The inflexible mind: A critical factor in understanding and addressing COVID-19 vaccine hesitancy.

Background: Vaccine hesitancy has gained heightened relevance amid the COVID-19 pandemic, underscoring the urgency of understanding its determinants. This study explores the association between Covid-19 vaccine hesitancy, mental health variables and inflexible thinking.
Methods: A convenience sample of 252 UK adults was assessed online between June 2021-July 2022 (when Covid-19 lockdown restrictions had finally eased). We assessed participants using the Oxford Covid Vaccine Hesitancy Scale (OCVHS), various aspects of mental health, using: the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Depression, Anxiety, and Stress scale (DASS-21), and finally, performance on a computerized version of the Wisconsin Card Sort Task (WCST). This study was preregistered at the Open Science Framework (https://osf.io/xd5wz).
Results: Multiple regression analyses showed that only cognitive inflexibility, and specifically the WCST item of perseverative errors, significantly predicted vaccine hesitancy.
Conclusion: Our exploratory analysis provides the first evidence that cognitive inflexibility, measured using an objective task, is an independent risk-factor for vaccine hesitancy. Public health strategies should consider the impact of an inflexible thinking style on the decision-making of those most at risk of vaccine hesitancy and adapt interventions accordingly.
Competing Interests: Declaration of competing interest Prof. Naomi Fineberg reports in the past 3 years she has held research or networking grants from the UKNIHR, COST Action, Orchard; accepted travel and/or hospitality expenses from the BAP, ECNP, RCPsych, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association; received payment from Elsevier for editorial duties and the Mental Health Academy for lecturing. Previously, she has accepted paid speaking engagements in various industry supported symposia and recruited patients for various industry-sponsored studies in the field of OCD treatment. She leads an NHS treatment service for OCD. She holds Board membership for various registered charities linked to OCD. She gives expert advice on psychopharmacology to the UK MHRA. She has participated in a WHO working group focusing on diagnosis and classification of obsessive compulsive or related disorders for the ICD-11. Dr Luca Pellegrini reports a relationship with European Cooperation in Science and Technology, the University of Hertfordshire, Orchard, ECNP-OCRN International College of Obsessive-Compulsive Spectrum Disorders (ICOCS), that includes: funding grants. Professor Laws and Dr. Clarke report no interest.
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