The COVID-19 outbreak has raised questions about how vulnerable groups experience the pandemic. Research that focuses on the view of individuals with pre-existing mental health conditions is still limited, and so are cross-country comparative surveys. We gathered our sample of qualitative data during the first lockdown after governmental measures against the spread of the SARS-CoV-2 virus came into force in Austria, Czechia, Germany, and Slovakia. A total of n = 1690 psychotherapists from four middle European countries answered the question of how the COVID-19 pandemic was addressed in sessions by their patients during the early stage of unprecedented public health conditions. We employed a descriptive qualitative methodology to determine themes following levels of the social-ecological model (SEM) regarding how the COVID-19 pandemic affected patients. At the public policy level, stressful environmental conditions concerned the governmental mitigation efforts. At the level of community/society, reported key themes were employment, restricted access to educational and health facilities, socioeconomic consequences, and the pandemic itself. Key themes at the interpersonal level regarded forced proximity, the possibility of infection of loved ones, childcare, and homeschooling. Key themes at the individual level were the possibility of contracting COVID-19, having to stay at home/isolation, and a changing environment. Within the SEM framework, adaptive and maladaptive responses to these stressors were reported, with more similarities than differences between the countries. A quantification of word stems showed that the maladaptive reactions predominated.

Austrian Federal Association for Psychotherapy 1030 Vienna Austria

Clinical and Biological Psychology Catholic University of Eichstätt Ingolstadt 85072 Eichstätt Germany

Clinical Psychology and Psychotherapy Brandenburg Medical School Theodor Fontane 16861 Neuruppin Germany

College of Applied Psychology 41155 Terezin Czech Republic

Department for Psychosomatic Medicine and Psychotherapy Danube University Krems 3500 Krems Austria

Olomouc University Social Health Institute Palacky University Olomouc 77111 Olomouc Czech Republic

Psychiatric Psychotherapeutic Outpatient Clinic Pro Mente Sana 81108 Bratislava Slovakia

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