Traumatology

Coping With COVID-19 Continuous Complex Stressors: The “Will-to-Exist-

Live, and Survive” and Perfectionistic Striving
Ibrahim A. Kira, Hanaa A. M. Shuwiekh, Kenneth Rice, Jeffrey S. Ashby, Amthal Alhuwailah, Mariam Sous Fahmy Sous,
Shadia Bint Ali Baali, Chafika Azdaou, Enas M. Oliemat, and Hikmet J. Jamil
Online First Publication, September 23, 2021. http://dx.doi.org/10.1037/trm0000352

CITATION
Kira, I. A., Shuwiekh, H. A. M., Rice, K., Ashby, J. S., Alhuwailah, A., Sous, M. S. F., Baali, S. B. A., Azdaou, C., Oliemat, E. M.,
& Jamil, H. J. (2021, September 23). Coping With COVID-19 Continuous Complex Stressors: The “Will-to-Exist-Live, and
Survive” and Perfectionistic Striving. Traumatology. Advance online publication. http://dx.doi.org/10.1037/trm0000352
 Traumatology
© 2021 American Psychological Association
ISSN: 1085-9373 https://doi.org/10.1037/trm0000352

Coping With COVID-19 Continuous Complex Stressors: The “Will-to-

Exist-Live, and Survive” and Perfectionistic Striving

Ibrahim A. Kira1, 2, Hanaa A. M. Shuwiekh3, Kenneth Rice2, Jeffrey S. Ashby2, Amthal Alhuwailah4,
Mariam Sous Fahmy Sous5, Shadia Bint Ali Baali6, Chafika Azdaou7, Enas M. Oliemat8,
and Hikmet J. Jamil9
1
Center for Cumulative Trauma Studies, Stone Mountain, Georgia, United States
2
Center for Stress, Trauma and Resiliency, Georgia State University
3
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Department of Psychology, Fayoum University

This document is copyrighted by the American Psychological Association or one of its allied publishers.

4
Department of Psychology, Kuwait University
5
Department of Psychology, South Valley University
6
Psychological Compatibility Center for Psychological Counseling, El-Riad, Saudi Arabia
7
Department of Psychology, University of Algiers
8
Department of Psychology, Hashemite University
9
Department of Family Medicine, Michigan State University

COVID-19 challenges the known traditional coping skills of the individual. New innovative concepts
are evolving that may help fill some gaps in our knowledge of intrinsic human strengths to cope with
the COVID-19 pandemic, such as the “will-to exist-live, and survive” (WTELS) and striving for higher
standards of perfectionism. The current study tested a model of coping to 3 main COVID-19 traumatic
stressors: fears of infection, economic traumas, and lockdown (related isolation/disturbed routines, and
social difficulties). We used a sample of 1,377 participants from 7 Arab countries and measures of
COVID-19 traumatic stressors, WTELS, striving for high standards (perfectionism), resilience, social
supports, socioeconomic status, and well-being. We conducted structural equation (SEM) analysis to
test whether WTELS as an independent variable predicts COVID-19 stressors as a latent variable (with
three observed COVID-19 stressors types: fears, economic, and lockdown stressors) and whether this
relationship is mediated in part by resilience, striving for high standards, social support, socioeconomic
status, and well-being. WTELS indirectly and indirectly via the mediating variables had significant
effects on lowering COVID-19 traumatic stress and its 3 stressor types. Alternative models did not fit as
well with the data. In addition, the model was strictly invariant across genders. We discuss the concep-
tual and clinical implications of the results.

Keywords: COVID-19, coping, traumatic stress, will to exist-live and survive, perfectionism

Supplemental materials: https://doi.org/10.1037/trm0000352.supp

As traumatologists and clinical psychologists, we witness the
unfolding of COVID-19 pandemic emergence and development in
real time, effecting its mass multiple traumatic impacts across the
globe. Witnessing the pandemic in progress gave us the challenge
of our lifetime, which is correcting our lenses and perspective to
understand what traumatic stress is and explore how our discipline
Ibrahim A. Kira https://orcid.org/0000-0001-8126-0020
The authors are grateful to Gada Ouda Hijazi at the Palestinian Planning
Center, and to Jumana Daibes, a faculty of Allied Medical Science in the
Arab American University, Palestine, West Bank, who helped to collect
data from the West Bank of Palestine.
Correspondence concerning this article should be addressed to Ibrahim
A. Kira, Center for Cumulative Trauma Studies, 4906 Woodhurst Way,
Stone Mountain, GA 30088, United States. Email: kiraaref@aol.com
and the individual may cope with such massive individual and
social traumas. The disciplines of traumatic stress are probably
still in a state of shock and did not realize as yet the real challenges
that COVID-19 poses to the current state of our knowledge of
stress, trauma, and coping. Our discipline will be at a significant
loss if we do not grasp this unique learning opportunity and de-
velop our current dominant trauma paradigms that focus on past
traumas. We rather adopt a life-course perspective that includes
attachment disruptions, discrimination, and continuous traumatic
stressors with larger scale traumas such as the COVID-19 pan-
demic and their global mental health dynamics (Kira, 2021). Type
III trauma is the most severe traumatic stress in terms of duration,
intensity, and symptom acuity, compared to Types I and II (Kira,
2001; Kira, et al., 2008; Kira, Ashby, et al., 2013; Kira, 2021).
Type I trauma is a single event, whereas Type II is a series of
events that continued within a limited time scale and stopped

1
 2 KIRA ET AL.
(Terr, 1991). Type III is the continuous traumatic stress (CTS) that
can present itself in different trajectories and pathways, for exam-
ple, community violence pathways (Straker & The Sanctuaries
Counseling Team, 1987), intergroup violence pathways (Kira,
Ashby, et al., 2013; Stein et al., 2018;), ongoing intersected dis-
criminations pathways (Kira, Omidy, et al., 2015), or ongoing
COVID-19 traumatic stress (Kira, Shuwiekh, Alhuwailah, et al.,
2021; Kira, Shuwiekh, Rice, et al., 2021; Shuwiekh et al., 2020).
Posttraumatic stress disorder (PTSD) Criterion “A” (American
Psychiatric Association, 2013) mainly includes Types I or II trau-
mas, only less severe. COVID-19 challenges the known traditional
coping skills of the individual. Traditional coping skills include
seeking and providing social support (Halbesleben, 2006; Prati &
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Pietrantoni, 2009), mobilizing internal and external resiliency
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resources (Hu et al., 2015; Joyce et al., 2018), and seeking higher
standards of perfectionism (Stoeber & Kersting, 2007), which is
associated with effort and achievement (Kobori et al., 2011). They
also include extending resources afforded by achieved higher
social status for those at the top or median of the social hierarchy,
as people with more resources can cope better with adverse events,
and this leads to better well-being in the long term (Pinquart &
Sörensen, 2000). However, ignoring those on the bottom may cre-
ate an unbalanced social hierarchy, injustices, and rebellions. The
COVID-19 pandemic “started tearing at the fabric of our most ba-
sic methods of coping and calls for new ways of adapting to and
thinking about the crisis” (Horesh & Brown, 2020, p. 332).
Coping With COVID-19: The Will-to-Exist-Live-and-
Survive model
Coping with these COVID-19 multilayered traumatic stressors
is an ominous challenge. It needs the mobilization of all innate
strengths and the wills of the individual to live and survive, in
addition to all available traditional resilience, seeking high stand-
ards of perfection, social support, and material resources. Explor-
ing coping trajectories with COVID-19 is the focus of the current
research. New innovative concepts are evolving that may help fill
some gaps in our knowledge of intrinsic human strengths to cope
with adversities that are severe, unusually persistent, continuous,
and complex traumatic stressors such as the COVID-19 pandemic.
Will (and volition)-to-exist-live and survive (WTELS) is proposed
recently in the literature as a master intrinsic positive motivator (or
metamotivator; Kira, Özcan, et al., 2020; Kira, Shuwiekh, Kuchar-
ska, 2020). The will to exist (WTE) represents the agency and the
executive self. WTE is the principal part of WTELS. Will or voli-
tion is a precognitive process related to agency and executive
action control (executive self; Haggard, 2017). The will to survive
(WTS), another essential part of WTELS, was behind the different
coping strategies for continuous traumatic stress of oppression
(Kira, Alawneh, et al., 2014). Will to live (WTL; Hutschnecker,
1951) is another essential dimension of WTELS. Bornet et al.,
2021, in a review, found that WTL in the reviewed studies was pos-
itively associated with resilience (r = .63), life satisfaction (r = .55),
happiness (r = .48), purpose in life (r = .42), quality of life (r =
.51), and the presence of social contacts (r = .47). WTE, WTS, and
WTL are proved to connect as powerful master motivation in the
unidimensional construct of WTELS (Kira, Özcan, et al., 2020).
WTELS is the intrinsic, innate motivation to exist, live, survive,
self-actualize, and succeed/thrive (Kira, Shuwiekh, et al., 2021,
p. 48). WTELS is an existential feature that is part of the person’s
agentic executive self (Kira, Lewandowski, et al., 2014). Although
its vigor dynamics fluctuate, it is activated upon exposure to rele-
vant threats and adversities such as COVID-19 traumatic stress.
WTELS, a noncognitive (or precognitive) factor, has cognitive,
emotional, behavioral, and mental health implications.
Another precognitive factor related to WTELS is striving for
higher standards (perfectionistic striving). Striving to live and sur-
vive is related to achieve a higher standard of performance that
enables actual living and surviving (Lee et al., 2003). Several
authors earlier suggested that perfectionism is one factor related to
active coping with adversities (Ashby, & Gnilka, 2017; Dunkley,
2018; Jowett et al., 2018; Stoeber & Janssen, 2011; van der Kaap-
Deeder et al., 2016). There are two main perfectionism dimen-
sions: perfectionistic strivings and perfectionistic concerns
(Stoeber & Otto, 2006). Perfectionistic strivings are setting high-
performance standards, whereas perfectionistic concerns are self-
criticalness or self-discrepancy between what should or ideal and
actual. The research found that perfectionistic striving is positively
associated with life satisfaction and hope (Ashby et al., 2011;
Gnilka et al., 2013; Rice & Ashby, 2007) and negatively associ-
ated with depression, stress, ineffective coping, and anxiety
(Gnilka et al., 2012; Noble et al., 2014; Rice & Ashby, 2007).
Striving for higher standards may be intimately related to WTELS.
Resilience is positively correlated with WTELS (Kira, Özcan, et
al., 2020) and with perfectionistic strivings (Stoeber & Corr,
2016). The resilience concept started in the general system’s
theory. It is referred to as the return to equilibrium upon a pertur-
bation (Holling, 1973) or as “the capacity of a system to absorb
disturbance and reorganize while changing, to still retain essen-
tially the same function, structure, identity, and feedbacks”
(Walker et al., 2004; p.2). Resilience is understood as referring to
positive adaptation, or the ability to maintain or regain mental
health, despite experiencing adversity (Wald et al., 2006). How-
ever, research on resilience is wrought with conceptual and meth-
odological issues. One common conceptualization is resilience as
a set of individual-level variables that protect well-being under
stressful circumstances (Connor & Davidson, 2003). However, the
development-based trauma framework considers different multi-
factorial causal pathways to resilience dealing with cumulative
stressors and traumas and is based on the diatheses model and
gene-environment interdependence. The social-ecological factors
that promote postrisk adaptation shape a person’s resilience
(Ungar, 2015). Resiliencies are processes and not a fixed attribute
and likely to be shaped by genetic and personality dispositions, de-
velopmental assets such as attachment styles, a network of nurtur-
ing or neglecting family and societal support or discriminating
systems, and different levels of community cohesion (Kira, 2019;
Rutter, 2012; Syvertsen et al., 2019). Resilience is culturally and
contextually built through dealing with different types of adver-
sities (Ungar, 2015). Based on this conception of resilience, social
support and relational interactions are parts of the resilience proc-
esses. Research examining resilience from this approach can be
helpful, as results can inform our understanding of the behavioral
dynamics related to well-being and functioning in the face of
adversities. Resilience was found to be significantly related to
WTELS (Kira, Özcan, et al., 2020).
 IMPACT OF COVID-19 AS TRAUMATIC STRESS
Another critical coping strategy related to WTELS and intimately
related to survival is seeking and exchanging social support
(Kroenke et al. 2006) and resilience (Rutter, 2012; Ungar, 2015).
An individual does not live alone and depends on his or her survival
by the supports he or she exchanges with a network of family,
peers, friends, and different formal and informal social real and vir-
tual groups. Social support is an interactional process in which the
individual is an active participant in providing and receiving the
material, informational, and emotional support to and from others.
The social support that an individual receives and gives may be
defined in terms of the existence and quantity of social relationships
and roles and their type, instrumental, emotional, or informational
(Helgeson, 2003). Social support improves wellness through two
pass ways: first, through social integration in large networks where
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individuals attain social and professional roles in the socioeconomic
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hierarchies and, second, through its “buffering” against the negative
impact of chronic stressors and traumatic events. Those who per-
ceive receiving a lower level of support at baseline report more
severe symptoms in follow-ups (Wang et al., 2018).
Similarly, social support predicts more significant symptom
remission (Jakubovski & Bloch, 2016) and better protection
against stressful life events (Kingsbury et al., 2020). Individuals
living in cohesive communities report improvements in their long-
term recovery and coping with community needs (Bergstrand &
Mayer, 2020). Empirical research found that social support has
positive health outcomes (Barth et al., 2010; Miyazaki et al.,
2003) and substantial well-being implications (for meta-analysis,
see Vera et al., 2020). Social support is a protective factor against
several mental health symptoms, such as depression symptoms
(Benson, 2012; Leahy-Warren et al., 2011). Thoits (2011) pro-
posed that social support facilitates effective coping strategies,
thereby directly and indirectly decreasing psychopathology risk.
He also found unique stress-buffering effects of active coping
from significant others’ social support. This broader perspective
lays the foundation for the stress-buffering model of social
support.
Recent research suggests that low levels of social support dur-
ing the COVID-19 pandemic were predictive of high stress and
anxiety, whereas social support improved sleep quality in indi-
viduals self-isolating at home (Xiao et al., 2020). Similarly,
social isolation associated with the lockdown during COVID-19
has been linked to a temporary disruption in sociocognitive abil-
ity (Bland et al., 2020). Community cohesion was found to
buffer against heath anxiety and perceived stress during the first
peak of the COVID-19 pandemic in the United Kingdom (Svens-
son, & Elntib, 2021).
Another highly relevant variable for coping with COVID-19 is
socioeconomic status (SES). Seeking/striving/achieving status
(equitable) is highly relevant for the will to exist and survive
within the competitive or cooperative social network and the
socioeconomic hierarchy. One of the critical dimensions of
COVID-19 traumatic stress is its economic stressors (Bazzoli et
al. 2021; Ettman et al. 2021; Kira, Shuwiekh, Alhuwailah, et al.,
2021; Sinclair et al. 2021). High SES and well-being can be pro-
tective factors buffering against stress. One of the robust predic-
tors of health and mortality is SES, even when controlling for
race and ethnicity (Gallo et al., 2009; Lin & Harris, 2009). Low
SES predisposes individuals to chronic stress, which over time,
compromises immune functioning, whereby one’s responses to
3
stressors may become maladaptive and contribute to various ill-
nesses, diseases, and deterioration of psychological health. SES
is connected to health through associations with stress and links
to psychosocial resources such as perceived control and social
support (Gallo, 2009).
In addition, SES is often included as a component of well-being.
There is a significant relationship between overall SES and well-
being (Hiscock et al. 2014). Higher SES can be a protective factor
against stress and is associated with greater resilience and higher
well-being (Cosco et al., 2016).
Gender differences in coping strategies are well-documented
(for a review, see Tamres et al., 2002). Further, there are existing
gender differences in mental health, with women having a higher
risk for PTSD (Olff et al., 2007) and a higher risk for depression
than men (Salk et al., 2017). Women had more anxiety and mood
disorders in all cohorts and countries than men, and men had
more externalizing and substance disorders than women. How-
ever, substantial intercohort narrowing of differences in major
depression was related to changes in the traditionality of female
gender roles ((Seedat et al., 2009). Gender differences in the
prevalence of mental disorders vary across countries. For exam-
ple, in Alexandria, Egypt, the rate of having depressive symp-
toms in girls was almost double that in boys. However, there was
no significant difference in Oman (another Arab country; Afifi,
2006). It is crucial to test if the coping model with COVID-19
traumatic stressors we plan to propose and test is stable and
invariant across genders.
The current study aims to explore the new potential mechanisms
of WTELS that may help cope with such complex continuous trau-
mas (COVID-19 stressors). That will help inform our understand-
ing of the mechanisms that the WTELS operate to drive the
individual’s strategies to survive severe adversities, which may
help innovate and guide intervention with their victim.
We will test a new coping model with COVID-19 continuous
traumatic stressors and its stability and invariance across genders.
In the model, WTELS exerts direct and indirect (mediated via the
other factors we discussed: resilience, perfectionistic striving, social
support, SES, and well-being) effects in reducing the effects of
COVID-19 traumatic stressors. WTELS is the independent variable,
while COVID-19 fear, COVID-19-economic trauma, and COVID-
19 routine disruption and isolation (lockdown stressors) are the de-
pendent variables. In the model, ongoing resilience, perfectionistic
striving, ongoing social support, existing socioeconomic status, and
well-being are mediating variables. Our assumption, based on pre-
vious findings, is that WTELS is a motivating factor for higher
striving, resilience, social support, SES, and well-being that will
mediate the indirect effect of WTELS on COVID-19 stressors, in
addition to its potential direct effects.
Cross-cultural/national variation with varieties of exposures to
stressors will be optimal for research and hypothesis testing. Arab
countries may speak the same language, but their levels of trauma-
tization and COVID-19 infection, COVID-19 traumatic stressors,
population density, and socioeconomic level vary widely (Shu-
wiekh et al., 2020). For example, Palestinians and Iraqis are histor-
ically more traumatized than Saudi Arabians, and the SES in
Kuwait is higher than in Egypt (Bouhlila, 2017). We will utilize a
data set previously collected from seven Arab countries to test the
model and the current study hypotheses.
 4 KIRA ET AL.
Hypotheses
Hypothesis 1: WTELS has direct and indirect negative effects
on lowering the three components of COVID-19 traumatic
stressors severity.
Hypothesis 2: WTELS is directly associated with striving with
high standards (perfectionistic striving), resilience, and social
support.
Hypothesis 3: WTELS has a direct and direct effect on higher
well-being and socioeconomic status.
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Hypothesis 4: The model of WTELS is strictly invariant across
This document is copyrighted by the American Psychological Association or one of its allied publishers.
genders in the country groups.
Method
Participants
A total of 1,374 (N = 1374) adult participants were recruited
from seven Arab countries (Egypt, Kuwait, Saudi Arabia, Jordan,
Algeria, Iraq, and Palestine). The subsamples included the follow-
ing: 18.6% from Egypt (N = 255); 32.2% from Kuwait (N = 442);
15.7% from Jordan (N = 216); 8% from Algeria (N = 110); 15.4%
from Saudi Arabia (N = 212); and 10.1% from Iraq and Palestine
(N = 139). Age in the main sample ranged from 18 to 75 years,
M = 31. 68, SD = 12.92, with 82% women, 93.6% Muslims, and
6.4% Christians. For education, 1.3% had reading and writing
level, 4.8% middle to the high school level, 69.7% college level,
and 24.2% graduate studies level. For marital status, 54.8% were
single 39.4 married, 1.4% widowed, and 4.4% divorced. For
employment, 28% work with the government, 46.3% were stu-
dents, 11.8% had a private business, 10% were retired, and 3.9%
were unemployed. For socioeconomic status, 28% reported work-
ing with the government, 46.3% students, 11.8% private business,
10% retired, and 3.9% unemployed.
Procedure
The study is a secondary data analysis of data initially collected
from seven Arab countries. Three articles were previously pub-
lished from this particular data set (Kira, Shuwiekh, Alhuwailah,
et al., 2021; Kira, Shuwiekh, Rice, et al., 2021; and Shuwiekh et
al., 2020). The published articles used the same data set with sig-
nificantly different research questions, conclusions, and scope and
did not objectively overlap. The first article focused on COVID-19
stressors’ measurement. The second article focused on the effects
of COVID-19 on SES and well-being. The third article focused on
the differential impact of COVID-19 on Arab countries. In addi-
tion, the primary measure of WTELS has never been used in pre-
vious articles from this data.
The data included measures of PTSD, anxiety, well-being,
social status, and other measures that were not used in all the
articles published. The research team used Google Drive and
developed a survey link. The collaborating professionals in differ-
ent Arab countries followed the chain recruiting method in
collecting data. They emailed the survey link to their contacts, ask-
ing them to complete the questionnaire and email the survey link
to their own contacts with the same request. All questionnaires
were answered individually by participants from April 28, 2020,
to May 25, 2020. Participation was voluntary; each person took
about 25 min to complete the questionnaire. No incentives were
offered. Inclusion criteria were being 18 years and older, being
literate, and electronically signing an online consent to partici-
pate. The sponsored university institutional board approved the
research.
Measures
The “Will-to-Exist- Live-and-Survive” Scale
The WTELS scale is a six-item scale that measures different
aspects of WTELS (Kira, Özcan, et al. 2020; Kira, Shuwiekh,
Kucharska, et al. 2020). It includes items such as “I am motivated
by a drive to live”; “My will to exist and survive adversity is gen-
erally high.” We scored each item on a 5-point scale: 4 = very
strong, 3 = strong, 2 = neutral, 1 = drained/depleted, 0 =
extremely depleted/I have no will to survive). Exploratory and con-
firmatory factor analyses found that the measure has a one-factor
structure. The measure’s one-factor structure was strictly invariant
across gender, cultural, and religious groups. The study found its
test–retest stability coefficient (4-week interval) on a sample (N =
34) to be .82 (Kira, Özcan, et al. 2020).
In addition, the study found that WTELS has good convergent,
divergent, and predictive validity. WTELS predicted a decrease in
existential anxiety and mental health symptoms and an increase in
emotion regulation (reappraisal), self-esteem, and posttraumatic
growth (Kira, Özcan, et al. 2020). The Cronbach’s reliability of
the scale in current data is. 91.
COVID-19 Traumatic Stressors Scale
The COVID-19 Traumatic Stress Scale is a 12-item scale
including three subscales (a) “threat/fear of the present and future
infection and death” stressors (five items); (b)“traumatic economic
stressors” (four items); and (c)“isolation and disturbed routines” or
lockdown stressors (three items; Kira, Shuwiekh, Alhuwailah,
et al., 2021). Items are scored on 5-point scale, from 1 (not at all)
to 5 (very much). Examples of items include the following: “How
concerned are you that you will be infected with the coronavirus?”
and “The coronavirus (COVID-19) has impacted me negatively
from a financial point of view.” “Over the past 2 weeks, I have felt
socially isolated as a result of the coronavirus.” In the initial study
(Kira, Shuwiekh, Alhuwailah, et al., 2021), the scale showed good
construct convergent-divergent and predictive validity. The
COVID-19 scale had an a of .88 in the current study. Its three sub-
scales had Cronbach’s a of .84, .75, and .70. respectively.
The MacArthur Scale of Subjective Social Status (Adler &
Stewart, 2007) is presented in a ladder format with 10 steps. The
participant was asked to reference him/herself according “to those
who have the most money, the most education, and the most
respected jobs.” The higher up you are on this ladder, the closer
you are to the people at the very top; the lower you are, the closer
you are to the people at the very bottom and choose one step of
the ladder that represents your status. The Society Ladder Scale is
a global measure of subjective social status related to the individual’s
 IMPACT OF COVID-19 AS TRAUMATIC STRESS
place in the social hierarchy. Different studies in different coun-
tries provided evidence of the ladder technique’s validity and
utility (Adler et al., 2008).
World Health Organization Wellbeing Index Scale
The World Health Organization Wellbeing Index Scale (WHO-
5) is a five-item scale. Example items are “I have felt active and
vigorous.” and “I woke up feeling fresh and rested” (Bech, 2004).
Items scored on a 5-point scale between all of the time and at no
time. The Arabic version of the WHO-5 was previously validated
in Arabic samples (Abdulameer et al., 2019). The measure has a
Cronbach’s a reliability of .89 in current data.
The Perfectionism Scale–Short Form (Rice et al., 2014) is
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designed to measure the positive and negative aspects of perfec-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
tionism. The scale contains eight self-report items with two sub-
scales: High Standards (four items; e.g., “I expect the best from
myself.”) and Discrepancy (four items; e.g., “My best just never
seems to be good enough for me.”). Respondents respond on a 5-
point scale ranging from 1 (strongly disagree) to 5 (strongly
agree). In current data, the Cronbach’s a for the standards subscale
is .81, and .70 for the Discrepancy subscale.
Connor-Davidson Resilience Scale 10-Item Version
The participant rates each item on a 5-point scale, with
responses from 0 (not true at all) to 4 (true nearly all times)
(Campbell-Sills &Stein, 2007; Connor & Davidson, 2003). The
total score ranges from 0 to 50. The original measure showed
adequate internal consistency, test–retest reliability, and conver-
gent and divergent validity (Connor & Davidson, 2003). The short
version Connor-Davidson Resilience Scale 10-Item Version (CD-
RISC-10) showed the same original version’s psychometrics
(Scali et al., 2012). In our sample, the CD-RISC-10 showed
adequate internal consistency (Cronbach’s a = .81).
Social Support Survey
The social support scale is a 12-item scale. It includes the Emo-
tional/Informational Support sub-scale (8 items) and Tangible
Support subscale (4 items), (Sherbourne, & Stewart, 1991). The
participant rates each item on a 5-point scale, from 1 (none of the
time) to 5 (all of the time). Multitrait scaling analyses supported
the dimensionality of four functional support dimensions: emo-
tional/informational, tangible, affectionate, and positive social
interaction. The measure proved to have good reliability and to be
fairly stable over time (Sherbourne & Stewart, 1991). It has a =
.92 in the current study.
Data Analysis
We used IBM-SPSS 22 and Amos 22 software to analyze the
data. The inspection of the variables indicated that there are no
missing values in the data. The survey was set up, as it was not
possible to proceed without entering a response. We conducted
zero-order correlations between the main variables. We tested the
impact of the WTELS model using structural equation hybrid
modeling (SEM). The model included WTELS as an independent
variable, resiliency, high standards, SES, social support, well-
being as mediating variables, and COVID-19 stressors as a latent
variable represented by the three traumatic stressors types: fears,
5
economic, and lockdown stressors as outcome variables. We used
Byrne’s (2012) recommendations for the SEM model for the
acceptable fit criteria. The criteria for good model fit were a non-
significant v2, chi-square/degrees of freedom (v2/df .5), compara-
tive fit index (CFI) values . .90, and root mean square error of
approximation (RMSEA) values , .06 (Weston & Gore, 2006).
We used a bootstrapping procedure with 10,000 bootstrap samples
to examine the significance of direct, indirect (mediated effects),
and total effects and 95% bias-corrected confidence intervals (95%
CI) for each variable. We trimmed the model by eliminating the
nonsignificant paths to simplify the presentation, which slightly
improved the model fit. Further, we tested alternative models to
explore potentially better fitted or equally fitted models.
Although SEM analysis can include several independent and de-
pendent variables simultaneously and identify the total direct and
indirect effects, it cannot identify the mediators that contribute to
the indirect effects and the effect size of each. For this reason, we
supplemented SEM analysis by SPSS PROCESS macro (Hayes,
2013; model 4). For PROCESS analysis, we utilized bootstrapping
sampling (n = 5,000) distributions to calculate the direct and indi-
rect effects and 95% CIs of the estimated effects.
In addition, to assess whether the SEM model of the effects of
WTELS on COVID-19 traumatic stress was invariant across gen-
ders in the country-groups, we conducted a multigroup invariance
analysis. We tested four nested models sequentially: a configural
invariance model, a metric invariance model, a scalar invariance
model, and a strict invariance model (van de Schoot et al., 2012).
According to Chen, 2007, the null hypothesis of invariance should
not be rejected when changes in CFI are #.01 and in RMSEA are
#.015.
Results
Descriptives
COVID-19 stressors (M = 33.52, SD = 8.45, maximum = 60,
minimum = 13, range = 47) are considered high comparing to a cut-
off point of 22. For its subscales, COVID-19 fear stressors (M =
13.58, SD = 4.89, maximum = 24, minimum = 5, range = 24);
COVID-19 economic stressors (M = 8.05, SD = 3.67, maximum =
20, minimum = 4, range = 20); COVID-19 lockdown stressors
(M = 11.89, SD = 2.63, maximum = 16, minimum = 4, range = 12);
and COVID-19 lockdown stressors seem to be the highest com-
pared to fears and economic stressors in the sample. For resilience
(M = 21.91, SD = 5.79, maximum = 36, minimum = 0, range = 36),
resilience seems to be medium to high. Social support (M = 41.89,
SD = 10.76, maximum = 60, minimum = 12, range = 48) seems to
be medium to high. Perfectionistic standards striving (M = 21.68,
SD = 4.50, maximum = 28, minimum = 4 range = 24) seems to be
high. WTELS (M = 20.43, SD = 5.53, maximum = 27, minimum =
1, range = 26) seems to be medium to high. SES (M = 6.68, SD =
1.99, maximum = 10, minimum = 1, range = 9) seems to be in the
medium range. Well-being (M = 10.82, SD = 5.92, maximum = 25,
minimum = 0, range = 25) seems to be low to medium.
Correlations
COVID-19 traumatic stress main scale scores correlated nega-
tively with SES and well-being and positively with social support.
 6 KIRA ET AL.

COVID-19 Fears subscale scores correlated negatively with SES
and well-being and positively with social support. COVID-19
Economic Trauma subscale scores correlated negatively with SES,
WTELS, well-being, and standards. COVID-19 Disrupted Rou-
tines and Isolation subscale scores correlated negatively with SES,
well-being, resilience, and standards. Well-being correlated signif-
icantly with SES.
WTELS correlated significantly with SES and well-being. Re-
silience correlated significantly with WTELS, SES, and well-
being. Social support is significantly correlated with WTELS,
well-being, and resilience. High standards are significantly corre-
lated with resilience, WTELS, social support, well-being, and
SES.
COVID-19 has the highest negative correlation with SES
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p = .000, LLCI = .04, ULCI = .01), and SES (effect size =
.01, SE = .00, Z = 2.40, p = .016, LLCI = .01, ULCI = .00).
WTELS indirect positive effects on well-being were mediated by
resilience (effect size = .06, SE = .01, Z = 3.82, p = .000, LLCI =
.03, ULCI = .09), social support (effect size = .05, SE = .01, Z = 4.314,
p = .000, LLCI = .03, ULCI = .07), and SES (effect size = .02,
SE = .01, Z = 2.53, p = .012, LLCI = .01, ULCI = .03). WTELS
indirect positive effects on resilience were mediated by perfection-
istic striving (standards; effect size = .24, SE = .02, Z = 10.14, p =
.000, LLCI = .19, ULCI = .29) and well-being (effect size = .04, SE
= .01, Z = 3.87, p = .000, LLCI = .02, ULCI = .06). WTELS indi-
rect positive effects on social support were mediated by perfection-
istic striving (standards; effect size = .19, SE = .04, Z = 5.09, p =
.000, LLCI = .12, ULCI = .26) and well-being (effect size = .09,

SE = .02, Z = 4.33, p = .000, LLCI = .05, ULCI = .13). WTELS

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( .24). SES has the highest correlation with wellbeing (.23).

WTELS has the highest correlation with striving for high stand-
ards (.49) and resilience (.42). Striving for high standards has the
highest correlation with resilience (.54) and WTELS. Social sup-
port has the highest correlation with WTELS (.32). Table 1 details
these correlations.
SEM Analysis and PROCESS Macro Mediation Results
The model had an adequate fit with the data (v2 = 132, df =21,
p = .000, CFI = .948, RMSEA = .062). COVID-19 lockdown stres-
sors accounted for the highest variance in the model (R2=.488). The
WTELS had direct medium-to-large effects on standards (perfec-
tionistic striving), and SES, direct and indirect effects on well-
being, social support, and resilience. Its direct effects on well-being
are 69% of its total effects, 67% of its total effects on social sup-
port, and 48% of its total effects on resilience. It has indirect nega-
tive effects on all COVID-19 stressors types. Using PROCESS
analysis to identify the mediators, the WTELS indirect negative
effects on COVID-19 fears were mediated by well-being (effect
size = .03, SE = .01, Z = 2.24, p = .018, LLCI = .05,
ULCI = .01), and SES (effect size = .01, SE = .00, Z = 2.73,
p = .014, LLCI = .03, ULCI = .01). WTELS indirect negative
effects on COVID-19 economic trauma were mediated by well-
being (effect size = .02, SE = .01, Z = 2.41, p = .016, LLCI =
.03, ULCI = .01), and SES (effect size = .01, SE = .00, Z =
2.62, p = .009, LLCI = .03, ULCI = .01). WTELS indirect
negative effects on COVID-19 isolation (lockdown) stressors were
mediated by well-being (effect size = .03, SE = .01, Z = 4.25,
indirect positive effects on well-being were mediated by resilience
(effect size = .06, SE = .01, Z = 3.82, p = .000, LLCI = .03, ULCI =
.09), social support (effect size = .05, SE = .01, Z = 4.31, p = .000,
LLCI = .03, ULCI = .07), and SES (effect size = .02, SE = .01, Z =
2.53, p = .012, LLCI = .01, ULCI = .03).
High standards (perfectionistic striving) had direct medium-to-large
effects on resilience and small-to-medium direct effects on social sup-
port. It has small but significant indirect effects on well-being. It had
small but significant negative effects on all the COVID-19 stressors.
Using PROCESS analysis to identify the mediators, perfectionisms
striving indirect positive effects on well-being were mediated by
WTELS (effect size = .15, SE = .02, Z = 6.55, p = .000, LLCI = .11,
ULCI = .20), resilience (effect size = .09, SE = .02, Z = 3.98, p =
.000, LLCI = .05, ULCI = .13), social support (effect size = .05, SE =
.01, Z = 4.31, p = .000, LLCI = .03, ULCI = .08), and SES (effect
size = .02, SE = .01, Z = 2.65, p = .008, LLCI = .01, ULCI = .04).
Perfectionisms striving indirect negative effects on COVID-19 eco-
nomic trauma were mediated by WTELS (effect size = .04, SE =
.01, Z = 2.89, p = .004, LLCI = .06, ULCI = .01), SES (effect
size = .02, SE = .01, Z = 2.75, p = .006, LLCI = .03, ULCI =
.01), and well-being (effect size = .02, SE = .01, Z = 2.37, p =
.018, LLCI = .03, ULCI = .00). Perfectionisms striving indirect
negative effects on COVID-19 isolation (lockdown) were mediated
by well-being (effect size = .02, SE = .01, Z = 4.10, p = .000,
LLCI = .03, ULCI = .01) and SES (effect size = .01, SE = .00,
Z = 2.51, p = .012, LLCI = .02, ULCI = .00).
Social support had direct effects on well-being and small but
highly significant negative effects on all COVID-19 stressors

Table 1
Zero-Order Correlations Between the Main Variables
Variable 1 2 3 4 5 6 7 8 9 10
1.COVID-19 traumatic stress 1
2.COVID-19 fears .82*** 1
3.COVID-19 Economic trauma .70*** .26*** 1
4.COVID-19 Routine disturbances .71*** .40*** .38*** 1
5.SES .24*** .15*** .24*** .15*** 1
6.Well-being .14*** .07** .14*** .12*** .23*** 1
7.WTELS .04 .03 .15*** .01 .16*** .39** 1
8.Resilience .02 .01 .01 .06* .08** .29*** .42*** 1
9.Social support .08** .12*** .05 .10*** .05 .23*** .32*** .22*** 1
10.Standards .01 .00 .08** .07** .12*** .26*** .49*** .54*** .33*** 1
Note. SES = socioeconomic status; WTELS = Will-to-exit, live, and survive.
* p , .05. ** p , .01. *** p , .001.
 IMPACT OF COVID-19 AS TRAUMATIC STRESS
types. Using PROCESS analysis to identify the mediators, social
support indirect negative effects on COVID-19 economic trauma
were mediated by WTELS (effect size = .01, SE = .00, Z =
2.84, p = .005, LLCI = .02, ULCI = .00) and well-being
(effect size = .01, SE = .00, Z = 2.37, p = .018, LLCI = .01,
ULCI = .00). Social support indirect negative effects on
COVID-19 isolation (lockdown) were mediated by well-being
(effect size = .01, SE = .00, Z = 4.08, p = .000, LLCI = .01,
ULCI = .01).
Resilience had direct effects on well-being and small but highly sig-
nificant negative effects on all COVID-19 stressors types. Using PRO-
CESS analysis to identify the mediators, resilience indirect negative
effects on COVID-19 economic trauma were mediated by WTELS
(effect size = .02, SE = .01, Z = 2.86, p = .004, LLCI = .04,
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ULCI = .01) and well-being (effect size = .01, SE = .00, Z =
This document is copyrighted by the American Psychological Association or one of its allied publishers.
2.37, p = .018, LLCI = .02, ULCI = .00). Resilience indirect
negative effects on COVID-19 isolation (lockdown) were mediated by
well-being (effect size = .02, SE = .00, Z = 4.10, p = .000,
LLCI = .03, ULCI = .01).
SES had direct effects on well-being. It had direct and indirect
negative effects on COVID-19 stressors and indirect negative
effects on all COVID-19 stressors types. Its direct negative effects
on COVID-19 stressors were 93% of its total effects. SES had the
highest negative effects on COVID-19 stressors, compared to
other variables.
Using PROCESS analysis to identify the mediators, we found
that SES indirect negative effects on COVID-19 disturbed routines
and isolations were mediated by well-being (effect size = .04,
SE = .01, Z = 3.69, p = .000, LLCI = .06, ULCI = .02). SES
indirect negative effects on COVID-19 economic trauma were
mediated by well-being (effect size = .03, SE = .01, Z = 2.28,
p = .023, LLCI = .04, ULCI = .01) and WTELS (effect size =
.02, SE = .01, Z = 2.02, p = .044, LLCI = .05, ULCI =
.01). WTELS was the only mediator of the SES indirect positive
effects on well-being (effect size = .07, SE = .03, Z = 2.68, p =
.007, LLCI = .03, ULCI = .13).
Well-being had direct negative effects on COVID-19 stressors
and indirect negative effects on all COVID-19 stressors types. The
negative effects of wellbeing on COVID-19 fears were mediated
by SES (effect size = .03, SE = .01, Z = – 4.38, p = .000,
LLCI = .04, ULCI = .02). The negative effects of well-being
on COVID-19 economic stressors were mediated by WTELS
(effect size = .03, SE = .01, Z = – 3.79, p = .000, LLCI = .04,
ULCI = .02) and SES (effect size = .03, SE = .01, Z = – 5.45,
p = .000, LLCI = .04, ULCI = .02). The negative effects of
well-being on COVID-19 lockdown stressors were mediated by
SES (effect size = .02, SE = .00, Z = – 4.10, p = .000, LLCI =
.02, ULCI = .01). The negative effects of well-being on
COVID-19 fears were mediated by SES (effect size = .03, SE =
.01, Z = – 4.38, p = .000, LLCI = .04, ULCI = .02). The nega-
tive effects of well-being on COVID-19 economic stressors were
mediated by WTELS (effect size = .03, SE = .01, Z = – 3.79,
p = .000, LLCI = .04, ULCI = .02) and SES (effect size =
.03, SE = .01, Z = – 5.45, p = .000, LLCI = .04, ULCI =
.02). The negative effects of well-being on COVID-19 lockdown
stressors were mediated by SES (effect size = .02, SE = .00, Z =
– 4.10, p = .000, LLCI = .02, ULCI = .01). The negative
effects of well-being on COVID-19 fears were mediated by SES
(effect size = .03, SE = .01, Z = – 4.38, p = .000, LLCI = .04,
7
ULCI = .02). The negative effects of well-being on COVID-19
economic stressors were mediated by WTELS (effect size = .03,
SE = .01, Z = – 3.79, p = .000, LLCI = .04, ULCI = .02) and
SES (effect size = .03, SE = .01, Z = – 5.45, p = .000, LLCI =
.04, ULCI = .02). The negative effects of well-being on COVID-
19 lockdown stressors were mediated by SES (effect size = .02,
SE = .00, Z = – 4.10, p = .000, LLCI = .02, ULCI = .01).
Figure 1 presents the standardized direct effect of WTELS on
the three types of COVID-19 traumatic stressors and through
mediators. Table 2 details the direct, indirect, and total effects and
the 95% confidence intervals of each variable in the model.
Alternative Models
We tested alternative models, with resilience as the independent
variable in the first alternative model, perfectionistic striving
(standards) in the second alternative model, SES in the third alter-
native model, well-being in the fourth alternative model, and
social support in the fifth alternative model. While the fit indices
of the first alternative model, in which resilience was an independ-
ent variable and WTELS was a mediating variable (v2 = 208258,
df = 21, p = .000, CFI = .912, RMSEA = .081), and the second al-
ternative model in which perfectionistic striving was independent
variable and WTELS was mediating variable v2 = 219.530, df =
21, p = .000, CFI = .907, RMSEA = .083) were still adequate.
However, the fit indices of these two models (resilience and per-
fectionist striving) were lower than the chosen model of WTELS
as the independent variable (v2 = 132.537, df = 21, p = .000, CFI =
.948, RMSEA = .062). Alternative Models 3, 4, and 5, in which
SES, well-being, and social support were independent variables
and WTELS were mediating variables, did not fit the data. Figures
S1 to S5 in the online supplemental materials represent the five al-
ternative models and include the fit indices of each.
Multigroup Invariance
Multigroup structural invariance indicated that the SEM model
of WTELS dynamics was strictly invariant across genders (men
and women). Table 3 included the structural fit indexes on the four
levels (configural, metric, scalar, and strict) for each analysis,
which did not significantly differ from each other according to the
criteria previously discussed.
Discussion
COVID-19 challenges most of the known basic methods of
managing stress and surviving adversities. The traditional coping
strategies do not seem enough. Innovation and searching how peo-
ple cope in real life and real time with such severe challenges may
inform such endeavors. The significance of the study is of identify-
ing potential coping dynamics that people utilize to cope with such
severe prolonged traumatic stressors. WTELS, as a metamotiva-
tion executive process, is a novel construct with broad coping
implications and evidential strength for effecting posttraumatic
growth and resilience in complex life challenges and such condi-
tions as continuous oppression and intergroup conflict (Kira,
Alawneh, et al., 2014; Kira, Özcan, et al. 2020). The current study
tested WTELS’s direct and indirect effects on a lower COVID-19
traumatic stress, higher well-being, and SES, and greater resilience
and striving for higher standards. The model fitted well with data
 8 KIRA ET AL.

Figure 1
Structural Equation Hybrid Modeling Model for the Direct Effect of Will to Exist,
Live, and Survive on Three Types of COVID-19 Traumatic Stress and Through
Mediators.
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This document is copyrighted by the American Psychological Association or one of its allied publishers.

Note. SES = socioeconomic status; WTELS = Will-to-exit, live, and survive; CFI = com-
parative fit index; RMSEA = root mean square error of approximation.

and was more robust than the alternative models. The results con-
firmed the study’s four hypotheses and found that the WTELS
model is strictly invariant across genders. A recent study found
that WTELS, as a master motivator, activates executive functions
(working memory and inhibition deficits) and was directly and
indirectly associated with lower depression, anxiety, PTSD, and
COVID-19 traumatic stress. Its indirect effects were mediated by
its effects on lower executive function deficits (Kira, Ayna, et al.,
2021). Another study identified two circuit pathways in coping
with cumulative adversities in believers and nonbelievers: Inter-
faith spirituality and WTELS, with WTELS, was the main coping
pathway for nonbelievers compared to those who believe in a
higher power (Kira, Özcan, et al., 2021).
These studies’ results emphasize the uniqueness of the proposed
concept of WTELS compared to posttraumatic growth and resil-
ience. The literature on the concept of resilience and its measure-
ment is developing with more innovations that accounts for
cultural and contextual diversity across populations (e.g., Lieben-
berg & Moore, 2018). Most instruments designed to measure resil-
ience overemphasize individual characteristics, including the
measure the current study utilized, without adequately addressing
the contextual resources that support resilience processes and the
social-ecological factors that promote postrisk adaptation and how
this is measured. An innovative approach has been reconceptual-
ized resilience as the experience of health under stress and the
dynamic processes that contribute to positive development and the
person’s developmental pathways to well-being (Liebenberg &
Ungar, 2017). The concept of posttraumatic growth needs to take
the same innovative approach to resilience, emphasizing its rela-
tionship to child and adult development and the social-ecological
factors that promote postrisk adaptation and how this is measured.
The concept of WTELS as a precognitive, metamotivational exec-
utive process is intimately related to a person’s developmental pro-
cess and the activation of social-ecological factors that promote
postrisk adaptation, such as resilience and posttraumatic growth. It
is vital to understand WTELS within the trauma and social-ecolog-
ical based developmental model. Future studies may test the model
using a different measure of resilience and posttraumatic growth
based on the developmental and the social-ecological model.
COVID-19 is a new trauma type that is multilayered (fears–
economic–isolation, grief), continues for a longer time scale, and
has mass and collective impact. Coping with such mass multilay-
ered trauma with continuous prolonged sequelae for the individ-
ual is more challenging than a single traumatic event, and the
individual needs to mobilize his or her whole wills and coping
capacity. COVID-19 seems to trigger such a coping capacity to-
tality of WTELS in the person. The powerful dynamics of
WTELS and striving for higher standards that contribute signifi-
cantly to resilience, coupled with social support, help reduce the
negative socioeconomic and mental health impact of COVID-19
on the individual’s well-being.
However, some researchers questioned the self-reported resil-
ience as a self-deception artifact that may not reflect actual resil-
ience (Roth & Herzberg, 2017). The same may apply to the self-
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Table 2
The Direct Indirect and Total Standardized Effects of Will-to-Exit, Live, and Survive on Three COVID-19 Traumatic Stress Factors With Mediators
Endogenous variables
Socioeconomic
Causal variables Standards Social support Resilience status Well-being COVID stressors COVID lockdown COVID economic COVID fears
Wills to exist, live, and survive
Direct effects .49* (.41/.53) .22** (.15/.27) .20** (.13/.22) .16*** (.10/.23) .27* (.21/.32) — — — —
Indirect effects — .11* (.06/.14) .22** (.17/.25) — .12** (.09/.15) .09** ( .12/ .06) .06** ( .08/ .04) .05** ( .07/ .03) .05** ( .07/ .03)
Total effects .49* (.41/.53) .33* (.25/.37) .42** (.35/.48) .16*** (.10/.23) .39** (.34/.45) .09** ( .12/ .06) .06** ( .08/ .04) .05** ( .07/ .03) .05** ( .07/ .03)
Standards (perfectionistic striving)
Direct effects — .22* (.13/.27) .45** (.38/.50) — — — — — —
Indirect effects — — — — .09** (.06/.12) .01** ( .02/ .01) .01** ( .01/ .00) .01** ( .01/ .00) .01** ( .01/ .00)
Total effects — .22* (.13/.27) .45** (.38/.50) — .09** (.06/.12) .01** ( .02/ .01) .01** ( .01/ .00) .01** ( .01/ .00) .01** ( .01/ .00)
Social support
Direct effects — — — — .11** (.05/.16) — — — —
Indirect effects — — — — — .01*** ( .02/ .01) .01*** ( .02/ .01) .01*** ( .02/ .00) .01*** ( .01/ .00)
Total effects — — — — .11** (.05/.16) .01*** ( .02/ .01) .01*** ( .02/ .01) .01*** ( .02/ .00) .01*** ( .01/ .00)
Resilience
Direct effects — — — — .14** (.08/.19) — — — —
Indirect effects — — — — — .02** ( .03/ .01) .01** ( .02/ .01) .01** ( .02/ .00) .01** ( .02/ .00)
Total effects — — — — .14** (.08/.19) .02** ( .03/ .01) .01** ( .02/ .01) .01** ( .02/ .00) .01** ( .02/ .00)
Socioeconomic status
Direct effects — — — — .17** (.12/.23) .26* ( .32/ .17) — — —
Indirect effects — — — — — .02** ( .04/ .01) .19** ( .24/ .14) .15** ( .20/ .11) .15** ( .19/ .10)
Total effects — — — — .17** (.12/.23) .28** ( 34/ 20) .19** ( .24/ .14) .15** ( .20/ .11) .15** ( .19/ .10)
Well-being
Direct effects — — — — — .12** ( .20/ .05) — — —
IMPACT OF COVID-19 AS TRAUMATIC STRESS

Indirect effects — — — — — — .08** ( .13/ .04) .07** ( .12/ .03) .07** ( .11/ .03)
Total effects — — — — — .12** ( .20/ .05) .08** ( .13/ .04) .07** ( .12/ .03) .07** ( .11/ .03)
R2 .235 .141 .327 .025 .206 .094 .488 .296 .297
* p , .05. ** p , .01. *** p , .001.
9
 10 KIRA ET AL.
Table 3
Multigroup Structural Invariance Analysis of the Model of the Effects of “Will to Exist-Live, and Survive” on COVID-19 Traumas
Through Mediators Across Genders (Male/Female) in the Country Groups
Gender (male/female) v2 df p v2/df
Configural 103.825 34 .000
Metric (weights) 135.053 53 .000
Scalar (intercepts) 137.503 54 .000
Residual (strict
invariance) 153.410 62 .000
Note. CFI = comparative fit index; RMSEA = root mean square error of approximation; IFL = incremental fit index; TLI = tucker-lewis index.
* p , .05. ** p , .01. *** p , .001.
report of WTELS as well; even the SEM model and the relation-
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ships between variables are pretty convincing. How much in
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self-report of WTELS reflects self- optimism or pessimism
biases? In addition, because WTELS was not measured before
the COVID-19 pandemic, it is difficult to say whether it was
enacted due to the challenge of COVID-19 stressors or if better
pre-WTELS allowed for better coping or both. Future studies
with longitudinal design may help clarify this point. However,
WTELS was significantly associated with a significant reduction
in internalizing disorders (Kira, Shuwiekh, Kucharska, et al.,
2020). A higher level of posttraumatic stress symptoms was neg-
atively related to the lower will to live in those who felt close to
death (Palgi, 2017). Study results found that WTELS’s direct
effects on reducing PTSD were strong and accounted for 88% of
its total effects on lower PTSD (Kira, Özcan, et al., 2020). The
plethora of social support, striving for high standards, and inner
resilience, drawn by the strong drive of WTELS, seems to be a
compelling coping powerhouse triggered by the challenges of
the unprecedented continuous multilayered COVID-19 traumatic
stress. WTELS represents the natural human coping response to
such unprecedented traumatic adversities.
Although analysis of the alternative models indicated the su-
periority of WTELS model fit, it also indicated that resilience
and perfectionist striving as independent variables have some-
how acceptable fit. That implies the critical importance of striv-
ing for higher standards and resilience and related developmental
assets in the coping dynamics to COVID-19 stressors.
The current study has several conceptual and clinical implications.
Conceptually, it emphasized that coping with such unprecedented
traumatic stress needs the intrinsic natural “will-to exist-live-and-sur-
vive” to kick in and master and mobilize all available inner and outer
resources. WTELS was directly associated with lowered COVID-19
economic trauma and indirectly with lowering its fears and isolation
stressors. It has significant effects on seeking higher standards, resil-
ience, social support, SES, and well-being, which is generally con-
sistent with previous findings discussed in the introduction and
reviewed by Bornet et al., 2021. It seems that WTELS mobilizes
inner and external resources to increase status and well-being that
release stressors, in addition to its direct effects. In this modified
model, SES and well-being are both outcome and mediating varia-
bles. Resilience in the context of continuous traumatic stress is an
ecological phenomenon in which the individual’s WTELS is an inte-
gral part of this formula of coping with continuous traumatic stress
(Nuttman-Shwartz & Green, 2021).
Clinically, current study results indicated that a critical focus of
the prevention and intervention with COVID-19 victims (and other
CFI RMSEA IFI TLI
3.054 .968 .039 .968 .931
2.548 .962 .034 .962 .938
2.546 .961 .034 .962 .939
2.474 .958 .033 .958 .941
victims of other types of CTS or Type III traumas) is to prime and
optimize their intrinsic natural WTELS, as it is one of the keys to
effective coping with such extreme traumas. The intensity of contin-
uous and prolonged traumatic stressors in Type III traumas and the
severity of cumulative and proliferated early on poly-victimizations
are challenging to treat. In addition, one of the significant contribu-
tions of the study is that it may be the first study that considered and
measured the different types of COVID-19 stressors simultaneously
and found that although all COVID-19 stressors are serious, the
lockdown stressors are the most severe. The cumulative effects of
COVID-19 stressors and especially lockdown stressors need to be
addressed in treatment. Our study provided evidence that WTELS
is a key that may release a chain of effective coping strategies of
tenacious goal pursuits and striving for higher standards, resilience,
and social support, significantly reducing COVID-19 traumatic
stress. Using motivational interviewing techniques to stimulate the
salience of WTELS as the master motivator may be helpful. Also,
some clinicians proposed the model of “current, continuous, and cu-
mulative trauma-focus cognitive behavior therapy” (Kira, Ashby, et
al., 2015), which may be relevant to COVID-19 continuous multi-
layered traumatic stress.
One of the limitations of the current study is that it was con-
ducted on convenient samples with limited and biased representa-
tion toward the female gender. That may affect the results as
women have higher PTSD and depression than men. Further, the
sample includes a unique cultural and religious group. From a
global perspective, especially in terms of the global pandemic, the
sample reflects a specific subgroup. We recommend more studies
that use more representative samples.
In addition, in measuring COVID-19 stressors, we did not mea-
sure the grief stressors related to lost loved ones to COVID-19
infection. Future studies should add and measure this critical
stressor. Another limitation is that the measures used are based
on participants’ self-reports. Self-reports are subject to under or
overreporting due to social desirability. Further, we have to cau-
tion that direct and indirect effects are statistical probabilistic
stochastic terms that have been used in SEM analysis and do not
mean the same thing in deterministic sciences of cause and
effect.
Conclusion
COVID-19 traumatic stress, a new severe trauma, is continuous
with a larger time scale. It is global. It is multilayered with at least
three dimensions: (1) threat/fear of the present and future infection
and death, (2) economic loss and related stressors, and (3) the
 IMPACT OF COVID-19 AS TRAUMATIC STRESS
stressors and traumatic stressors related to the disturbed life rou-
tines, isolation, and family and social life. In addition, grief and
mourning of losing to COVID-19 infection and death is another
(Kira, Ayna, et al. 2021). COVID-19, with its unprecedented
impact, is challenging the individual capacity to cope. Coping to
such unprecedented traumatic stress needs the intrinsic natural will
to exist, live, and survive to kick in and master and mobilize all
available inner and outer resources. The current study’s signifi-
cance stems from providing empirical evidence of the significance
of the person’s wills and the importance of motivating and sup-
porting the person’s natural innate WTELS as part of prevention
and intervention strategies with COVID-19.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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