Self-directed moral emotion, its healthy and corrosive forms.
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226 to 250 of 547Mindfulness to Manage Moral Injury: Rationale and development of a live online 7-week group intervention for veterans with moral injury.
Background: Military service puts service members at risk for moral injury. Moral injury is an array of symptoms (e.g., guilt, shame, anger) that develop from events that violate or transgress one's moral code.
Objective: We describe adaption of in-person mindfulness training program, Mindfulness to Manage Chronic Pain (MMCP), to address symptoms of moral injury to be delivered live via the web. We discuss how we will assess benchmarks (i.e., recruitment, credibility and acceptability, completion rates, and adherence) of the Mindfulness to Manage Moral Injury (MMMI) program.
Methods: Aim 1: To develop and then adapt the MMCP program based on feedback from experts and veterans who took part in Study 1. Aim 2: To develop an equally intensive facilitator-led online Educational Support (ES) program to serve as a comparison intervention and conduct a run-through of each program with 20 vetera…
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Treatment for Moral Injury: Impact of Killing in War.
Purpose of review: Veterans who kill in war are at risk of developing negative mental health problems including moral injury, PTSD, spiritual distress, and impairments in functioning. Impact of Killing (IOK) is a novel, cognitive-behaviorally based treatment designed to address the symptoms associated with killing that focuses on self-forgiveness and moral repair through cultivation of self-compassion and perspective-taking exercises, such as letter writing, and active participation in values-driven behavior.
Recent findings: In a pilot trial assessing IOK, participants demonstrated a reduction in multiple mental health symptoms and improvement in quality-of-life measures, and they reported IOK was acceptable and feasible. Furthermore, trauma therapists have reported that moral injury is relevant to their clinical work, expressed a desire for additional training on the impact of killing,…
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Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review.
Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these cohorts have not been systematically explored, nor have the unique circumstances that may exist across countries been explored. Here, we sought to identify and compare, across the globe, potentially morally injurious or distressful events (PMIDEs) in HCWs and PSP during the COVID-19 pandemic. A scoping review was conducted to identify and synthesize global knowledge on PMIDEs in HCWs and select PSP. Six databases were searched, including MEDLINE, EMBASE, Web of Science, PsychInfo, CINAHL, and Global Health. A total of 1,412 articles were retrieve…
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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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The stigma associated with gestational diabetes mellitus: A scoping review.
Background: Gestational diabetes mellitus (GDM) affects an increasing number of pregnant women globally. Although studies have identified psychosocial ramifications associated with GDM, stigma in the form of experienced discrimination and self-blame and its consequences have received limited attention. Our objective was to examine the current evidence on stigma, as experienced among women with GDM, including the potential adverse consequences hereof.
Methods: A scoping review was conducted with citations retrieved from the databases MEDLINE, CINAHL, EMBASE and, PsycINFO. Studies published before 15 June 2022, when the search was conducted, were included.
Findings: We identified 1388 citations and included 44 in the review. We found that women with GDM may experience stigma in the form of overt discrimination from healthcare personnel and relatives, and in the form of internalised stigma,…
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Socio-Cultural Constraints in Protecting Child Rights in a Society in Transition: A Review and Synthesis from Oman.
In line with international best practice, the Arabian Gulf countries have ratified the Convention on the Right of the Child (CRC), which has some clauses on child abuse and neglect. The present discourse, made from within an Arabian Gulf society, specifically Oman, reviews the socio-cultural differences of the region and explores the potential regional challenges for effectively implementing the CRC mandated child protection legislation. The international best practices evolved for individualistic, "guilt-based" societies, which may need to be modified to suit the "shame-based" collective societies in the Arabian Gulf where the individual autonomy is overridden by that of the family and society. This may mean that the entire spectrum of child abuse may need to be studied in-depth, starting from what constitutes child abuse and neglect, the methods adopted for identifying cases, setting p…
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Bayuo J, Wong FKY (2021)reviewMEDLINE-indexed journal, not yet read by usBurns : journal of the International Society for Burn Injuries31 citations Issues and concerns of family members of burn patients: A scoping review.
Introduction: The issues and concerns that emerge in the families of burn patients have received minimal attention.
Objective: To map out what is known about the challenges facing the family members of burn patients.
Methods: The review followed the PRISMA Extension guidelines for scoping reviews and the review approach by Arksey and O'Malley to synthesize the available evidence. Twenty-six (26) papers from various database searches were identified and included in the review. The citation retrieval and retention methods are reported in a PRISMA statement.
Results: Although most of the studies included parents (n=21), the evidence suggests that the shared concerns of family members include taking on new roles, and psychosocial and financial issues. Uniquely, parents had to endure blame, shame and guilt; partners/spouses were faced with difficulties in re-establishing an emotional connecti…
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Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers.
Background: Public Safety Personnel (e.g., firefighters, paramedics, and police officers) are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger.
Objective: This scoping review was designed to identify the extant empirical research regardi…
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Treatment Interventions for Women With Alcohol Use Disorder.
Women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to access treatment than men with AUD. A literature review identified several barriers to women seeking help: low perception of a need for treatment; guilt and shame; co-occurring disorders; employment, economic, and health insurance disparities; childcare responsibilities; and fear of child protective services. Women entering treatment present with more severe AUD and more complex psychological, social, and service needs than men. Treatment program elements that may reduce barriers to AUD treatment include provision of childcare, prenatal care, treatment for co-occurring psychological problems, and supplemental social services. Research has suggested that outcomes for women are best when treatment is provided in women-only programs that include female-specific content. To date, research o…
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Maguen S, Price MA (2020)reviewMEDLINE-indexed journal, not yet read by usPsychological trauma : theory, research, practice and policy19 citations Moral injury in the wake of coronavirus: Attending to the psychological impact of the pandemic.
Moral injury is a helpful lens through which we can better understand and prepare for the downstream psychosocial impact faced by health care providers during the coronavirus pandemic. Moral injury is psychological weight caused by a transgression of one's own or shared morals and values and can manifest as guilt, shame, inability to self-forgive, demoralization, and, in the worst case, self-harming behaviors. Given the morally challenging and life-threatening decisions our health care workers need to make daily in the face of consistent and ongoing death and loss, it is important to prepare for moral injury and the psychological toll by offering psychological support early and as often as needed at both the personal and institutional level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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The Second Victim Phenomenon: How Are Midwives Affected?
Perinatal care providers are likely to encounter adverse events such as intrapartum emergencies, traumatic births, or maternal or fetal deaths. As a result of being directly or indirectly involved in an adverse event, health care providers can be considered second victims. The experience of the second victim phenomenon can lead to significant physical, psychological, and psychosocial sequelae that can negatively impact the provider's personal and professional life for either a short or long duration of time. When health care providers experience an adverse event, they may manifest symptoms of guilt, shame, blame, flashbacks, nightmares, insomnia, isolation, helplessness, and hopelessness, thereby becoming the second victim. Following an adverse event, health care providers who experience second victim phenomenon experience stages of recovery that influence subsequent professional and per…
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Stovall M, Hansen L, van Ryn M (2020)reviewMEDLINE-indexed journal, not yet read by usJournal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing52 citations A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident.
Background: To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post-traumatic stress disorder, and other trauma-related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one's self, in a high-stakes situation.
Objective: The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI.
Methods: A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electron…
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Understanding stillbirth stigma: A scoping literature review.
Background: The World Health Organization, and the 2011 and 2016 Lancet Stillbirth series as well as medical and scientific literature, have all called for stillbirth stigma to be reduced. However, few studies have explored or attempted to conceptualise the meaning of stigma in the context of stillbirth.
Aim: To explore the current knowledge surrounding stillbirth stigma, specifically the extent, type and experiences of bereaved parents.
Methods: A five-stage scoping review framework was utilised. A search of relevant databases (MedLine, EMBASE, PsychInfo, PsychArticles, and Ovid Emcare) was undertaken with several key words related to 'stillbirth' and 'stigma.' The reference lists of included studies were also searched.
Findings: A total of 23 resources met the inclusion criteria for this review. A thematic analysis regarding how stigma was conceptualised and/or experienced within resul…
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Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review.
Background: Moral injury (MI) involves distress over having transgressed or violated core moral boundaries, accompanied by feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. MI is often found in Veterans and Active Duty Military personnel with posttraumatic stress disorder (PTSD). MI is widespread among those with PTSD symptoms, adversely affects mental health, and may increase risk of suicide; however, MI is often ignored and neglected by mental health professionals who focus their attention on PTSD only. Methods: A review of the literature between 1980 and 2018 conducted in 2018 is presented here to identify scales used to assess MI. Databases used in this review were PsychInfo, PubMed (Medline), and Google Scholar. Search terms were "moral injury," "measuring," "screening," "Veterans," and "Active Duty Military." Inclusion criteria we…
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Suffering in Silence: Medical Error and its Impact on Health Care Providers.
Background: All humans are fallible. Because physicians are human, unintentional errors unfortunately occur. While unintentional medical errors have an impact on patients and their families, they may also contribute to adverse mental and emotional effects on the involved provider(s). These may include burnout, lack of concentration, poor work performance, posttraumatic stress disorder, depression, and even suicidality.
Objectives: The objectives of this article are to 1) discuss the impact medical error has on involved provider(s), 2) provide potential reasons why medical error can have a negative impact on provider mental health, and 3) suggest solutions for providers and health care organizations to recognize and mitigate the adverse effects medical error has on providers.
Discussion: Physicians and other providers may feel a variety of adverse emotions after medical error, including g…
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The Impact of Childhood Sexual Abuse on Women's Sexual Health: A Comprehensive Review.
Introduction: Childhood sexual abuse (CSA) has been identified as a potent risk factor for sexual dysfunction. Certain characteristics of the abuse experience, such as repeated abuse, appear to affect the risk of developing sexual dysfunction. Despite the robust findings that CSA can be detrimental to sexual function, there is little consensus on the exact mechanisms that lead to these difficulties.
Aim: To summarize the most up-to-date research on the relation between CSA and women's sexual function.
Methods: The published literature examining the prevalence of sexual dysfunction among women with CSA histories, various types of sexual dysfunctions, and mechanisms proposed to explain the relation between CSA and later sexual difficulties was reviewed.
Main outcome measures: Review of peer-reviewed literature.
Results: Women with abuse histories report higher rates of sexual dysfunction c…
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Fonzo GA (2018)reviewMEDLINE-indexed journal, not yet read by usNeurobiology of stress44 citations Diminished positive affect and traumatic stress: A biobehavioral review and commentary on trauma affective neuroscience.
Post-traumatic stress manifests in disturbed affect and emotion, including exaggerated severity and frequency of negative valence emotions, e.g., fear, anxiety, anger, shame, and guilt. However, another core feature of common post-trauma psychopathologies, i.e. post-traumatic stress disorder (PTSD) and major depression, is diminished positive affect, or reduced frequency and intensity of positive emotions and affective states such as happiness, joy, love, interest, and desire/capacity for interpersonal affiliation. There remains a stark imbalance in the degree to which the neuroscience of each affective domain has been probed and characterized in PTSD, with our knowledge of post-trauma diminished positive affect remaining comparatively underdeveloped. This remains a prominent barrier to realizing the clinical breakthroughs likely to be afforded by the increasing availability of neuroscie…
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Complications: acknowledging, managing, and coping with human error.
Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on …
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Scoping Review of the Mental Health of Parents of Infants in the NICU.
Objective: To synthesize and summarize evidence regarding the mental health of parents of infants in the NICU.
Data sources: Thirteen electronic databases were searched in October 2014 using the following terms individually and in combination: postpartum woman, mother, NICU, preterm birth, depression, anxiety, acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and parental stress.
Study selection: We examined the published research regarding the experiences of parents who have infants admitted to the NICU, the mental health problems that parents may develop, the tools that have been used to identify such problems, and factors related to parental mental health.
Data extraction: After the exclusion of articles according to preset criteria, we included 66 articles in the full review.
Data synthesis: Mental health issues are common in parents of infants in the NICU across div…
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Emotions and emotion regulation in posttraumatic stress disorder.
Posttraumatic stress disorder (PTSD) has been associated with negative emotions such as shame, guilt, anger, and disgust, as well as impairments in the ability to effectively regulate these emotional states. There is evidence showing that each of these negative emotions and emotion regulation difficulties are related to the severity of PTSD stemming from various trauma types. In contrast, much less is known about the temporal relationship between these features and PTSD. Studies have found that treatments for PTSD often lead to improvements in these negative emotions and in emotion regulation difficulties, but how these features impact the efficacy of various PTSD treatments is less clear.
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Psychological parameters of psoriasis.
Psoriasis is a chronic, inflammatory scaling dermatosis. The marked visible appearance of the lesions have a negative impact on body image that leads to decreased self-esteem, hence seriously compromising the patient's quality of life. The clinical picture critically affects the social well-being of the patient since the disease is commonly misunderstood and feared by the social environment as being contagious. The patient feels stigmatized and this further intensifies their lack of self-confidence and self-esteem. Feelings of shame and guilt increase the tendency toward suicidal ideation. The poor quality of life of psoriatic patients has been associated with excessive alcohol consumption, increased smoking and greater use of tranquilizers, sedatives and antidepressants. As far as mental impairment is concerned, a correlation has been found between psychological stress and the clinical …
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Noradrenaline effects on social behaviour, intergroup relations, and moral decisions.
Recent research has begun to elucidate the neural basis of higher order social concepts, such as the mechanisms involved in intergroup relations, and moral judgments. Most theories have concentrated on higher order emotions, such as guilt, shame, or empathy, as core mechanisms. Accordingly, psychopharmacological and neurobiological studies have investigated the effects of manipulating serotonin or oxytocin activity on moral and social decisions and attitudes. However, recently it has been determined that changes in more basic emotions, such as fear and anger, might also have a significant role in social and moral cognition. This article summarizes psychopharmacological and fMRI research on the role of noradrenaline in higher order social cognition suggesting that indeed noradrenergic mediated affective changes might play key - and probably causal - role in certain social attitudes and mo…
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Characteristics of binge eating disorder in relation to diagnostic criteria.
The objective of this review was to examine the evidentiary basis for binge eating disorder (BED) with reference to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) diagnostic criteria for BED. A PubMed search restricted to titles and abstracts of English-language reviews, meta-analyses, clinical trials, randomized controlled trials, journal articles, and letters using human participants was conducted on August 7, 2015, using keywords that included "binge eating disorder," DSM-5, DSM-IV, guilt, shame, embarrassment, quantity, psychological, behavior, and "shape and weight concerns." Of the 257 retrieved publications, 60 publications were considered relevant to discussions related to DSM-5 diagnostic criteria and were included in the current review, and 20 additional references were also included on the basis of the authors' knowledge and/or on a review of…
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Cognitive and emotional impairments in obsessive-compulsive disorder: Evidence from functional brain alterations.
There is a common agreement on the existence of dysfunctional cortico-striatal-thalamus-cortical pathways in OCD. Despite this consensus, recent studies showed that brain regions other than the CSTC loops are needed to understand the complexity and diversity of cognitive and emotional deficits in OCD. This review presents examples of research using functional neuroimaging, reporting abnormal brain processes in OCD that may underlie specific cognitive/executive (inhibitory control, cognitive flexibility, working memory), and emotional impairments (fear/defensive, disgust, guilt, shame). Studies during resting state conditions show that OCD patients have alterations in connectivity not only within the CSTC pathways but also in more extended resting state networks, particularly the default mode network and the fronto-parietal network. Additionally, abnormalities in brain functioning have be…
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Pratt SD, Jachna BR (2015)reviewMEDLINE-indexed journal, not yet read by usInternational journal of obstetric anesthesia49 citations Care of the clinician after an adverse event.
The past two decades has seen a growing understanding that health care leads to harm in a large number of patients. With this insight has come an understanding that clinicians who care for patients who are harmed experience an understandable and predictable emotional response. After an adverse event, medical care givers may experience a wide range of symptoms including anger, guilt, shame, fear, loneliness, frustration and decreased job satisfaction. These may be accompanied by physical signs of fatigue, sleep disturbances, concentration difficulties, tachycardia and hypertension. These clinicians have been referred to as the "second victims." While many clinicians recover relatively quickly from an adverse event, for some this syndrome can last for weeks, months or indefinitely. Some have even contemplated or completed suicide. Being involved in an adverse event or error may also negati…
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