Shame and guilt الخجل والذنب

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ تُوبُوٓاْ إِلَى ٱللَّهِ تَوۡبَةࣰ نَّصُوحًا عَسَىٰ رَبُّكُمۡ أَن يُكَفِّرَ عَنكُمۡ سَيِّـَٔاتِكُمۡ وَيُدۡخِلَكُمۡ جَنَّٰتࣲ تَجۡرِي مِن تَحۡتِهَا ٱلۡأَنۡهَٰرُ يَوۡمَ لَا يُخۡزِي ٱللَّهُ ٱلنَّبِيَّ وَٱلَّذِينَ ءَامَنُواْ مَعَهُۥۖ نُورُهُمۡ يَسۡعَىٰ بَيۡنَ أَيۡدِيهِمۡ وَبِأَيۡمَٰنِهِمۡ يَقُولُونَ رَبَّنَآ أَتۡمِمۡ لَنَا نُورَنَا وَٱغۡفِرۡ لَنَآۖ إِنَّكَ عَلَىٰ كُلِّ شَيۡءࣲ قَدِيرࣱ‏

Believers, turn to God in sincere repentance. Your Lord may well cancel your bad deeds for you and admit you into Gardens graced with flowing streams, on a Day when God will not disgrace the Prophet or those who have believed with him. With their lights streaming out ahead of them and to their right, they will say, ‘Lord, perfect our lights for us and forgive us: You have power over everything.’

إِنَّمَا ٱلتَّوۡبَةُ عَلَى ٱللَّهِ لِلَّذِينَ يَعۡمَلُونَ ٱلسُّوٓءَ بِجَهَٰلَةࣲ ثُمَّ يَتُوبُونَ مِن قَرِيبࣲ فَأُوْلَٰٓئِكَ يَتُوبُ ٱللَّهُ عَلَيۡهِمۡۗ وَكَانَ ٱللَّهُ عَلِيمًا حَكِيمࣰ ا

But God only undertakes to accept repentance from those who do evil out of ignorance and soon afterwards repent: these are the ones God will forgive, He is all knowing, all wise

وَلَيۡسَتِ ٱلتَّوۡبَةُ لِلَّذِينَ يَعۡمَلُونَ ٱلسَّيِّـَٔاتِ حَتَّىٰٓ إِذَا حَضَرَ أَحَدَهُمُ ٱلۡمَوۡتُ قَالَ إِنِّي تُبۡتُ ٱلۡـَٰٔنَ وَلَا ٱلَّذِينَ يَمُوتُونَ وَهُمۡ كُفَّارٌۚ أُوْلَٰٓئِكَ أَعۡتَدۡنَا لَهُمۡ عَذَابًا أَلِيمࣰ ا

It is not true repentance when people continue to do evil until death confronts them and then say, ‘Now I repent,’ nor when they die defiant: We have prepared a painful torment for these

وَهُوَ ٱلَّذِي يَقۡبَلُ ٱلتَّوۡبَةَ عَنۡ عِبَادِهِۦ وَيَعۡفُواْ عَنِ ٱلسَّيِّـَٔاتِ وَيَعۡلَمُ مَا تَفۡعَلُونَ

it is He who accepts repentance from His servants and pardons bad deeds- He knows everything you do

أَلَمۡ يَعۡلَمُوٓاْ أَنَّ ٱللَّهَ هُوَ يَقۡبَلُ ٱلتَّوۡبَةَ عَنۡ عِبَادِهِۦ وَيَأۡخُذُ ٱلصَّدَقَٰتِ وَأَنَّ ٱللَّهَ هُوَ ٱلتَّوَّابُ ٱلرَّحِيمُ

Do they not know that it is God Himself who accepts repentance from His servants and receives what is given freely for His sake? He is always ready to accept repentance, most merciful

وَإِذۡ قَالَ مُوسَىٰ لِقَوۡمِهِۦ يَٰقَوۡمِ إِنَّكُمۡ ظَلَمۡتُمۡ أَنفُسَكُم بِٱتِّخَاذِكُمُ ٱلۡعِجۡلَ فَتُوبُوٓاْ إِلَىٰ بَارِئِكُمۡ فَٱقۡتُلُوٓاْ أَنفُسَكُمۡ ذَٰلِكُمۡ خَيۡرࣱ لَّكُمۡ عِندَ بَارِئِكُمۡ فَتَابَ عَلَيۡكُمۡۚ إِنَّهُۥ هُوَ ٱلتَّوَّابُ ٱلرَّحِيمُ

Moses said to his people, ‘My people, you have wronged yourselves by worshipping the calf, so repent to your Maker and kill [the guilty among] you. That is the best you can do in the eyes of your Maker.’ He accepted your repentance: He is the Ever Relenting and the Most Merciful

O you who have faith, repent to God with true repentance. “O believers, familiars, and friends, all of you repent! Come back to My threshold! Turn to Me! Though you have done what comes from you, I will do what comes from Me! Nobody accepts the defective except here. Come back! No threshold forgives sins but here. Seek shelter in Me! Come from the unkindly to the Lovingly Kind! Come from the pain of despair to hope! I have no fear of forgiving sins, come back! I am not ashamed to accept the defective, return!” Read the equivalent of this verse in “Be penitent toward your Lord” [39:54]. The station of penitence is higher than the station of repentance. Penitence is the servant's return to his Lord with heart and aspiration, and repentance is the servant's return from disobedience to obedience. What is penitence? Coming from the valley of hypocrisy on the feet of truthfulness to the valley

O you who believe! Repent to God with sincere repentance read nasūhan or nusūhan a truthful repentance so that one does not return to committing that sin again nor have the desire to return to it. It may be that your Lord ‘asā an expression denoting ‘a hope’ that will be realised will absolve you of your misdeeds and admit you into gardens orchards underneath which rivers flow on the day when God will not let down by admitting into the Fire the Prophet and those who believe with him. Their light will be running before them in front of them and it will be on their right. They will say yaqūlūna this denotes the beginning of a new syntactically independent sentence ‘Our Lord! Perfect our light for us towards Paradise — whereas the hypocrites their light will be extinguished — and forgive us Our Lord. Assuredly You have power over all things’.

It is for God to turn only toward those who do the ugly in ignorance and then soon turn. Those-God will turn toward them. And God is knowing, wise. Turning/repentance [tawba] is the mark of the road, the leader to the court, the key to the treasure, the intercessor of union, the head of every happiness, and the basis of freedom. First is regret in the heart, second apology with the tongue, and then cutting off from bad things and bad people. It has come in the report that when someone repents but does not put aside bad friends, he is not a repenter. When someone repents but does not put aside food and drink, he is not a repenter. When someone repents but does not put aside his bedclothes and empty his eyes of sleep, he is not a repenter. When someone repents but does not expend the wealth left over after food, he is not a repenter. The precondition of repentance is that you detach your h

This turning will not belong to those who keep on doing ugly deeds until death is present for one of them, and then he says: “Surely now I have turned.” In the tongue of learning, one must repent before death, even if it be one moment. In the tongue of practice, one must repent before the soul has the habit of seeing itself and worshiping itself. When someone is pleased with himself and gazes upon himself habitually, the door to repentance has been shut to him and the water of deliverance taken away from him. Quit being the companion of self-nurturing habit-worshipers! Kiss the dust beneath the feet of those who have disowned self! [DS 972] Not everyone who has repented in the road of the Shariah, thereby reaching pardon and forgive- ness, has reached truthfulness in love in respect of the Haqiqah. For a long time David the prophet wept and pleaded. At last it was said to him, “O David!

The repentance that God accepts that is the one which He has prescribed for Himself to accept out of His bounty is only of those who do evil an act of disobedience in ignorance bi-jahālatin a circumstantial qualifier in other words ‘they are ignorant’ while they are disobeying their Lord; then repent shortly thereafter before the last gasps of death; God will relent to those He will accept their repentance. And God is ever Knowing of His creatures Wise in what He does with them.

Repentance is not for those who do evil deeds sins until when death approaches one of them and the pangs of death begin he says upon witnessing his predicament ‘Indeed now I repent’ for this would not avail him and would not be accepted from him; neither for those who die disbelieving if they repent in the Hereafter upon seeing the chastisement it will not be accepted from them. Those — We have prepared for them a painful chastisement.

حَدَّثَنَا عَبَّاسُ بْنُ عَبْدِ الْعَظِيمِ الْعَنْبَرِيُّ، وَغَيْرُ، وَاحِدٍ، قَالُوا حَدَّثَنَا أَبُو دَاوُدَ الطَّيَالِسِيُّ، حَدَّثَنَا عِمْرَانُ الْقَطَّانُ، عَنْ قَتَادَةَ، عَنْ سَعِيدِ بْنِ أَبِي الْحَسَنِ، عَنْ أَبِي هُرَيْرَةَ، رضى الله عنه عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ لَيْسَ شَيْءٌ أَكْرَمَ عَلَى اللَّهِ تَعَالَى مِنَ الدُّعَاءِ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ حَسَنٌ غَرِيبٌ لاَ نَعْرِفُهُ مَرْفُوعًا إِلاَّ مِنْ حَدِيثِ عِمْرَانَ الْقَطَّانِ وَعِمْرَانُ الْقَطَّانُ هُوَ ابْنُ دَاوَرَ وَيُكْنَى أَبَا الْعَوَّامِ ‏.‏ حَدَّثَنَا مُحَمَّدُ بْنُ بَشَّارٍ، حَدَّثَنَا عَبْدُ الرَّحْمَنِ بْنُ مَهْدِيٍّ، عَنْ عِمْرَانَ الْقَطَّانِ، بِهَذَا الإِسْنَادِ نَحْوَهُ ‏.‏

Abu Hurairah narrated that:The Prophet said: “There is nothing more honorable with Allah [Most High] than supplication.”

حَدَّثَنَا أَحْمَدُ بْنُ مَنِيعٍ، حَدَّثَنَا مَرْوَانُ بْنُ مُعَاوِيَةَ، عَنِ الأَعْمَشِ، عَنْ ذَرٍّ، عَنْ يُسَيْعٍ، عَنِ النُّعْمَانِ بْنِ بَشِيرٍ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏"‏ الدُّعَاءُ هُوَ الْعِبَادَةُ ‏"‏ ‏.‏ ثُمَّ قَرَأََ ‏:‏ ‏(‏وقالَ رَبُّكُمُ ادْعُونِي أَسْتَجِبْ لَكُمْ إِنَّ الَّذِينَ يَسْتَكْبِرُونَ عَنْ عِبَادَتِي سَيَدْخُلُونَ جَهَنَّمَ دَاخِرِينَ ‏)‏ ‏.‏ قَالَ هَذَا حَدِيثٌ حَسَنٌ صَحِيحٌ ‏.‏ وَقَدْ رَوَاهُ مَنْصُورٌ وَالأَعْمَشُ عَنْ ذَرٍّ وَلاَ نَعْرِفُهُ إِلاَّ مِنْ حَدِيثِ ذَرٍّ ‏.‏ هُوَ ذَرُّ بْنُ عَبْدِ اللَّهِ الْهَمْدَانِيُّ ثِقَةٌ وَالِدُ عُمَرَ بْنِ ذَرٍّ ‏.‏

An-Nu`man bin Bashir narrated that:The Prophet said: “The supplication, is worship.” Then he recited: And Your Lord said: “Call upon me, I will respond to you. Verily, those who scorn My worship, they will surely enter Hell humiliated

وإن كان في معصية فمراقبته بالتوبة والندم والإقلاع والحياء والاشتغال بالتفكر

وأما النوع الرابع وهو المنجيات فهو التوبة والندم على الذنوب والصبر على البلاء والشكر على النعماء والخوف والرجاء والزهد في الدنيا والإخلاص والصدق في الطاعات ومحبة الله وتعظيمه والرضا بأفعاله والشوق إليه والخشوع والتواضع له

فإذا أراد أن يكتسب لنفسه أحوال التوبة والندم فليفتش ذنوبه أولا وليتفكر فيها وليجمعها على نفسه وليعظمها في قلبه

قال وشرائط التوبة ثلاثة الندم والإقلاع والإعتذار

فحقيقة التوبة هي الندم على ما سلف منه في الماضي والإقلاع عنه في الحال والعزم على أن لا يعاوده في المستقبل

فأما الندم فإنه لا تتحقق التوبة إلا به إذ من لم يندم على القبيح فذلك دليل على رضاه به وإصراره عليه وفي المسند الندم توبة

Gender differences in self-conscious emotional experience: a meta-analysis.: The self-conscious emotions (SCE) of guilt, shame, pride, and embarrassment are moral emotions, which motivate adherence to social norms and personal standards and emerge in early childhood following the development of self-awareness. Gender stereotypes of emotion maintain that women experience more guilt, shame, and embarrassment but that men experience more pride. To estimate the magnitude of gender differences in SCE experience and to determine the circumstances under which these gender diffe

Shame and the motivation to change the self.: A central question of human psychology is whether and when people change for the better. Although it has long been assumed that emotion plays a central role in self-regulation, the role of specific emotions in motivating a desire for self-change has been largely ignored. We report 2 studies examining people's lived experiences of self-conscious emotions, particularly shame, in motivating a desire for self-change. Study 1 revealed that when participants recalled experiences of shame, guilt, or em

An examination of the relationship between shame, guilt and self-harm: A systematic review and meta-analysis.: Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of S

Shame-proneness, guilt-proneness and anxiety symptoms: A meta-analysis.: There is a growing body of investigations showing that shame and guilt are important features of various psychological problems including anxiety disorders. This study quantitatively summarized the magnitude of the associations of shame and guilt with anxiety symptoms. We looked both at the associations with broader categories of anxiety symptoms (i.e., undifferentiated anxiety symptoms, trait and state anxiety), but also with symptoms specific to individual anxiety disorders. In most cases, sha

Shame, guilt, and posttraumatic stress symptoms: A three-level meta-analysis.: Existing empirical findings are inconsistent on the correlations of shame and guilt with posttraumatic stress symptoms (PTSS). This study aimed to quantitatively summarize the strength of the associations of shame and guilt with PTSS and explore potential moderators. Based on a three-level meta-analytic method, shame was positively correlated with PTSS, no matter whether the effects of guilt were controlled; guilt also had a positive correlation with PTSS, regardless of whether the effects of sh

Shame, guilt, and depressive symptoms: a meta-analytic review.: Recent theoretical and empirical work has facilitated the drawing of sharp conceptual distinctions between shame and guilt. A clear view of these distinctions has permitted development of a research literature aimed at evaluating the differential associations of shame and guilt with depressive symptoms. This study quantitatively summarized the magnitude of associations of shame and guilt with depressive symptoms. Two hundred forty-two effect sizes were obtained from 108 studies employing 22,411

The Limbic Brain, Moral Distress and Ethical Decision-Making in Nursing Practice.

Nursing practice unfolds at the intersection of the body's regulatory systems and the emotional and social realities of care. The paper examines how the limbic brain mediates between the body's internal environment, interoception, allostatic regulation and autonomic arousal, and the external social world shaped by hierarchy, norms, power and institutional pressures. It also explores how this mediating role influences moral perception and clinical decision-making. Drawing on Damasio's somatic marker hypothesis and contemporary work on affective neuroscience, I analyse the strengths and limitations of the claim that emotion is not opposed to reason but an essential element of it. I integrate the complementary neurocognitive perspectives of predictive processing, interoceptive inference and the neural architecture of moral emotion, with nursing ethics literature on moral distress, to show h…

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Moral Injury as a Wound of Meaning and Conscience: An Introductory Synthesis of Conceptual Foundations, Spiritual Dimensions, and Clinical Implications.

Moral injury (MI) refers to moral, relational, and existential suffering that may follow exposure to potentially morally injurious events (PMIEs), including violence, betrayal, systemic injustice, or interpersonal abuse. Although initially conceptualized within military contexts, moral injury has increasingly been documented across civilian, occupational, and clinical populations such as healthcare professionals, first responders, and humanitarian workers. Despite rapid growth in the literature, the construct remains theoretically fragmented and diagnostically undefined, complicating assessment and intervention. This narrative review synthesizes conceptual, empirical, and methodological literature on moral injury with particular attention to its psychological, moral, and existential dimensions. The literature suggests that moral injury is best understood as a multidimensional form of tra…

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Women's body image across resistance training modalities: A multidimensional mixed methods study.

Resistance training (RT) is recognized for its psychological benefits, including improvements in body image. However, RT encompasses diverse modalities that vary in emphasis on aesthetics, performance, and health, and little research has examined how these different modalities shape women's body image. This study examined women's body image across four RT modalities: Bodybuilding, CrossFit, Strength Sports, and General Health. A convergent mixed methods design was employed in a sample of 153 women (ages 18-40) who had at least six months of RT experience. Participants completed measures assessing positive (e.g., body appreciation, pride) and negative (e.g., shame, guilt, envy) body image and responded to open-ended questions targeting body image across perceptual, cognitive, emotional, and behavioral dimensions. Quantitative data were analyzed using ANOVAs and Chi-square tests to examine…

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Deepfake perpetrator conversation for adults with sexual abuse-related posttraumatic stress disorder: intervention development and multiple baseline study protocol.

Background: A conversation between a victim and a perpetrator of sexual abuse has the potential to reduce posttraumatic stress disorder (PTSD) symptoms in the victim. However, an actual conversation may not always be possible or feasible. Deepfake technology may offer a way to simulate a conversation in a clinical context. Therefore, a feasible, acceptable and potentially effective intervention protocol is required. Objective: We aimed to develop an intervention protocol for a deepfake victim-perpetrator conversation to be used in the treatment of patients with sexual abuse-related PTSD, that would be technologically, legally, ethically, and clinically feasible as well as acceptable. In addition, we aimed to design a single-case experimental design (SCED) multiple baseline study to evaluate its efficacy. Method: The intervention protocol was developed through an iterative multidisciplina…

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Problematic Pornography Use Among Indian Adults: Patterns, Preferences, Motives, Psychosocial Impacts, and Support Strategies.

Background: Problematic pornography use (PPU) is an emerging behavioral concern in the technological era with significant biopsychosocial impacts. While research on PPU has expanded globally, evidence from the Indian context remains scarce, particularly regarding comparisons between individuals with and without PPU and their motives, preferences, and psychosocial outcomes. Objectives: This study explored patterns, preferences, motives, psychosocial impacts, and support strategies to provide a better understanding of PPU and intervention planning in the Indian context. Methods: The study employed an online cross-sectional survey with 112 participants (ages 18-46; mean = 25.5, SD = 5.44; gender: 81.3% male, 16.1% female, 2.7% nonbinary) who had experienced pornography-related difficulties in the past six months. Data were collected using a sociodemographic datasheet, details of pornography…

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Religion, Faith, and Spirituality as Barriers and Facilitators to Antiretroviral Therapy Initiation Among People with HIV in Indonesia.

Indonesia is a country deeply rooted in religion, faith, and spirituality. These aspects significantly determine individuals' decision-making and behavior, including health care decisions. Given the suboptimal attainment of the HIV-cascade targets in the country, we conducted a study to explore the role of religion, faith, and spirituality on antiretroviral therapy (ART) initiation. Our study involved individual interviews with 67 participants recruited from community health centers, public hospitals, and private clinics, predominantly Muslim, including 17 untreated people with HIV (ART-naïve), 30 people with HIV on treatment (ART-experienced), and 20 HIV service providers. Findings revealed that many individuals perceived HIV as a godly punishment related to individual failure (prior risk-prone behaviors), generating shame, guilt, and stigma. Perceiving religion as punitive and unforgiv…

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Commanding with compassion: harnessing the potential of military chaplains within the NATO structure.

The purpose of this article is to foster a better general understanding of military chaplains within NATO by elucidating their roles, highlighting what distinguishes military chaplains from military medical (psychiatrists and psychologists), and offering general suggestions on how military commanders at the tactical (battalion) level can benefit from military chaplains. The context for this paper is the ongoing research conducted by NATO's Science and Technology Organization (STO) Human Factors and Medicine (HFM) Research Task Group (RTG) 352, titled "Moral Challenges in the Future Security Environment (FSE): Guidance for Leaders", which began in 2022 and will continue through 2025. The research methodology employed in this article is known as collaborative inquiry, which emphasizes a partnership between academic researchers in military chaplaincy and practitioners (i.e. military chaplai…

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Veterans' experiences of moral injury, treatment and recommendations for future support.

Introduction: Moral injury (MI) significantly impacts the lives of many UK military veterans however, there is a lack of manualised treatment to address the needs of this population. To develop future treatments that are acceptable and well tolerated, veterans should be consulted on their experiences of existing psychological treatments and suggestions for future treatments. Methods: 10 UK military veterans were interviewed about their experiences of receiving treatment for psychological difficulties after MI, and beliefs about core components of future treatments. Thematic analysis of these interviews were conducted. Results: 2 superordinate themes were identified: experiences of previous mental health treatment and perceptions of the proposed treatments. Reflections on cognitive behavioural therapy were mixed, with some describing that it did not ameliorate their guilt or shame. In fut…

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Promoting sexual well-being

INTRODUCTION The fundamental drive behind most feelings, thoughts, and behavior is sexuality. Sexuality influences the way an individual projects himself psychologically and socially, and it is determined by genetic, anatomical, physiological, and other biological characteristics, as well as sociocultural factors. Interpersonal relationships and developmental experiences also shape individual sexuality in a significant way. Sexuality includes the gender identity of a person, internal sexual representations including private thoughts and fantasies as well as manifest behavior with self and others. Our sense of humor, way of dressing, and way of talking are all influenced by sexuality. Neuropsychologist Karl Pribram described four drives that motivate us to accomplish our goals. These drives included feeding, fighting, fleeing, and sex. Physical and psychological health essentially needs t…

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Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment.

Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims' life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is …

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Moral injury: understanding Swedish veterans who are assessed but not diagnosed with PTSD.

This article is based on an interview study of 24 Swedish veterans who experienced deteriorating mental health and increased suffering without meeting the criteria for a PTSD diagnosis. With no clinical answers as to the cause of their deteriorating mental health, they have been thrown into a veteran's health limbo. The analysis was based on an inductive logic. A key finding of the analysis was a kind of deep-seated permanent moral conflict that could be conceptualized as moral injury. Such an injury can give rise to intense guilt, shame, anxiety, anger, dejection, bitterness, identity issues and more. The results section of the article details five different yet for the sample representative cases of moral injury and their implications. The notion of moral injury is linked to Mead's division of the self into an I and me, where me is the socially constructed part of the self that is char…

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Women's experience of infertility & treatment - A silent grief and failed care and support.

Infertility is one of the components of sexual and reproductive health and rights, but is not as widely addressed as pregnancy, birth, and contraception. Infertility is a global problem, and it is estimated that around 186 million individuals are affected worldwide. Infertility and infertility treatment impact on women's overall wellbeing including their mental, emotional, sexual and spiritual health. Anxiety and depression is prevalent in these women. This study sought to explore the experiences of women going through infertility and IVF in a global context. This study is a metasynthesis with a meta-ethnographic analysis design based on 19 qualitative research studies, including 503 women, focusing on women's experiences of infertility and IVF treatments. Three main themes were identified; the personal reproductive trauma, the impact of and on relationships, and being failed by the heal…

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Ethics and frontline nursing during COVID-19: A qualitative analysis.

Background: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. Research design: Qualitative analysis using a directed content methodology. Participants and research context: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations: Participant privacy and data conf…

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'There is trauma all round': A qualitative study of health workers' experiences of caring for parents after stillbirth in Kenya and Uganda.

Background: Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents' needs. However, very few studies have explored health worker's experiences in these settings. Aim: To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda. Methods: Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse-midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda, were interviewed. Data were analysed following Van Manen's reflexive approach. Results: Three main themes summarised participants' expe…

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RSA reactivity to parent-child conflict as a predictor of dysregulated emotion and behavior in daily life.

Background: Individual variability in tonic (resting) and phasic (reactivity) respiratory sinus arrhythmia (RSA) may underlie risk for dysregulated emotion and behavior, two transdiagnostic indicators that permeate most psychological disorders in youth. The interaction between tonic and phasic RSA may specify unique physiological profiles during the transition to adolescence. The current study utilized clinically referred youth (Mage = 12.03; s.d. = 0.92) to examine baseline RSA, RSA reactivity, and their interaction as predictors of dysregulated emotion and behavior in daily life. Method: Participants were 162 youth (47% female; 60% minority) in psychiatric treatment for any mood or behavior problem. RSA was assessed during three, 2-minute baselines and an 8-minute parent-child conflict discussion task. Dysregulated emotion and behavior were assessed during a 4-day ecological momentary …

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How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study.

Background: There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. Methods: Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. Results: While nurses sense a strong expectation to minimise the use…

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A qualitative study of minority ethnic women's experiences of access to and engagement with perinatal mental health care.

Background: Approximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessing appropriate perinatal mental health care. Aims: To explore minority ethnic women's experiences of access to and engagement with perinatal mental health care. Methods: Semi-structured interviews were conducted with 18 women who had been diagnosed with perinatal mental health difficulties and who were supported in the community by a specialist perinatal mental health service in South London, United Kingdom. Women who self-identified as being from a minority ethnic group were purposefully selected. Data were transcribed verbatim, uploaded into…

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'I can't cope with multiple inputs': a qualitative study of the lived experience of 'brain fog' after COVID-19.

Objective: To explore the lived experience of 'brain fog'-the wide variety of neurocognitive symptoms that can follow COVID-19. Design and setting: A UK-wide longitudinal qualitative study comprising online focus groups with email follow-up. Method: 50 participants were recruited from a previous qualitative study of the lived experience of long COVID-19 (n=23) and online support groups for people with persistent neurocognitive symptoms following COVID-19 (n=27). In remotely held focus groups, participants were invited to describe their neurocognitive symptoms and comment on others' accounts. Individuals were followed up by email 4-6 months later. Data were audiotaped, transcribed, anonymised and coded in NVIVO. They were analysed by an interdisciplinary team with expertise in general practice, clinical neuroscience, the sociology of chronic illness and service delivery, and checked by pe…

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Forgiveness: A Key Component of Healing From Moral Injury?

Service members and veterans can be exposed to potentially traumatic and morally injurious experiences (PMIEs) including participating in, witnessing, or failing to prevent an act(s) that transgresses their core beliefs. Violation of one's deeply held morals and values can be profoundly distressing and shatter one's sense of self at the deepest level. Relationships with self, others, the world, and for some, the Sacred, can also be fractured. Post-Traumatic Stress Disorder (PTSD) and/or Moral Injury (MI) can result. Left unresolved, MI can leave individuals struggling with guilt, shame, cognitive dissonance, and negative self-attributions. A holistic approach that addresses the psychological and spiritual harm associated with MI is warranted. We wonder if forgiveness can help individuals struggling with MI to address the harm caused by actions or inactions, release negative emotions, and…

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Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study.

Background: The COVID-19 pandemic and climate change are both significant and pressing global challenges, posing threats to public health and wellbeing. Young people are particularly vulnerable to the distress both crises can cause, but understanding of the varied psychological responses to both issues is poor. We aimed to investigate these responses and their links with mental health conditions and feelings of agency. Methods: We conducted an online survey between Aug 5 and Oct 26, 2020, targeting a diverse sample of young people (aged 16-24 years, n=530) in the UK. The survey was distributed using a combination of a survey panel (panel sample) and direct approaches to youth groups and schools who shared the survey with young people in their networks (community sample). We collected data on respondents' psychological responses to both climate change and the COVID-19 pandemic, their sens…

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The Psychological Distress of Food Insecurity: A Qualitative Study of the Emotional Experiences of Parents and Their Coping Strategies.

Background: Food insecurity increases the risks of diet-related chronic disease and mental health outcomes in low-income adults; however, the pathways underlying these associations have not been clearly identified. Chronic, psychological distress may represent an important pathway between food insecurity and health. Objective: To identify types of psychological distress, experiential descriptions, and the array of emotional responses and coping strategies specific to food insecurity among parents with children DESIGN: A phenomenological qualitative study using one-on-one, in-depth interviews. Participants and setting: Forty-eight adults (parents) were recruited from the San Francisco Bay Area in 2016-17. Eligibility criteria included any experience of household food insecurity over the past 12 months, having a child aged 7 to 14 years, and both parent and child with the ability to speak …

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Moral wounds run deep: exaggerated midbrain functional network connectivity across the default mode network in posttraumatic stress disorder.

Background: A moral injury occurs when a deeply held moral code has been violated, and it can lead to the development of symptoms of posttraumatic stress disorder (PTSD). However, the neural correlates that differentiate moral injury and PTSD remain largely unknown. Intrinsic connectivity networks such as the default mode network (DMN) appear to be altered in people with PTSD who have experienced moral injury. However, brainstem, midbrain and cerebellar systems are rarely integrated into the intrinsic connectivity networks; this is a critical oversight, because these systems display marked differences in people with PTSD and are thought to underlie strong moral emotions such as shame, guilt and betrayal. Methods: We conducted an independent component analysis on data generated during script-driven memory recall of moral injury in participants with military- or law enforcement-related PTS…

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Planning and designing a self-compassion intervention for family carers of people living with dementia: a person-based and co-design approach.

Background: This article describes the research activities undertaken to plan and design a self-compassion intervention for family carers of people living with dementia using a person-based and co-design approach. In providing this example, our aim is two-fold: to highlight the value of using qualitative research and co-design processes within intervention development; and to showcase systematic reporting of an intervention's early planning and design stages. Methods: A person-based and co-design approach informed the planning and design of the self-compassion intervention. In Stage 1, qualitative interviews were undertaken with 14 family carers of people living with dementia and 14 professional stakeholders. In Stage 2, intervention guiding principles were developed, psychological theory was incorporated, and six family carers of people living with dementia were engaged as co-designers.…

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Medical errors during training: how do residents cope?: a descriptive study.

Background: Physicians' self-perceived medical errors lead to substantial emotional distress, which has been termed the "second victim phenomenon." Medical errors during residency are associated with increased burnout and depression. It is important to know how residents cope with self-perceived medical errors and how they gain personal and emotional support in order to develop effective interventions. Objective: To assess the impact of self-perceived medical errors on residents' well-being, the range of coping strategies during training, and the extent of personal and institutional support. Methods: An online cross-sectional survey was administered via email in October 2018 to 286 residents across all specialties in a 548-bed single urban academic medical center. The survey covered three domains focusing on residents' most serious self-perceived medical error: (1) emotional response, (2…

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Mental Health Clinician Community Clergy Collaboration to Address Moral Injury Symptoms: A Feasibility Study.

Moral injury (MI) symptoms (guilt, shame, isolation) can be associated with military experiences. While a degree of overlap is recognized between MI and posttraumatic stress disorder (PTSD) symptoms, MI symptoms do not always respond to evidence-based treatments for PTSD. Mental Health Clinician Community Chaplain Collaboration (MC4) was delivered by community clergy to address MI symptoms through facilitation of forgiveness and community reintegration. Thirteen veterans participated and the results suggested that MC4 was generally feasible and acceptable. However, it is unlikely community clergy time could keep up with demand. Shifting intervention delivery to Department of Veterans Affairs (VA) chaplains will alleviate many barriers experienced in this feasibility study.

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