Self-directed moral emotion, its healthy and corrosive forms.
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201 to 225 of 547Moral Injury: An Integrative Review.
Individuals who are exposed to traumatic events that violate their moral values may experience severe distress and functional impairments known as "moral injuries." Over the last decade, moral injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about moral injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about moral injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how moral injury might and might not respond to evidence…
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Never underestimate fears, blocks, and resistances: The interplay between experiential practices, self-conscious emotions, and the therapeutic relationship in compassion focused therapy.
Experiential practices are a core component of compassion focused therapy (CFT). Throughout the treatment process, the client's engagement with these practices may become blocked, resulting in a rupture in the therapeutic relationship. In these instances, the interplay between these experiential practices and the therapeutic relationship becomes an essential focus of therapy to repair the rupture, re-engage the client in the therapeutic process, and proceed with the CFT treatment plan. This paper presents the case of a man diagnosed with social anxiety disorder, with the presence of shame-based self-criticism, treated via 12 sessions of CFT. CFT was proceeding well until certain embodiment practices and chair work were introduced, at which point the client refused to continue and became disengaged in the session. The process of repair and re-engagement will be discussed from the perspect…
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Attachment and the Development of Moral Emotions in Children and Adolescents: A Systematic Review.
In recent years, the development of social and moral emotions (often associated to pro-social behaviors) has become the subject of increased research interest. However, the relation between these emotions and attachment is less studied. The present systematic literature review (PROSPERO: CRD42021247210) was designed to synthesize current empirical contributions that explore the link between attachment and the development of moral emotions (e.g., empathy, sympathy, altruism, and guilt) during childhood and adolescence. Article exclusion criteria included: studies with participants not living in natural contexts (e.g., institutionalized); studies on mental illness; qualitative research; research that does not reliably evaluate attachment or moral emotions; research on intervention programs; and non-peer-reviewed articles. Only 10 studies were found eligible. Results highlight a present foc…
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A test of Berggren's model of dental fear and anxiety.
Berggren's (1984) model of dental fear and anxiety predicts that dentally anxious individuals postpone treatment, leading to a deteriorating dental state and subsequently to fear of negative evaluations in relation to their oral condition. The present study aimed to test one of the core assumptions of this model, namely that deterioration of dental health status would mediate the effects of avoidance of dental care on self-reported fear of negative evaluation. Participants were 73 patients (mean age 38.5 yr) meeting the diagnostic and statistical manual of mental disorders - 4th edn - Text Revision (DSM-IV-TR) criteria of dental phobia. Variables in the theoretical model were operationalized with multiple measures. A series of Sobel tests indicated that mediation was present for the relationship between years of avoidance and fear of negative self-evaluation when dental health status was…
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Damage to the prefrontal cortex increases utilitarian moral judgements.
The psychological and neurobiological processes underlying moral judgement have been the focus of many recent empirical studies. Of central interest is whether emotions play a causal role in moral judgement, and, in parallel, how emotion-related areas of the brain contribute to moral judgement. Here we show that six patients with focal bilateral damage to the ventromedial prefrontal cortex (VMPC), a brain region necessary for the normal generation of emotions and, in particular, social emotions, produce an abnormally 'utilitarian' pattern of judgements on moral dilemmas that pit compelling considerations of aggregate welfare against highly emotionally aversive behaviours (for example, having to sacrifice one person's life to save a number of other lives). In contrast, the VMPC patients' judgements were normal in other classes of moral dilemmas. These findings indicate that, for a selecti…
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Exposure to combat incidents within military and civilian populations as possible correlates of potentially morally injurious events and moral injury outcomes among Israeli combat veterans.
Objectives: Exposure to potentially morally injurious events (PMIEs) is considered a necessary but insufficient determinant of moral injury (MI) outcomes. However, a question remains regarding possible acts and the necessary features of PMIEs that should be considered transgressive and might lead to MI psychopathological outcomes. We aim to examine the links between exposure to combat incidents within civilian Palestinian populations (CPPs), PMIEs and MI-related outcomes of posttraumatic stress disorder (PTSD) symptoms (PTSS), trauma-related guilt and shame. We also aim to explore the mediating roles of subjective perceptions of PMIEs in the relationship between exposure to combat incidents within CPP and MI-related outcomes among combat veterans.
Method: A volunteer sample of 716 Israeli combat veterans responded to self-report questionnaires in a cross-sectional design study.
Results: …
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The stigma perceived by people bereaved by suicide and other sudden deaths: A cross-sectional UK study of 3432 bereaved adults.
Objective: To test the hypothesis that perceived stigma scores in young adults bereaved by suicide are significantly higher than in young adults bereaved by other sudden deaths, whether blood-related to the deceased or not.
Methods: We conducted a cross-sectional study of all staff and students aged 18-40 at 37 UK higher educational institutions in 2010, and identified 3432 respondents who had experienced a sudden bereavement of a close contact since reaching the age of 10, either due to sudden natural causes, sudden unnatural causes, or suicide. We used multivariable regression to compare scores on the stigma, shame, responsibility and guilt subscales of the Grief Experience Questionnaire, adjusting for socio-demographic factors and pre-bereavement psychopathology.
Results: People bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; …
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Shame if you do--shame if you don't: women's experiences of infant feeding.
Emotions such as guilt and blame are frequently reported by non-breastfeeding mothers, and fear and humiliation are experienced by breastfeeding mothers when feeding in a public context. In this paper, we present new insights into how shame-related affects, cognitions and actions are evident within breastfeeding and non-breastfeeding women's narratives of their experiences. As part of an evaluation study of the implementation of the UNICEF UK Baby Friendly Initiative Community Award within two primary (community based) care trusts in North West England, 63 women with varied infant feeding experiences took part in either a focus group or an individual semi-structured interview to explore their experiences, opinions and perceptions of infant feeding. Using a framework analysis approach and drawing on Lazare's categories of shame, we consider how the nature of the event (infant feeding) and…
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Emotion regulation in children and adolescents.
Within the past two decades, an "affect revolution" [Fischer and Tangney, Self-conscious Emotions: The Psychology of Shame, Guilt, Embarrassment, and Pride 1995:3-22] in research has revolutionized the ways in which emotion processes have been conceptualized and subsequently studied. This review discusses the literature on emotion regulation (ER) in childhood and adolescence by first summarizing the trajectory of emotional development from infancy through adolescence, followed by a discussion of the biological and environmental influences on ER, and then a review of the literature linking ER to psychosocial functioning. The penultimate section offers practical suggestions for identifying ER difficulties in children and strategies for intervention efforts. Potential areas for future research conclude the review.
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Shahar B (2020)reviewMEDLINE-indexed journal, not yet read by usJournal of clinical medicine5 citations New Developments in Emotion-Focused Therapy for Social Anxiety Disorder.
Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning,…
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Case formulation in emotion-focused therapy.
Case formulation in emotion-focused therapy aids therapists to both conceptualize core emotion schemes and follow markers across therapy that signify tasks aimed at emotional transformation. The case formulation process will be illustrated in the successful case of Jina, a woman with a history of childhood emotional abuse who sought therapy for depression. The three stages of case formulation are co-constructed between client and therapist. In stage one, the therapist assesses her initial emotion processing style and listens as the emotion-based narrative unfolds. In stage two, the core emotion scheme and formulation narrative organize around feelings of shame of inferiority and attachment-related feelings of being rejected and unloved. Attendant secondary emotions of powerlessness, and unmet needs for validation emerge. Stage three evolves as the therapist follows process markers, promp…
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"You are already all you need to be": A case illustration of compassion-focused therapy for shame and perfectionism.
This paper presents the case of a 28-year-old woman diagnosed with major depressive disorder, with strong features of perfectionism, shame, and self-criticism, treated via 12 sessions of compassion-focused therapy (CFT). CFT is an integrative therapeutic approach that draws upon evolutionary psychology, attachment theory, and applied psychological processes from neuroscience, clinical and social psychology. The effectiveness of compassion focused approaches with perfectionism and self-criticism across a range of clinical disorders is becoming increasingly well-established. Given this mounting evidence, a four-phase, 12-session CFT treatment plan was developed for this case: (1-2) establishing the therapeutic relationship; (3-4) psychoeducation regarding the evolutionary model of compassion; (5-8) compassionate mind training and skills development; (9-11) working with perfectionism, shame…
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Developing a compassionate mind to enhance trauma-focused CBT with an adolescent female: a case study.
Background: Shame and disgust are often associated with posttraumatic stress disorder (PTSD) following interpersonal traumas such as sexual assault. It has been suggested that individuals with high levels of shame might do less well in standard cognitive behavioural (CBT) interventions.
Aims: To see whether applying compassion-focused therapy and developing a compassionate mind can enhance trauma-focused CBT in an adolescent with high levels of shame and disgust the way it has been shown to within the adult population.
Method: This single case study describes how trauma-focused CBT was enhanced by compassionate mind training. It details work using this approach with an adolescent female experiencing shame and disgust-based flashbacks. Treatment was provided for 20 sessions over 8 months. Symptoms of PTSD, depression and self-criticism, as well as the ability to self-soothe/reassure, were…
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Feldman M (2008)case reportMEDLINE-indexed journal, not yet read by usThe International journal of psycho-analysis3 citations Grievance: the underlying oedipal configuration.
In this paper the author describes some of the clinical features encountered in patients who seem to 'nurture' a persistent grievance. He gives clinical examples, and discusses the nature of the powerful underlying dynamics. He suggests that contained within the patient's grievance is a set of phantasies that constitute the expression of his fear and hatred of reality, particularly the reality of the oedipal situation, the child's relationship to the creative parental couple, which Money-Kyrle (1968, 1971) has characterised as an essential element of 'the facts of life'. The phantasies the patient has evolved serve to protect him from envy and jealousy, anxiety and guilt. The primitive oedipal phantasies on which the grievance rests also contribute to the excitement and gratification that are characteristic of the grievance. The analysis of the underlying state of mind helps to account f…
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Anxiety in youth with and without specific learning disorders: exploring the relationships with inhibitory control, perfectionism, and self-conscious emotions.
Introduction: Since early research on Specific Learning Disorders (SLD), their relationship with emotional issues have been recognized, although emotional factors have received less attention compared to the cognitive processes related with academic achievement.
Methods: This study aimed to investigate mechanisms that may increase vulnerability to generalized and social anxiety in youth with SLD, compared to their non-diagnosed peers. We examined cognitive factors (inhibitory control), personality traits (self-oriented, socially prescribed perfectionism), and self-conscious emotions (shame, guilt). The sample included 134 individuals aged 10 to 16, divided into two groups: 67 with SLD and 67 without diagnoses, matched by age, sex, and IQ. Participants completed questionnaires on anxiety, perfectionism, and selfconscious emotions, alongside an inhibitory control task.
Results: Findings re…
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Bourke M, Pila E (2023)MEDLINE-indexed journal, not yet read by usThe International journal of eating disorders4 citations Body-related self-conscious emotions, self-compassion, and dietary restraint in Canadian undergraduate university students: A multilevel mediation and moderation analysis.
Objective: Self-compassion has an inverse association with dietary restraint however, the mechanisms linking self-compassion and dietary restraint are not clear. This study aimed to determine to what extent self-compassion was inversely concurrently related to dietary restraint, indirectly through body-related self-conscious emotions, and to what extent trait self-compassion moderated the concurrent within-person association between body-related self-conscious emotions and dietary restraint.
Method: Data was collected from 224 Canadian university students who reported on trait self-compassion at baseline and body-related shame, guilt, envy, and embarrassment, and dietary restraint biweekly between November 2020 and August 2021.
Results: Results from a 2-1-1 multilevel mediation model showed that trait self-compassion was indirectly concurrently related to dietary restraint through body-r…
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"Oh no! What happened?" an investigation of parent-child conversations about self-conscious emotions.
Parents play an important role in socializing children's emotion understanding. Previous research shows that parents emphasize different aspects of emotion contexts depending on the discrete emotion. However, there is limited research on how parents and children discuss self-conscious emotions, such as embarrassment, guilt, and shame, and what socialization practices parents employ to elicit children's talk about these emotions. In this study, children (N = 166, 78 females, 88 males) ages 2-3 years (M = 2.46, SD = 0.26) and their parents (65.5% White, 10.2% Black, 17.5% Hispanic, 2.4% Asian American, and 5.4% other) from a large city in the Western United States discussed a wordless storybook depicting different female and male characters experiencing self-conscious emotions (embarrassment, guilt, shame, awe, and pride). Parents' and children's emotion talk and parents' questions were co…
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Impact of having a sibling with cancer or type I diabetes mellitus on psychopathology and self-conscious emotions in adolescents: a comparative study including controls.
Background: OBJECTIVE: Having a child diagnosed with cancer is stressful for the whole family and may cause significant psychological impact on parents and siblings. Chronic, life-altering diseases may also have similar effects in siblings due to the daily life changes in the family to accommodate the child with chronic disease. We investigated the impact of having a sibling with cancer or type 1 diabetes mellitus (T1DM) on the psychological features of adolescents, with particular focus on self-conscious emotions such as guilt and shame-which are associated with the development of psychopathologies.
Method: Sixty-four children who were siblings of patients diagnosed with cancer (CS group), 54 children who were siblings of patients diagnosed with T1DM (DMS group), and 200 adolescents with siblings who did not have any chronic disease (control group) were included in the study. The CS gro…
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Compliance and Self-Reporting During the COVID-19 Pandemic: A Cross-Cultural Study of Trust and Self-Conscious Emotions in the United States, Italy, and South Korea.
The coronavirus COVID-19 pandemic is an unprecedented health crisis. Many governments around the world have responded by implementing lockdown measures of various degrees of intensity. To be effective, these measures must rely on citizens' cooperation. In the present study, we drew samples from the United States (N = 597), Italy (N = 606), and South Korea (N = 693) and examined predictors of compliance with social distancing and intentions to report the infection to both authorities and acquaintances. Data were collected between April 6th and 8th 2020. We investigated the role of cultural orientations of horizontal and vertical individualism and collectivism, self-conscious emotions of shame and guilt related to the infection and trust in the government's action. Across all countries, vertical collectivism (VC) predicted stronger shame, whereas horizontal collectivism predicted stronger …
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The relationship between trauma, shame, and guilt: findings from a community-based study of refugee minors in Germany.
Background: The relationships between traumatic stress and self-conscious emotions, such as shame and guilt, remain to be fully explored, especially in refugees, who frequently are exposed to a multitude of stressors.
Objective: The aim of the present study was to investigate shame and guilt in refugee minors and to assess to what extent a greater cumulative exposure to traumatic stressors would result not only in more severe posttraumatic stress disorder (PTSD) symptoms but also in higher levels of shame and guilt.
Methods: Thirty-two male refugee minors, who were all below the age of 18 when they sought asylum in Germany, agreed to participate. At the time of the assessment, the age ranged from 11 to 20 years. Eighteen refugees had arrived without relatives in their host country ("unaccompanied minors"). In structured diagnostic interviews, a PTSD diagnosis was established using the UC…
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Blame and guilt - a mixed methods study of obstetricians' and midwives' experiences and existential considerations after involvement in traumatic childbirth.
Introduction: When complications arise in the delivery room, midwives and obstetricians operate at the interface of life and death, and in rare cases the infant or the mother suffers severe and possibly fatal injuries related to the birth. This descriptive study investigated the numbers and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns.
Material and methods: A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study with selected survey participants.
Results: The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existentia…
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Black sheep get the blues: a psychobiological model of social rejection and depression.
Major life events involving social rejection are strongly associated with onset of depression. To account for this relation, we propose a psychobiological model in which rejection-related stressors elicit a distinct and integrated set of cognitive, emotional, and biological changes that may evoke depression. In this model, social rejection events activate brain regions involved in processing negative affect and rejection-related distress (e.g., anterior insula, dorsal anterior cingulate cortex). They also elicit negative self-referential cognitions (e.g., "I'm undesirable," "Other people don't like me") and related self-conscious emotions (e.g., shame, humiliation). Downstream biological consequences include upregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, and inflammatory response. Pro-inflammatory cytokines play an important role in this proc…
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Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review.
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response …
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Post-Traumatic Stress Disorder in Unaccompanied Refugee Minors: Prevalence, Contributing and Protective Factors, and Effective Interventions: A Scoping Review.
In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review the current literature regarding PTSD in unaccompanied refugee minors (URM). The authors searched Ovid Medline, Embase, and Cochrane Library from 1 January 2008 through 15 January 2019. Thirty full texts were chosen that specifically studied unaccompanied refugee minors (URM). The results showed that URM had a prevalence of post-traumatic stress disorder (PTSD of 17-85% across the studies reviewed. There were numerous factors that contributed to PTSD, including cumulative stress and trauma, guilt, shame, and uncertainty about legal status. Protective factors included resilience, a trusted mentor, belongi…
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Denov M (2022)reviewMEDLINE-indexed journal, not yet read by usEuropean journal of psychotraumatology7 citations Encountering children and child soldiers during military deployments: the impact and implications for moral injury.
Background: During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Objective: This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings t…
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