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

Dread and solace: Talking about perinatal mental health.

Perinatal mental health issues are a global public health challenge. Worldwide, it is estimated that 10% of pregnant women, and 13% of women who have just given birth, experience a mental disorder. Yet, for many reasons - including stigma, limited access to services, patients' lack of awareness about symptoms, and inadequate professional intervention - actual rates of clinical and subclinical perinatal mental health issues are likely higher. Studies have explored experiences such as postpartum depression, but few involve a wider-ranging exploration of a variety of self-reported perinatal mental health issues through personal narrative. We conducted 21 narrative interviews with women, in two Canadian provinces, about their experiences of perinatal mental health issues. Our aim was to deepen understanding of how individual and cultural narratives of motherhood and perinatal mental health c…

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Understanding the psychosocial impact of joint hypermobility syndrome and Ehlers-Danlos syndrome hypermobility type: a qualitative interview study.

Purpose: Little attention has been paid to psychosocial factors in Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome (hypermobility type). This study sought to identify the psychosocial impact by examining participants' lived experiences; and identify characteristics of effective coping. Materials and methods: Adults with Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome (Hypermobility Type) were invited to discuss their own lived experiences and the impact of the condition. All met recognized criteria for clinically significant joint hypermobility, and had a self-confirmed diagnosis. The transcripts were coded and analyzed using inductive thematic analysis. Results: Seventeen participants (14 women, 3 men) purposively selected to broadly represent different genders, ages and ethnicities. Analysis identified five key themes: healthcare limitations, a lack of awareness of Join…

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Physical Distancing Behavior: The Role of Emotions, Personality, Motivations, and Moral Decision-Making.

Objective: Physical distancing behavior (PDB) is a key disease prevention strategy for limiting the spread of COVID-19. In order to effectively encourage it among adolescents, it is necessary to understand the associated mental mechanisms. Health behavior theories suggest that emotions, personality, motivation, and moral disengagement could all play a role. On the basis of a longitudinal study, we investigated the importance of these factors in predicting PDB. Methods: The participants were 347 adolescents residing in Italy. Data were collected in four waves starting from 1 year before the pandemic. A structural equation model based on health behavior theory was tested. Results: After the COVID-19 national lockdown, adolescents experienced fewer positive emotions and more negative emotions compared with 1 year earlier. Nevertheless, these emotional changes, and adolescents' personality (…

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Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP.

This study aims to develop and assess the psychometric properties of a measure of moral injury (MI) symptoms for identifying clinically significant MI in health professionals (HPs), one that might be useful in the current COVID-19 pandemic and beyond. A total of 181 HPs (71% physicians) were recruited from Duke University Health Systems in Durham, North Carolina. Internal reliability of the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP) was examined, along with factor analytic, discriminant, and convergent validity. A cutoff score was identified from a receiver operator curve (ROC) that best identified individuals with significant impairment in social or occupational functioning. The 10-item MISS-HP measures 10 theoretically grounded dimensions of MI assessing betrayal, guilt, shame, moral concerns, religious struggle, loss of religious/spiritual faith, loss of mea…

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Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study.

Background: Knee osteoarthritis (OA) is a highly prevalent and debilitating condition. Exercise is a recommended treatment because of its effectiveness at improving pain and function. However, exercise is underutilized in OA management. Difficulty accessing health care has been identified as a key barrier to exercise uptake. Innovative and scalable methods of delivering exercise treatments to people with knee OA are needed. We developed a self-directed eHealth intervention to enable and encourage exercise participation. The effectiveness of this intervention on pain and function in people with knee OA is being evaluated in a randomized clinical trial. Objective: This study aimed to explore the attitudes and experiences of people with knee OA who accessed the self-directed eHealth intervention and the features perceived as useful to facilitate self-directed exercise. Methods: This was a q…

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Exploring transformative learning when developing medical students' non-technical skills.

Context: Non-technical skills (NTS) training should be incorporated into medical students' education and simulation-based approaches are often utilised to facilitate this. Such experiences have the potential to foster transformative learning by facilitating a reassessment of one's prior assumptions and a significant shift in one's outlook, referred to as the process of perspective transformation. The aim of this research was to explore how NTS training might facilitate transformative learning in final-year medical students. Methods: Following ethical approval, medical student volunteers from four medical schools (Aberdeen, Dundee, Edinburgh and Glasgow) participated in simulation sessions, were debriefed with an emphasis on NTS using a behavioural marker system and then took part in focus groups. Focus group discussions were semi-structured and questions were based on the phases of persp…

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Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy.

Objectives: Substance misuse during pregnancy can be harmful to the health of both mothers and infants. Existing recovery services or prenatal care for pregnant women with substance use disorders (SUD) in the U.S. and other countries typically fall short in providing the necessary specialized care women with SUDs need. Disclosure of substance misuse is one key factor in gaining access to specialized prenatal care; yet, barriers such as social stigma and internal shame and guilt lead many women to under-report any substance misuse during their pregnancy. This study sought to understand the process of how and why pregnant women with SUDs choose to disclose or not disclose their substance misuse to their providers when seeking prenatal care. Methods: Data were collected through interviews with N = 21 women with SUDs in the northeast U.S. whose young children had been exposed to opioids, coc…

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Stigmatization and Quality of Life in Patients with Psoriasis.

Introduction: Each dermatological condition associated with the presence of visible skin lesions can evoke the following psychological response of the patient: shame, anxiety, anger, or even depression. Psoriasis may additionally be a cause of social rejection, which significantly impairs a patient's private life and social functioning, and may contribute to stigmatization, alienation, and deterioration of their quality of life. The aim of the study was to determine the level of stigmatization and the quality of life of persons with psoriasis in relation to sociodemographic characteristics. Methods: The study, which included 166 patients with plaque psoriasis, was carried out with the 33-item Feelings of Stigmatization Questionnaire, Dermatology Life Quality Index (DLQI), and a dedicated sociodemographic survey. Results: Compared with women, men had higher stigmatization scores in the "F…

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The influence of individualistic and collectivistic morality on dementia care choices.

Background: If collectivistic-oriented family carers choose professional care for dependents with dementia, they risk being stigmatised as failing their obligation. This may influence dementia care choices. Research question: How may individualistic and collectivistic values influence choices in dementia care? Method: Qualitative design with in-depth interviews with a total of 29 nurses, 13 family members in Norway and the Balkans and 3 Norwegian dementia care coordinators. A hermeneutic content-focused analysis was used. Ethical considerations: Ethical approval was obtained from the Regional Ethics Committee for Research, South-Eastern Norway, and the nursing homes' leadership. Findings: Family domain reasons why institutionalisation of dependents with dementia was seen as a last resort: obligation towards family members, particularly parents; worry about other family members' reactions…

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Stress and perceived stigma among parents of children with epilepsy.

Purpose: The present study aimed at understanding the stress and perceived stigma among parents of children with epilepsy seeking treatment at a tertiary referral center for neurology in South India. Materials and methods: Parents of sixty children suffering from epilepsy in the age group of 4-15 years were interviewed to explore parental stress and perceived stigma. They were recruited consecutively over a period of 6 months in 2015. Tools administered were Childhood-Illness related Parenting Stress Inventory (Manford in J Neurol 264(8):1811-24, 2017) and the Parent Stigma Scale (Baca et al. in Value Health 13(6):778-786, 2010). Results: The mean age of parents was 37.2 years, and the majority of parents who used to bring their child to the hospital were male (71.7%) and educated up to the secondary/intermediate level (36%) and were from lower socio-economic status. The mean age of chil…

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Sex differences in mental health symptoms and substance use and their association with moral injury in veterans.

Objective: This study examines potential sex differences in 3 types of experiences (i.e., atrocities of war, cognitive and emotional changes from combat, and leadership failure or betrayal) that may result in moral injury (i.e., guilt, shame, inability to forgive one's self, inability to forgive others, and withdrawn behavior associated with these three types of experiences). In addition, we examine whether moral injury results in different associations with mental health and substance use outcomes for female versus male veterans. We expected more symptoms of depression and anxiety for women and more symptoms of hazardous alcohol use and drug abuse for men. Also, we examined sex as a moderator between moral injury and outcomes, expecting stronger relationships between moral injury and symptoms of depression and anxiety among women and stronger associations between moral injury and alcoho…

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Patient perspectives on the process and outcomes of psychiatric genetic counseling: An "Empowering Encounter".

Genetic counseling (GC) for individuals with mental illness (MI) has been shown to improve patient outcomes, such as increased empowerment and self-efficacy. However, we do not understand how the process of GC results in these improvements or what aspects of the process are critical. In this qualitative study, we explored the process and outcome of psychiatric GC from the patient's perspective. Ten Canadian adults with a diagnosed MI were interviewed prior to, and 1 month following, psychiatric GC. Interview transcripts were analyzed using Grounded Theory methodology and generated a theoretical framework that describes the process and outcomes of psychiatric GC from the patient's perspective. Participants described the counseling process to be an "empowering encounter" and identified specific attributes of the process and characteristics of the counselor that contributed to their empower…

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Moral injury and suicidality among combat-wounded veterans: The moderating effects of social connectedness and self-compassion.

Objective: Among combat veterans, moral injury (i.e., the guilt, shame, inability to forgive one's self and others, and social withdrawal associated with one's involvement in events that occurred during war or other missions) is associated with a host of negative mental health symptoms, including suicide. To better inform and tailor prevention and treatment efforts among veterans, the present study examined several potential risk (i.e., overidentification and self-judgment) and protective (i.e., self-kindness, mindfulness, common humanity, and social connectedness) variables that may moderate the association between moral injury and suicidality. Method: Participants were 189 combat wounded veterans (96.8% male; mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (n = 176, 93.1%) …

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Parental Burnout: When Exhausted Mothers Open Up.

Until recently, research conducted on parental exhaustion was exclusively concerned with parents of sick children. However, situations where exhaustion occurs as a result of being physically and emotionally overwhelmed by one's parental role in the absence of a child's condition is gaining increasing interest. The aim of our study was to give voice to exhausted mothers, in order to get a better understanding of what it means to be exhausted in relation with one's parental role, from the perspective of those who have experienced it. We referred to phenomenological interpretative analysis for methods of data collection and data analysis, and included five mothers who were each interviewed twice. Our analysis revealed a superordinate theme of fear, which was central in every aspect of the mothers' accounts of their experiences, from the fear to not be a good enough mother to the fear relate…

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"Opening a Door to a New Life": The Role of Forgiveness in Healing From Moral Injury.

For military veterans struggling with moral injury, forgiveness can become both an animating concern and a potential path to healing. In this perspective piece, we draw on our clinical work and research findings to examine why forgiveness matters to veterans who feel guilt and shame about their actions in war, what type of forgiveness is attainable and meaningful, and what role clinicians can play in facilitating forgiveness. We conclude by reflecting on the potential, as well as the limits and tensions, of forgiveness work in the context of military moral injury.

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The psychological structure of humility.

Psychological inquiry into humility has advanced considerably over the past decade, yet this literature suffers from 2 notable limitations. First, there is no clear consensus among researchers about what humility is, and conceptualizations vary considerably across studies. Second, researchers have uniformly operationalized humility as a positive, socially desirable construct, while dismissing evidence from lay opinion and theological and philosophical traditions suggesting that humility may also have a darker side. To redress these issues, we conducted the first comprehensive, bottom-up analysis of the psychological structure of humility. Here we report 5 studies (total N = 1,479) that involve: (a) cluster analysis and categorization of humility-related words, generated by both lay persons and academic experts; (b) exploratory and confirmatory factor analyses of momentary and disposition…

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'Scared of going to the clinic': Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities.

Background: Men who have sex with men (MSM), sex workers (SW) and people who use drugs (PWUD) are at increased risk for HIV because of multiple socio-structural barriers and do not have adequate access to appropriate HIV prevention, diagnosis and treatment services. Objective: To examine the context of access to healthcare experienced by these three 'Key Populations', we conducted a qualitative study in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province. Method: We carried out in-depth interviews to explore healthcare workers' perceptions, beliefs and attitudes towards Key Populations. Focus group discussions were also conducted with members of Key Populations exploring their experiences of accessing healthcare. Results: Healthcare workers described their own attitudes towards Key Populations and demonstrated a lack of relevant knowl…

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"The Less I Think About It, the Better I Feel": A Thematic Analysis of the Subjective Experience of Malignant Mesothelioma Patients and Their Caregivers.

Aim: A cancer diagnosis-and in particular a Malignant Mesothelioma (MM) one-breaks the somatopsychic balance of the individual, compromising the quality of residual life and giving rise to many negative emotions difficult to integrate and to elaborate (such as depression, fears, anxieties, hopelessness, guilt, shame, and rage). Several national and international guidelines acknowledged the importance of evaluating psychological and socio-relational features in MM patients and their caregiver. However, only few studies have investigated the subjective experience of MM patients and even less research has focused on the caregivers' experience. Thus, the aim of the present study is to investigate the lived experience of both MM patients and their caregivers, providing an in-depth comprehension of the psychological sequelae of the disease. Materials and Methods: Within a psychoanalytically-in…

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The NSSI Family Distress Cascade Theory.

Nonsuicidal self-injury (NSSI) is a complex behaviour and occurs most commonly during adolescence. This developmental period is characterized by the drive to establish an equilibrium between personal autonomy and connectedness with primary caregivers. When an adolescent self-injures, caregivers often experience confusion about how to react. Reports of feeling guilt, fear, and shame are common in the wake of learning about a child's self-injury. This cascade of negative feelings and self-appraisals may lead to hypervigilance and increased caregiver efforts to control the child's behaviour. The adolescent may experience this as an intrusion, leading to worse family functioning and increased risk of NSSI. This cascade is not well acknowledged or articulated in current literature. This article remedies this gap by presenting the NSSI Family Distress Cascade.

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Psychometric Properties of a Modified Moral Injury Questionnaire in a Military Population.

Moral injury (MI) results from perpetration of or exposure to distressing events, known as morally injurious events (MIEs), that challenge moral beliefs and values. Due to the type of involvement in recent military conflicts, many veterans report MIEs that may cause dissonance and, in turn, MI. Although two existing measures assess MIEs, neither currently assesses the defining characteristics of MI (i.e., guilt, shame, difficulty forgiving self and others, and withdrawal). The present study reports the initial psychometric test of a modified version (Robbins, Kelley, Hamrick, Bravo, & White, 2017) of the Moral Injury Questionnaire - Military version (MIQ-M; Currier, Holland, Drescher, & Foy, 2015) in a sample of 328 military personnel (e.g., veterans, National Guard/reservists, active duty members). The MIQ-M was modified to assess both MIEs and the defining characteristics of MI. Explor…

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An ecological momentary assessment of the effect of fasting during Ramadan on disordered eating behaviors.

Dietary restriction contributes to disordered eating (DE) behaviors and associated cognitions. However, it is unclear how these outcomes are impacted by dietary restriction for religious purposes, such as fasting observed by Muslims during Ramadan. Using ecological momentary assessment, this study assessed the impact of Ramadan fasting on DE behaviors and correlates. Muslim participants fasting during Ramadan (n = 28) and a control group of non-fasting participants (n = 74) completed baseline measures assessing demographic characteristics and eating pathology. A mobile phone application then prompted participants six times per day for seven days to self-report on dietary restriction efforts, body satisfaction, temptation to eat unhealthily, feelings of guilt or shame following food, and DE behaviors including bingeing, vomiting, and other purging behaviors (use of laxatives, diuretics, o…

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Perinatal depression in Nigeria: perspectives of women, family caregivers and health care providers.

Background: Perinatal maternal depression is common and undertreated in many sub-Saharan African countries, including Nigeria. While culture shapes the social determinants and expression of depressive symptoms, there is a dearth of research investigating these processes in African contexts. Methods: To address this gap, we conducted in-depth interviews with 14 women with perinatal depression, 14 of their family caregivers and 11 health providers, using the McGill Illness Narrative Interview as part of a larger trial of a stepped-care intervention. Interpretation of themes was guided by cultural constructivist and critical anthropological perspectives that situate perinatal depression in its complexity as a disorder that is embedded in webs of social relations and embodied practices. Results: Study respondents used idioms of distress that identified perinatal conditions that consist of so…

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Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events.

Objective: We investigated whether potentially morally injurious events (PMIEs) during a combat deployment may lead to PTSD through distinct pathways from danger-based events. We also examined the prevalence of perpetration-based PMIEs, during which service members behaved in ways that violated their own moral values, and betrayal-based PMIEs, during which personal moral expectations were violated by trusted others. Method: Using a sample of 867 active duty Marines from a single infantry battalion that engaged in heavy ground combat while deployed to Afghanistan, a structural equation model was built to examine the relationships between perpetration- and betrayal-based PMIEs, combat experiences, and peritraumatic dissociation reported at 1 month postdeployment, and guilt/shame, anger, and PTSD symptoms reported at 8 months postdeployment. Results: The relationship between betrayal-based …

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Effects of a Mindful Rational Living Intervention on the Experience of Destructive Emotions.

The objective of this study was to measure the effects of a 90-day mindful rational living (MRL) program on the experience of destructive emotions-anger, anxiety, depression, guilt-among a normal population in a pilot trial. The MRL program combines mindfulness meditation techniques with rational emotive behavior therapy (REBT) strategies. Participants were 17 adults who completed the MRL program. Participants completed pre- and post-intervention assessments, which included scales measuring anger, anxiety, depression, guilt, rumination, shame, and subjective happiness. As hypothesized, participants showed significant decreases in anger, rumination, anxiety, depression, and shame after participating in the MRL program. There were no significant increases in subjective happiness. Findings from this pilot study provide preliminary support for the potential utility of interventions that comb…

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Mothers' experience of not breastfeeding in a breastfeeding culture.

Aims and objectives: To describe women's experience of not breastfeeding in a breastfeeding culture. Background: Breastfeeding represents a fundamental cultural value in Norway and many other countries, and a mother may often have intense emotions about breastfeeding her child. Political and health authorities in many countries have given high priority to encourage breastfeeding among mothers. However, breastfeeding can be challenging and sometimes affects mothers' mental health and the joy of interaction. Design: Qualitative design. Methods: Individual semistructured interviews with 12 mothers. Qualitative content analysis was used to analyse the interviews. Results: Three main categories emerged from the data: (1) desire to adapt to Norwegian culture, (2) feeling as though one was breaking the law and (3) lack of and unbalanced information. The mothers in this study wanted to breastfee…

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