discharge those feelings&#41;&#59; &#40;7&#41; Behavioral disconnect &#40;reduce efforts to deal with the stressor&#44; including giving up effort to achieve goals with which the stressor interferes&#41;&#59; &#40;8&#41; Positive reframing &#40;looking for the positive and favorable side of the problem and trying to improve or grow from the situation&#41;&#59; &#40;9&#41; Denial &#40;denying the reality of the stressful event&#41;&#59; &#40;10&#41; Acceptance &#40;accepting what is happening&#44; that it is real&#41;&#59; &#40;11&#41; Religion &#40;tendency to return to religion in times of stress&#44; increase participation in religious activities&#41;&#59; &#40;12&#41; Substance use -alcohol&#44; medications &#40;drinking alcohol or other substances in order to feel good or to help cope with the stressor&#41;&#59; &#40;13&#41; Humor- &#40;making jokes about the stressor or laughing at stressful situations&#41;&#59; and &#40;14&#41; Self-blame &#40;criticizing and blaming oneself for what happened&#41;&#46; Second order factors are&#58; Cognitive coping&#44; Social coping&#44; Avoidance coping and Spiritual coping&#46; Higher scores reflect a higher tendency to implement the corresponding coping strategies&#46; We asked participants to report how often they used the strategy described in each project to respond to COVID-19&#46; Cronbach&#39;s alpha in this study was &#46;80 and &#46;82 &#40;clinical and non-clinical group&#44; respectively&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Firstly&#44; Chi-square and one-factor ANOVA were used to examine potential group differences in clinical and demographic variables&#46; Subsequently&#44; <span class="elsevierStyleItalic">t</span> Student&#44; ANOVA test and post-hoc comparisons &#40;Tukey or Games-Howel&#41; were carried out&#46; A covariance analysis was performed when there were significant differences between groups in some variables &#40;anxiety and depression&#41; considered influential in their coping strategies&#46; Independent samples tests &#40;Kruskal Wallis H test&#41; were performed within the clinical group&#44; taking into account presence&#47;absence of comorbidity and OCD subtypes&#46; The Pearson correlation was used to analyze the relationship between variables&#46; Cohen&#39;s d &#40;standardized mean differences&#41; were calculated to estimate the magnitude of between-group differences&#44; 0&#46;20 low&#44; 0&#46;50 medium&#44; and 0&#46;80 high&#46; All participants were included in analyzes&#46; SPSS Statistic 22&#46;00 was used for statistical analysis&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Group equivalence</span><p id="par0085" class="elsevierStylePara elsevierViewall">Groups were equivalent in sex &#40;<span class="elsevierStyleItalic">p</span> &#61; &#46;610&#41;&#44; age &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;875&#41;&#44; who they live with &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;313&#41;&#44; and marital status &#40;<span class="elsevierStyleItalic">p</span> &#61; &#46;127&#41;&#46; Differences were seen in educational level &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;001&#41;&#44; anxiety &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41; and depression &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41;&#46; The OCD group achieved worse results in the clinical variables mentioned&#46; See <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">A comparison of OCD and healthy CG in coping strategies</span><p id="par0090" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">t</span> Student showed a significant group effect in the following positive strategies&#58; positive reframing &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41;&#44; acceptance &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41;&#44; humor &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;&#46;001&#41;&#44; CG obtaining best scores&#46; The OCD group achieved better results in instrumental support &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;030&#41; and religion &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41;&#46; In addition&#44; the clinical group showed higher means in denial &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;004&#41; and self-blame &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41;&#46; Second order factors&#44; cognitive coping and spiritual coping showed statistical significance &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239; &#46;001&#41;&#44; the CG used cognitive strategies most&#44; while the OCD group presented emotional strategies most&#46; Higher ES were found in acceptance &#40;<span class="elsevierStyleItalic">d</span>&#8239;&#61;&#8239;0&#46;84&#41; and humor &#40;<span class="elsevierStyleItalic">d</span>&#8239;&#61;&#8239;0&#46;68&#41;&#46; ES in cognitive coping was medium&#46; See <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Coping strategies controlling level of anxiety and depression</span><p id="par0095" class="elsevierStylePara elsevierViewall">As anxiety and depression variables reached statistically significant differences between groups&#44; covariance analysis was conducted&#46; It was observed that when controlling anxiety and depression&#44; planning showed significant differences&#44; <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;017&#44; this strategy being higher in the CG&#46; However&#44; there were no differences in the use of instrumental support &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;912&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Intragroup comparisons based on comorbidity and OCD subtypes</span><p id="par0100" class="elsevierStylePara elsevierViewall">As for comorbidity&#44; differences were observed in denial &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;026&#41;&#44; substance use &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;022&#41;&#44; self-blame &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;002&#41; and avoidance coping &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239; &#46;001&#41;&#46; Participants who did not suffer comorbidity with other disorders achieved lower scores in maladaptative strategies&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As regards the obsession type variable&#44; no statistically significant differences were found in any analyzed variables &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#62;&#8239; &#46;05&#41;&#46; Additionally&#44; types of compulsions showed no differences in any strategy analyzed&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Correlation between coping strategies and anxiety and depression in OCD group</span><p id="par0110" class="elsevierStylePara elsevierViewall">Results showed a significant positive correlation among anxiety and emotional strategies&#44; such as relief&#44; denial and self-blame&#59; a negative correlation was found with acceptance&#46; In addition&#44; depression was negatively correlated with active coping&#44; positive reframing&#44; and humor&#46; Cognitive coping was negatively related with depression&#46; See <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">The general aim of this study was to know the coping strategies of Spanish OCD patients during the COVID-19 lockdown &#40;April 2020&#41;&#46; The coping strategies most used by both groups were acceptance&#44; use of emotional support&#44; self-distraction&#44; active coping and planning&#46; These are positive coping strategies that helped control stress produced at the beginning of lockdown&#46; It is important to note that these data were collected during the month of April 2020&#46; At that time&#44; the population was not yet subjected to prolonged stress&#44; something that is happening at the present time&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The comparison regarding the use of coping strategies between groups&#44; indicated that OCD patients presented higher means in instrumental support &#40;seeking help&#44; advice&#44; and information from competent people &#41;&#44; religion &#40;tendency to return to religion in times of stress&#44; increase participation in religious activities&#41;&#44; denial &#40;denying the reality of the stressful event&#41; and self-blame &#40;criticizing and blaming oneself for what happened&#41;&#46; These may be related to the obsessions and compulsions themselves&#44; specifically&#44; with blame obsessions&#44; checking and religious compulsions&#46; In addition&#44; seeking help&#44; advice&#44; and information in excess can be counterproductive for these patients&#44; and can exacerbate obsessional and anxiety behaviors&#44; in some cases becoming verification compulsions &#40;Finerberg et al&#46;&#44; 2020&#41;&#46; Some patients spend hours each day watching television and checking online media reports of COVID-19&#44; increasing levels of discomfort and worsening OCD symptoms &#40;<a class="elsevierStyleCrossRef" href="#bib0070">French &#38; Lyne&#44; 2020</a>&#41;&#46; On the other hand&#44; the healthy control group used positive coping strategies&#58; reframing &#40;looking for the positive and favorable side of the problem and trying to improve or grow from the situation&#41;&#44; acceptance &#40;accepting what is happening&#44; that it is real&#41; and humor &#40;making jokes about the stressor or laughing at stressful situations&#41;&#44; strategies that allow facing the stressor perceived as non-controllable in a more positive way&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">As indicated by <a class="elsevierStyleCrossRef" href="#bib0110">Matheson and Anisman &#40;2003&#41;</a>&#44; given that coping strategies likely operate in conjunction with one another&#44; their effectiveness may vary as a function of alternative strategies that are adopted concurrently or sequentially&#46; In this case&#44; the strategies used by the CG are along the lines of facing the situation more positively and decisively&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">This coincides with results obtained by <a class="elsevierStyleCrossRef" href="#bib0090">Ladouceur et al&#46; &#40;2000&#41;</a> finding that OCD patients reported strategies linked to thought content&#44; those most used being seeking&#44; analyzing and distracting activity&#46; <a class="elsevierStyleCrossRef" href="#bib0130">Moritz et al&#46; &#40;2018&#41;</a> also found that OCD and depressive patients displayed more maladaptive coping and avoidance as well as less adaptive coping than nonclinical controls&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Another element to take into account is whether those strategies used by the OCD group are related to the neutralization of obsessions&#44; it being necessary not to reinforce this mechanism &#40;<a class="elsevierStyleCrossRef" href="#bib0065">Freeston &#38; Ladouceur&#44; 1997</a>&#41;&#46; Trying not to think &#40;denial&#41; may create conditions for intrusive thoughts that culminate in rumination &#40;<a class="elsevierStyleCrossRef" href="#bib0185">Wegner&#44; 1989</a>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The next target was to learn whether coping strategies can be influenced by anxiety and depression&#46; It was observed that&#44; when controlling anxiety and depression&#44; planning strategy was significantly higher in the healthy control group&#46; In addition&#44; there were no differences in the use of instrumental support between both groups&#46; Therefore&#44; these clinical variables seem to be relevant in which strategies are used &#40;<a class="elsevierStyleCrossRefs" href="#bib0160">Rosa-Alc&#225;zar et al&#46;&#44; 2019&#59; Se&#231;er &#38; Ula&#351;&#44; 2020&#59; Storch et al&#46;&#44; 2010</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">OCD is also associated with other psychological disorders&#44; such as tics&#44; attention deficit-hyperactivity disorder&#44; autism spectrum disorders &#40;ASD&#41; depression and anxiety disorders which increase degree of discomfort and complicate both treatment and prognosis &#40;<a class="elsevierStyleCrossRef" href="#bib0180">Storch et al&#46;&#44; 2010</a>&#41;&#46; For this reason&#44; we analyzed whether there were differences in coping strategies in the OCD group due to comorbidity&#46; Comorbidity showed differences in denial&#44; substance use&#44; self-blame and avoidance coping&#46; OCD patients who did not suffer comorbidity with other disorders achieved lower scores in maladaptive strategies&#46; Therefore&#44; the greater the comorbidity&#44; the greater the severity and use of maladaptive strategies&#46; This result is in line with that reported by other research where comorbidity was associated with poor response to treatment&#44; and therefore worse use of strategies to cope with stressful situations &#40;<a class="elsevierStyleCrossRef" href="#bib0020">Barrett et al&#46;&#44; 2005</a>&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">On the other hand&#44; obsession and compulsion types did not affect coping strategies used&#46; This obtained result may be unusual&#44; since as mentioned above&#44; the coping strategies used by the OCD group seemed to be related to obsessions and compulsions&#46; We would have expected patients with contamination&#44; somatic obsessions and cleaning&#47;washing and accumulation compulsions&#44; to present more maladaptive strategies &#40;<a class="elsevierStyleCrossRefs" href="#bib0015">Banerjee&#44; 2020&#59; French &#38; Lyne&#44; 2020</a>&#41;&#46; However&#44; given these results&#44; we must take three elements into account&#46; The first is that perhaps&#44; the moment data was collected&#44; the first weeks of confinement&#44; when stress is not so acute&#44; affects results&#44; since&#59; the situation of maintained stress is what often worsens the patient&#180;s condition&#46; Therefore&#44; it is necessary to analyze results over time&#46; The second element to consider is that the OCD patient worries excessively by overestimating real threats&#44; such as with COVID-19&#44; or incorporating unreal threats&#46; It may occur that OCD patients worsen or even change obsessions and compulsions&#44; regardless of whether these are related to the variables enhanced by the pandemic &#40;<a class="elsevierStyleCrossRefs" href="#bib0050">Fineberg et al&#46;&#44; 2020&#59; Rivera &#38; Carballea&#44; 2020</a>&#41;&#46; The third element is that we have analyzed the main subtypes reported by patients and therapists&#44; but have not evaluated the dimensions of the symptoms&#46; Perhaps if we had been able to carry out a face-to-face evaluation we could have analyzed these dimensions&#44; being able to arrive at more conclusive results&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The final aim was to assess the relationship between coping strategies and anxiety and depression in the OCD group&#46; Higher anxiety was related to relief&#44; denial&#44; religion&#44; self-blame and spiritual coping&#46; Therefore&#44; higher depression is negatively related with active coping&#44; positive reframing&#44; acceptance&#44; self-distraction and humor&#46; These results are in line with previous studies where high depression and anxiety levels enhance coping that do not lead to effectively resolving stressful situations &#40;<a class="elsevierStyleCrossRef" href="#bib0110">Matheson &#38; Anisman&#44; 2003</a>&#41;&#46; The high correlation between anxiety and depression and denial and self-blame might enhance rumination&#44; the main response of the disorder we are studying&#46; Therefore&#44; we can indicate that changes in coping strategies depend on affective states &#40;<a class="elsevierStyleCrossRef" href="#bib0095">Lazarus&#44; 2000</a>&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The current study has important implications for clinical practice in OCD patients&#46; Firstly&#44; coping strategies in OCD patients and CG are more focused on emotions than problem solving&#46; For this reason&#44; and as the pandemic might take time to disappear&#44; it is important to train in useful and adaptive coping for both populations&#46; Teaching a flexible repertoire of coping strategies will help people cope with different stressors and in a range of circumstances&#46; This requires providing psychoeducation on COVID-19 and its impact on physical and psychological health&#44; distinguishing between these rational adaptive rituals and obsessional and compulsive acts in the context of OCD&#44; controlling exposure and consumption of the internet and mass media &#40;<a class="elsevierStyleCrossRef" href="#bib0155">Rosa-Alc&#225;zar et al&#46;&#44; 2020</a>&#41;&#46; Governments should study if the information provided generates panic or whether it promotes self-protection behaviors&#46; The consumption of excessive media coverage pertinent to COVID19 may impact negatively on mental health &#40;<a class="elsevierStyleCrossRef" href="#bib0010">Balasubramanian et al&#46;&#44; 2020</a>&#41;&#46; In addition&#44; it would be important to establish a daily routine&#44; even if stuck at home&#46; Patients under quarantine or staying at home under restrictions are at great risk of sleep problems&#44; thus increasing anxiety and worsening OCD symptoms&#46; It is relevant to be in contact with professionals&#44; review medication and observe the anxiety and depression levels that increase the use of maladaptive strategies in OCD patients &#40;<a class="elsevierStyleCrossRefs" href="#bib0050">Fineberg et al&#46;&#44; 2020&#59; Rosa-Alc&#225;zar et al&#46;&#44; 2019</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This study had some limitations&#46; First&#44; selection of patients was not random&#46; This was a cross sectional study&#46; Participants were assessed by a self-report scale&#46; The application of the questionnaire was online&#44; so that administration conditions and situational variables that could influence completion and responses could not be controlled&#46; In addition&#44; due to lockdown&#44; administration possibilities were very limited&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As future prospects&#44; it would be relevant to evaluate two uncontrolled variables&#58; tolerance to uncertainty &#40;a variable that is being studied in patients with OCD&#44; and very relevant to the current situation with COVID-19&#41;&#44; and whether they themselves or their relatives have been infected with COVID-19&#46; Furthermore&#44; it would be interesting to carry out a longitudinal research&#44; which studies how participants evolve with this pandemic over time&#44; in particular at 6&#44; 12&#44; and 18 months&#46; The course of the epidemic along with the presence of other stressors &#40;unemployment&#44; family illness&#44; financial problems&#41; could influence changes in people&#39;s coping strategies and challenge emotions&#46;</p></span></span>"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Group equivalence"
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            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "A comparison of OCD and healthy CG in coping strategies"
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            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Coping strategies controlling level of anxiety and depression"
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            3 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Intragroup comparisons based on comorbidity and OCD subtypes"
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            4 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Correlation between coping strategies and anxiety and depression in OCD group"
            ]
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          "identificador" => "sec0060"
          "titulo" => "Discussion"
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        7 => array:2 [
          "identificador" => "xack579822"
          "titulo" => "Acknowledgements"
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        8 => array:1 [
          "titulo" => "References"
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      ]
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    "tienePdf" => true
    "fechaRecibido" => "2020-10-04"
    "fechaAceptado" => "2020-12-14"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1464100"
          "palabras" => array:5 [
            0 => "Obsessive-compulsive disorder"
            1 => "Coping strategies"
            2 => "COVID-19"
            3 => "Lockdown"
            4 => "Experiment"
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        ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1464099"
          "palabras" => array:5 [
            0 => "Trastorno obsesivo-compulsivo"
            1 => "Estrategias de afrontamiento"
            2 => "COVID-19"
            3 => "Confinamiento"
            4 => "Experimento"
          ]
        ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background&#47;Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The main aim of this study was to compare coping strategies in obsessive-compulsive disorder &#40;OCD&#41; patients and a healthy control group during COVID-19 lockdown and to analyze the relationship with some variables which may influence results &#40;depression&#44; anxiety&#44; comorbidity&#44; subtype of obsession-compulsion&#41;&#46; Method&#58; There were 237 participants&#44; 122 OCD and 115 healthy controls&#44; aged 17-61 years old &#40;<span class="elsevierStyleItalic">M</span> &#61; 33&#46;48&#44; <span class="elsevierStyleItalic">SD</span> &#61; 11&#46;13&#41;&#46; Results&#58; Groups showed differences in the use of some adaptive strategies &#40;positive reinterpretation&#44; acceptance&#44; humor&#41; and maladaptive &#40;denial&#44; self-blame&#41;&#46; Within obsessive-compulsive group&#44; comorbidity affected the greater use of inappropriate strategies &#40;denial&#44; substance abuse and self-blame&#41; while type of obsession-compulsion did not influence use&#46; Anxiety and depression levels were related to the use of less adaptive strategies&#46; Conclusions&#58; These findings strengthen the need for training in the use of effective and adaptive coping strategies&#44; making it necessary to improve clinical follow-up of these patients&#46; It is relevant to be in contact with healthcare professionals&#44; review medication and observe the anxiety and depression levels&#46;</p></span>"
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            "titulo" => "Background&#47;Objective"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes&#47;Objetivo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue comparar las estrategias de afrontamiento utilizadas por pacientes con Trastorno obsesivo-compulsivo &#40;TOC&#41; durante el confinamiento debido a la COVID-19 frente a controles sanos y analizar su relaci&#243;n con algunas variables que pueden influir en los resultados &#40;ansiedad&#44; depresi&#243;n&#44; comorbilidad&#44; tipo de obsesiones-compulsiones&#41;&#46; M&#233;todo&#58; Los participantes fueron 237&#44; 122 diagnosticados de Trastorno obsesivo-compulsivo y 115 controles sanos&#44; con edades comprendidas entre 13 y 58 a&#241;os &#40;M &#61; 34&#44;60&#44; DT&#8239;&#61;&#8239;10&#44;41&#41;&#46; Resultados&#58; Los grupos presentaron diferencias en el uso de algunas estrategias adaptativas &#40;reinterpretaci&#243;n positiva&#44; aceptaci&#243;n&#44; humor&#41; y desadaptativas &#40;negaci&#243;n&#44; autoculpa&#41;&#46; Dentro del grupo TOC&#44; la comorbilidad afect&#243; para el mayor uso de estrategias inadecuadas &#40;negaci&#243;n&#44; abuso de sustancias y autoculpa&#41;&#44; mientras que el tipo de obsesiones-compulsiones no influy&#243; en el uso de las mismas&#46; Los niveles de ansiedad y depresi&#243;n estaban relacionadas con el uso de estrategias menos adaptativas&#46; Conclusiones&#58; Estos hallazgos refuerzan la necesidad de entrenar en la utilizaci&#243;n de estrategias de afrontamiento eficaces y adaptativas&#44; siendo necesario mejorar el seguimiento cl&#237;nico de estos pacientes&#46; Es importante estar en contacto con profesionales de la salud&#44; revisar la medicaci&#243;n y observar los niveles de ansiedad y depresi&#243;n&#46;</p></span>"
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        "etiqueta" => "Figure 1"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CONSORT Flow diagrams of study development&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#46; OCD&#58; Obsessive compulsive disorder&#59; CG&#58; Control group&#46; <span class="elsevierStyleItalic">M</span> &#61; mean&#59; <span class="elsevierStyleItalic">SD</span>&#58; Standard deviation&#59; n&#46;s&#46;&#58; Not significant&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCD&#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&#46;50&#8239;&#177;&#8239;10&#46;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&#46;71&#8239;&#177;&#8239;10&#46;53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66 &#40;54&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;57&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56 &#40;45&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;42&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Years OCD duration &#40;Mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#46;06&#8239;&#177;&#8239;10&#46;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No comorbidity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">82 &#40;67&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Comorbidity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40 &#40;32&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Type of comorbidity <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depression&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Disorders personality&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;12&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Disorders estr&#233;s Trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others problems Anxiety &#40;Social anxiety&#44; agoraphobia&#44; panic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marital status <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Single&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;53&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;56&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Married&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;39&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;40&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Divorced&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Educational level <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span> &#40;3&#41;&#8239;&#61;&#8239;17&#46;09&#59; <span class="elsevierStyleItalic">p</span> &#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Elementary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secundary education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;18&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;25&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;20&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>University student&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;72&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Who did you spend quarantine with&#63; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;9&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Friends&#47;Partner&#47;Flatmate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#46;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Family&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107 &#40;87&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103 &#40;89&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anxiety &#40;<span class="elsevierStyleItalic">M&#8239;&#177;&#8239;SD</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;71&#8239;&#177;&#8239;4&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;42&#8239;&#177;&#8239;4&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">t</span>&#40;235&#41;&#8239;&#61;&#8239;7&#46;78&#59; <span class="elsevierStyleItalic">p</span> &#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depression &#40;<span class="elsevierStyleItalic">M&#8239;&#177;&#8239;SD</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;08&#8239;&#177;&#8239;4&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;31&#8239;&#177;&#8239;3&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">t</span>&#40;235&#41;&#8239;&#61;&#8239;5&#46;39&#59; <span class="elsevierStyleItalic">p</span> &#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2797708.png"
              ]
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sample characteristics&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#46; OCD&#58; Obsessive compulsive disorder&#59; CG&#58; Control group&#46; ES&#8239;&#61;&#8239;Effect size Cohen&#42; Negative indicated that the group compared in first place reached worst score acieved by the group appearing in second place&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GroupOCD &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;122&#41; <span class="elsevierStyleItalic">M&#8239;&#177;&#8239;SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GroupControl&#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;115&#41; <span class="elsevierStyleItalic">M&#8239;&#177;&#8239;SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Cohen&#180;s d&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Active coping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;39&#8239;&#177;&#8239;1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;67&#8239;&#177;&#8239;1&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-1&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Planning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;07&#8239;&#177;&#8239;1&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;38&#8239;&#177;&#8239;1&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-1&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Instrumental support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;85&#8239;&#177;&#8239;1&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;35&#8239;&#177;&#8239;1&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive reframing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;66&#8239;&#177;&#8239;1&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;43&#8239;&#177;&#8239;6&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-3&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acceptance</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;58&#8239;&#177;&#8239;1&#46;61</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;93&#8239;&#177;&#8239;1&#46;09</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-7&#46;50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;84</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emotional support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;44&#8239;&#177;&#8239;1&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;28&#8239;&#177;&#8239;1&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Denial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;55&#8239;&#177;&#8239;1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94&#8239;&#177;&#8239;1&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;62&#8239;&#177;&#8239;1&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;31&#8239;&#177;&#8239;1&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-blame&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;57&#8239;&#177;&#8239;1&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;63&#8239;&#177;&#8239;1&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;15&#8239;&#177;&#8239;1&#46;74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-5&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Religion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;95&#8239;&#177;&#8239;1&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;98&#8239;&#177;&#8239;1&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-distraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;88&#8239;&#177;&#8239;1&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;75&#8239;&#177;&#8239;1&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;524&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Substance use&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Behavioral disconnet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;92&#8239;&#177;&#8239;1&#46;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coping second level</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cognitive coping&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;</span> &#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Social coping&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Avoidance coping&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;80&#177;4&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;12&#177;3&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;189&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spiritual coping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;95&#8239;&#177;&#8239;1&#46;98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anxiety&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Active coping&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&#46;28&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Plannig&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;22&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Instrumental support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;30&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive refraiming&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;38&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acceptance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;39&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;57&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emotional support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Denial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;43&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;32&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relief&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;27&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-blame&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;40&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;30&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;33&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Religion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;26&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-distraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;18&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Substance use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;23&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Behavioral disconnet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;19&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coping second level</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cognitive coping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&#46;36&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Social coping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;28&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Avoidance coping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;32&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spiritual coping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;26&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Correlations among anxiety and depression and coping strategies&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Manual diagn&#243;stico y estad&#237;stico de los trastornos mentales &#40;DSM-5&#41;"
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              "identificador" => "bib0010"
              "etiqueta" => "Balasubramanian et al&#46;&#44; 2020"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of COVID-19 on the mental health of surgeons and coping strategies"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Balasubramanian"
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                            2 => "R&#46; Bennett"
                            3 => "V&#46; Paleri"
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                    0 => array:2 [
                      "doi" => "10.1002/hed.26291"
                      "Revista" => array:6 [
                        "tituloSerie" => "Head &#38; Neck"
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                      "titulo" => "The COVID-19 outbreak&#58; Crucial role the psychiatrists can play"
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                        "tituloSerie" => "Asian Journal of Psychiatry"
                        "fecha" => "2020"
                        "volumen" => "50"
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              "identificador" => "bib0020"
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                    0 => array:2 [
                      "titulo" => "Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder&#58; Long-term follow-up and predictors of outcome"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                      "doi" => "10.1097/01.chi.0000172555.26349.94"
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                        "tituloSerie" => "Journal American Academic Child Adolescent Psychiatry"
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              "identificador" => "bib0025"
              "etiqueta" => "Benatti et al&#46;&#44; 2020"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What Happened to Patients With Obsessive Compulsive Disorder During the COVID-19 Pandemic&#63; A Multicentre Report From Tertiary Clinics in Northern Italy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "B&#46; Benatti"
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                            3 => "A&#46; Fiorillo"
                            4 => "L&#46; Celebre"
                            5 => "N&#46; Girone"
                            6 => "N&#46; Fineberg"
                            7 => "S&#46; Bramante"
                            8 => "S&#46; Rigardetto"
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                      "titulo" => "Predicting adaptive and maladaptive responses to the Coronavirus &#40;COVID-19&#41; outbreak&#58; A prospective longitudinal study"
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