Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 1;13(13):1575.
doi: 10.3390/healthcare13131575.

Difficulties in Emotion Regulation and Stress in Intensive Care Unit Nurses During COVID-19: Exploring the Mediating Role of Psychological Inflexibility and the Moderating Effect of Work Experience

Cristian Di Gesto  1 , Giulia Rosa Policardo  2 , Sara Bocci Benucci  3 , Eriada Çela  4 , Caterina Grano  1
Affiliations

Difficulties in Emotion Regulation and Stress in Intensive Care Unit Nurses During COVID-19: Exploring the Mediating Role of Psychological Inflexibility and the Moderating Effect of Work Experience

Cristian Di Gesto et al. Healthcare (Basel). .

Abstract

Background/objectives: The COVID-19 pandemic has placed intensive care unit (ICU) nurses under intense psychological pressure, increasing emotional and psychological stress. Two constructs-difficulties in emotion regulation and psychological inflexibility (i.e., low contact with the present moment and a lack of committed action based on personal values)-have been associated with increased perceived stress levels but remain underexplored in this population.

Aims: This study investigated whether psychological inflexibility mediates the relationship between emotion regulation difficulties and perceived stress in ICU nurses. It also examined whether years of ICU work experience moderate the direct relationship between emotion regulation difficulties and perceived stress.

Methods: A cross-sectional study was conducted with 210 ICU nurses (65.2% women; 34.8% men; mean age = 40.25 years ± 11.36) from Italian public hospitals. The participants completed the Difficulties in Emotion Regulation Scale, the Acceptance and Action Questionnaire-II, and the Perceived Stress Scale. A moderated mediation model was tested to examine whether psychological inflexibility mediates the relationship between emotion regulation difficulties and perceived stress and whether years of ICU work experience moderate the path between these variables.

Results: Higher difficulties in emotion regulation predicted greater psychological inflexibility, which, in turn, predicted higher perceived stress. Psychological inflexibility fully mediated the relationship between emotion regulation difficulties and perceived stress. Additionally, years of ICU work experience significantly moderated the direct link between emotion regulation difficulties and perceived stress. This relationship was strongest for nurses with 1-15 years of ICU experience. The model explained 33% of the variance in perceived stress.

Conclusions: This study highlights the importance of the novel construct of psychological inflexibility in the context of healthcare professionals and its role in shaping perceived stress. Addressing psychological inflexibility through targeted interventions may help mitigate stress and promote well-being among ICU nurses.

Keywords: emotion regulation; healthcare workers; moderated mediation model; perceived stress; psychological inflexibility.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Moderated mediation model. Notes. Coefficients are β unstandardized.
See this image and copyright information in PMC

References

    1. Lai J., Ma S., Wang Y., Cai Z., Hu J., Wei N., Wu J., Du H., Chen T., Li R., et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw. Open. 2020;3:e203976. doi: 10.1001/jamanetworkopen.2020.3976. - DOI - PMC - PubMed
    1. Goudarzian A.H., Nikbakht Nasrabadi A., Sharif-Nia H., Farhadi B., Navab E. Exploring the concept and management strategies of caring stress among clinical nurses: A scoping review. Front. Psychiatry. 2024;15:1337938. doi: 10.3389/fpsyt.2024.1337938. - DOI - PMC - PubMed
    1. Maniaci G., La Cascia C., Giammanco A., Maria C., Ferraro L., Tripoli G., Scaglione A., Sartorio C., Seminerio F., Toia F., et al. Latent burnout profiles in a sample of frontline healthcare professionals after the peak of the Italian COVID-19 pandemic. Mediterr. J. Clin. Psychol. 2022;10:1–19. doi: 10.13129/2282-1619/mjcp-3292. - DOI
    1. Messineo L., Tosto C. Perceived stress and affective experience in Italian teachers during the COVID-19 pandemic: Correlation with coping and emotion regulation strategies. Eur. J. Psychol. Educ. 2023;38:1271–1293. doi: 10.1007/s10212-022-00661-6. - DOI - PMC - PubMed
    1. Hayes S.C., Luoma J.B., Bond F.W., Masuda A., Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav. Res. Ther. 2006;44:1–25. doi: 10.1016/j.brat.2005.06.006. - DOI - PubMed

LinkOut - more resources