Several legal scholars have recently argued that U.S. tort law’s physical-emotional distinction commits tort to the objectionable position of mind-body dualism, but they have not considered the distinction’s role as an aid to judicial cognition and decision-making. Drawing primarily on the law of negligent infliction of emotional distress, this essay argues that tort’s physical-emotional distinction is not a relic of mind-body dualism but a heuristic that judges have used to structure and simplify the difficult (...) but unavoidable task of drawing lines between legally cognizable and non-cognizable harm. The analysis has at least three normative implications: (1) users of tort’s physical-emotional distinction should clarify that they neither endorse dualism nor depreciate emotional harm; (2) because judicial expertise may not extend to the task of drawing lines between legally cognizable and non-cognizable harm, judicial performance in this area may be more adequate than critics suggest; and (3) although it may not be possible to determine the optimal way of drawing lines between legally cognizable and non-cognizable emotional harm, moral-philosophical tools such as Rawlsian and Scanlonian contractualism may be able to identify partial or pro tanto considerations for choosing among different ways of doing so. (shrink)

Many legal jurisdictions permit victims of targeted hate speech to sue for damages in civil courts. In the US plaintiffs may sue for damages using the tort of intentional infliction of emotional distress. Indeed, back in 1982 Richard Delgado proposed the introduction of a new tort of racial insult to handle such cases. In South Africa plaintiffs can use the delict of injuria. Although there have been some successful lawsuits, the tort of intentional infliction of (...) class='Hi'>emotional distress has been an unreliable means of recovering damages for psychological harms caused by targeted hate speech. One major obstacle to recovery in the US has been the tendency of courts to view the use of racial insults, for instance, as too ordinary or commonplace to count as ‘extreme and outrageous conduct’. Even Delgado’s tort of racial insult would not recognise as a cause of action the mere use of a racial insult; the insult must demean. But once again this opens up significant leeway for courts to treat many commonplace racial insults as non-demeaning. In South Africa the courts have interpreted the delict of injuria using the abstract test of whether the speech ‘impaired the plaintiff’s dignity’. The open-textured nature of this test has led courts to diverge in their understanding of the dignitary threat posed by almost identical forms of hate speech. In this article I argue that these two torts and one delict should be comprehensively rethought. At the level of theory, we should think of them as protecting people’s fundamental rights to human dignity and the expression of human dignity as well as people’s fundamental rights to civic dignity and confidence in their civic dignity. And, at the level of practice, courts should adopt what I am proposing as two new legal tests for degradation and humiliation as a way of interpreting and operationalising these two torts and one delict in cases of targeted hate speech. (shrink)

Emotion-processing impairment represents a risk factor for the development of somatic illness, affecting negatively both health-related quality of life and disease management in several chronic diseases. The present pilot study aims at investigating the associations between alexithymia and depression, anxiety, and HRQoL in patients with Hashimoto’s thyroiditis ; examining the association between these three psychological conditions together with HRQoL, and thyroid autoantibodies status as well as thyroid echotexture in patients with HT; and comparing the intensity of all these clinical psychological (...) features in patients with HT versus controls. Twenty-one patients with serologically or ultrasonographically verified HT and 16 controls with non-toxic goiter or postsurgical hypothyroidism were recruited for this study. Serum thyrotropin and free thyroxine, as well as thyroid autoantibodies, were assayed. Alexithymia, depression, anxiety, and HRQoL were assessed with Toronto Alexithymia Scale; Beck Depression Inventory, second edition; Hamilton Anxiety Rating Scale; and Health Survey Short-Form 36, respectively. A negative relationship between the difficulty to describe feelings and the cognitive component of depression was found. Besides, patients with seronegative HT had lower somatic anxiety than patients with HT who tested positive. Besides, no statistically significant difference was found between patients with HT and controls with regard to somatic anxiety. The present study suggests the relevance of alexithymia in patients suffering from HT, which may be intertwined with a possible state of underreported depression that is mainly expressed through physical complaints. Promoting the capability to describe and communicate feelings could contribute to psychological elaboration and coping with the disease and, consequently, to the improvement of self-management and perceived HRQoL. (shrink)

Background: Patients at the end-of-life and their families experience a strong emotional impact. The wellbeing of the patient at the end-of-life and their family caregiver are related. Aim: to explore the elements related with the emotional wellbeing of patients with and without cognitive impairment at the end-of-life and that of their primary family caregivers. Design: Cross- sectional study. Participants: data was collected from 202 patients at the end of life with different diagnosis (COPD, cancer and frail elderly) as (...) well as from their respective 202 primary family caregivers. Results: Structural equation models indicated that the emotional state of the patients was best predicted by their functional independence and the burden of their family caregivers. At the same time, the emotional state of the primary family caregiver was predicted by their burden and not by the cognitive state or the functional independence of the patient. Nevertheless, the burden of the family caregiver, which is the only variable predicting both the emotional state of the patient and that of the caregiver, was directly related with the functional independence of the patient and indirectly with the patient’s cognitive state. Conclusions: The burden of the family caregiver stands out as a key factor in the reduction of the emotional distress of patients at the end-of-life –whether or not they present significant cognitive impairment- and that of their family caregivers. (shrink)

The COVID-19 pandemic context put to test all adaptive skills of human beings around the world. In this disruptive context, a sample of 401 respondents, aged between 19 and 65 years old, were assessed using the Unconditional Self-Acceptance Questionnaire, the Cognitive Emotion Regulation Questionnaire, the Emotional Distress Profile and the Autonomy Questionnaire, from Cognitrom Assessment System. The main objectives of the study aimed at identifying the significant differences in emotional distress, coping mechanisms, autonomy and self-acceptance based (...) on gender and age as grouping variables, and the significant relationships between all these variables. Statistics show differences in behavioural and emotional autonomy between male and female, differences related to catastrophizing and blaming others as resilience mechanisms between male and female, differences in self-acceptance and positive assessment between young people and adults, and significant negative correlations between emotional distress and all types of autonomy, significant positive correlation with coping mechanisms like blaming others, catastrophizing, self-blame and acceptance, and significant negative correlation with positive assessment and refocusing on planning. All results are discussed in the context of the disruption caused by the pandemic context and in relationship with the necessity of supporting people to maintain their mental health and well-being, now more than ever, with the new turning back to the previous way of life caused by the lifting of the state of alert by the authorities. (shrink)

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the (...) healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

_Background:_ Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. _Objective:_ To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of service satisfaction (...) at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. _Methods:_ The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. _Results:_ At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the “Tension” dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions “Relatives' Involvement” and “Professionals' Skills and Behavior.” _Conclusions:_ The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

ObjectiveApproximately half of all people living with amyotrophic lateral sclerosis experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, (...) and current level of physical functioning.DesignIn a cross-sectional design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.Main Outcome MeasuresQuestionnaires assessed emotional distress, physical functioning, repetitive negative thinking, metacognitive beliefs, and demographic factors.ResultsMaladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.ConclusionsThese data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches. (shrink)

Criminal law theorists overwhelmingly agree that for some conduct to constitute punishment, it must be imposed intentionally. Some retributivists have argued that because punishment consists only of intentional inflictions, theories of punishment can ignore the merely foreseen hardships of prison, such as the mental and emotional distress inmates experience. Though such distress is foreseen, it is not intended, and so it is technically not punishment. In this essay, I explain why theories of punishment must pay close attention (...) to the unintentional burdens of punishment. In two very important contexts — punishment measurement and justification — we use the term “punishment” to capture not only intentional harsh treatment but certain unintentional harsh treatment as well. This means that the widely accepted view that punishment is an intentional infliction requires substantial caveats. It also means that any purported justification of punishment that addresses only the intentional infliction of punishment is woefully incomplete. -/- [This paper has been published under a Creative Commons Attribution-NonCommercial-ShareAlike license.]. (shrink)

IntroductionAnimal Assisted Interventions are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents.ObjectivesThe aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of (...) satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed.MethodsAll published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations.ResultsOf the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal.ConclusionAlthough further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993]. (shrink)

An emerging literature has begun to document the emotional consequences of everyday executive functions on emotional distress. Little is known, however, about whether this relation is mediated by other variables. A multiple mediation model was proposed to integrate core concepts of daily executive dysfunctions with emotional distress in order to increase understanding of their relationship to psychological well-being and emotional regulation. The working hypothesis was that dimensions of well-being and emotional regulation may be (...) a suitable mediator. It was hypothesized that dimensions of well-being and emotional regulation are a possible mediator between the executive dysfunctions and psychological distress. Participants were 122 undergraduate students from university courses in General Education and Social Education at, the Universidad Complutense de Madrid, with a mean age of 21.76. Results indicate that several dimensions of psychological well-being and emotional reappraisal strategies mediate the relationships between daily executive dysfunctions and psychological distress. Implications of these data are discussed. (shrink)

Storytelling pivots around stance seen as a window unto emotion: storytellers project a stance expressing their emotion toward the events and recipients preferably mirror that stance by affiliating with the storyteller’s stance. Whether the recipient’s affiliative stance is at the same time expressive of his/her emotional resonance with the storyteller and of emotional contagion is a question that has recently attracted intriguing research in Physiological Interaction Research. Connecting to this line of inquiry, this paper concerns itself with storytellings (...) of sadness/distress. Its aim is to identify factors that facilitate emotion contagion in storytellings of sadness/distress and factors that impede it. Given the complexity and novelty of this question, this study is designed as a pilot study to scour the terrain and sketch out an interim roadmap before a larger study is undertaken. The data base is small, comprising two storytellings of sadness/distress. The methodology used to address the above research question is expansive: it includes CA methods to transcribe and analyze interactionally relevant aspects of the storytelling interaction; it draws on psychophysiological measures to establish whether and to what degree emotional resonance between co-participants is achieved. In discussing possible reasons why resonance is (not or not fully) achieved, the paper embarks on an extended analysis of the storytellers’ multimodal storytelling performance (reenactments, prosody, gaze, gesture) and considers factors lying beyond the storyteller’s control, including relevance, participation framework, personality, and susceptibility to emotion contagion. (shrink)

Differences in empathic abilities between acting, dance, and psychology students were explored, in addition to the appropriateness of existing empathy measures in the context of these cohorts. Students (N= 176) across Higher Education Institutions in the United Kingdom and Europe were included in the online survey analysis, consisting of the Reading the Mind in the Eyes (RME) test, the Interpersonal Reactivity Index (IRI), the Empathy Quotient (EQ), and the E-drawing test (EDT), each measuring particular facets of empathy. Based on existing (...) evidence and our understanding of the discipline practices, we predicted that acting students would perform the best at identifying people’s emotional expressions but might lack other cognitive or affective empathy skills, particularly those related to emotional reactions. This cohort thus provides an opportunity to evaluate different empathy measures. While actors showed significantly higher RME scores than dancers, the difference between actors and psychologists was marginal. Moreover, actors’ scores did not differ significantly on other empathy measures, such as their concern for others’ emotional wellbeing or fantasy, both measured by IRI subscales. Psychology students scored highest in the IRI perspective taking subscale and the data supported anecdotal evidence that psychologists were more concerned for others’ emotional wellbeing than dancers or actors. Dancers seemed the least concerned with others’ perspectives and emotional states, which we explained through a somatosensory ‘inward’ focus required by their art form. Nevertheless, compared to the general population, our groups reported higher empathic abilities on all IRI subscales except for personal distress. Altogether, our study shows that the RME, the IRI, and the EDT vary in their susceptibility to different facets of empathic abilities in acting, dance, and psychology students whereas the EQ does not. Emotions can be expressed and perceived through language, facial expressions, or behavior. As many empathy tests focus on one type of signal they might miss other strategies. Where empathy tests are applied to individuals that have a predominance to read or respond to others in a particular way, as we showed through these three disciplines, they might not capture these empathic strategies. We thus propose that empathy tests must evolve by means of integrating varied forms of communication. (shrink)

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one’s under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.

Adopting an ecological perspective on children’s functioning and psychological well-being, we investigated the association between agency and life satisfaction, and its bearing on trauma symptoms and negative emotions in a group of Bedouin children living in the occupied Palestinian territories. Specifically, we hypothesized that the more children were agentic, the more they would be satisfied with their lives; and that greater life satisfaction would be associated with reduced trauma symptoms. A sample of 286 Bedouin children attending primary schools in four (...) different villages in the Jordan Valley completed the Multidimensional Students’ Life Satisfaction Scale (MSLSS), Positive Affect and Negative Affect Scale for Children (PANAS-C), Children’s Impact of Event Scale (CRIES-13), and the Children’s Hope Scale (CHS). Structural equation modelling was performed to evaluate the cumulative network of direct and indirect effects between children’s agency, life satisfaction, and trauma symptoms. The findings confirmed the key role of life satisfaction in mitigating traumatic reactions. Higher levels of life satisfaction were associated with reduced negative emotions and trauma symptoms, suggesting that agency may be viewed as a pre-determining factor with the potential to protect children from trauma symptoms. We discuss the implications for research and clinical practice. (shrink)

The coronavirus disease imposes an unusual risk to the physical and mental health of healthcare workers and thereby to the functioning of healthcare systems during the crisis. This study investigates the clinical knowledge of healthcare workers about COVID-19, their ways of acquiring information, their emotional distress and risk perception, their adherence to preventive guidelines, their changed work situation due to the pandemic, and their perception of how the healthcare system has coped with the pandemic. It is based on (...) a quantitative cross-sectional survey of 185 Swiss healthcare workers directly attending to patients during the pandemic, with 22% of them being assigned to COVID-19-infected patients. The participants answered between 16th June and 15th July 2020, shortly after the first wave of COVID-19 had been overcome and the national government had relaxed its preventive regulations to a great extent. The questionnaire incorporated parts of the “Standard questionnaire on risk perception of an infectious disease outbreak”, which were adapted to the case of COVID-19. Clinical knowledge was lowest regarding the effectiveness of standard hygiene. Knowledge of infectiousness, incubation time, and life-threatening disease progression was higher, however still significantly lower than regarding asymptomatic cases and transmission without physical contact. 70% of the healthcare workers reported considerable emotional distress on at least one of the measured dimensions. They worried significantly more strongly about patients, elderly people, and family members, than about their own health. Adherence to preventive guidelines by the government displayed patterns such that not all guidelines were followed equally. Most of the participants were faced with a lack of protective materials, personnel, structures, processes, and contingency plans. An increase in stress level was the most prevalent among the diverse effects the pandemic had on their work situation. Better medical equipment, better protection for their own mental and physical health, more personnel, more comprehensive information about the symptoms of the disease, and a system of earlier warning were the primary lessons to be learned in view of upcoming waves of the pandemic. (shrink)

This paper examines the development of medical technology in terms of Max Weber's theory of rationalization. It argues that medical technology is a part of the general process of social, political and economic changes in modern Western societies. Medical technology today keeps many people alive who, in the past, would have died from their illness. In recent years, burgeoning technological achievements in medicine have been regarded as a threat to the individual's freedom to die. Many people believe that the prolongation (...) of life only adds to the suffering of the patient and to the emotional distress of the family. They argue that a quiet death is preferable to the indignities inflicted by mechanical life support. This paper addresses these issues in light of Weber's theoretical arguments. (shrink)

Multiple moral emotions were examined from a dynamic motivational framework through two hypothetical dilemmas that originate from the cognitive-developmental research program in morality. A questionnaire based on recognition task measurement of moral motivation and emotions was administered to 546 college students. As part of the dynamic complexity of moral motivation, intrapersonal operation of multiple emotions were expected and found toward each emotion target in each judgment context. Compassion and distress were among the most important moral emotions. Relatively strong degrees (...) of anger and hate were reported toward the victimizers in ways that distinguished judgment choices. Participants distinguished a variety of positive emotions from anger and hate through differential associations with judgment choices. The study revealed orderly patterns of variability in the multiplicity of moral emotional experience based on relations with specific emotion targets, judgment choices, and developmental quality of moral motivation. The overall developmental quality of moral motivation was negatively associated with hate and positively associated with anger toward the victimizers. Emotional awareness was also found to be positively related to the developmental quality of moral motivation. Exploring the intrapersonal multiplicity of moral emotional experience has important implications for understanding the complexity of moral decision making and motivation. (shrink)

This article clarifies my current and seemingly ever-changing position on issues relating to emotions. The position derives from my differential emotions theory and it changes with new empirical findings and with insights from my own and others’ thinking and writing. The theory distinguishes between first-order emotions and emotion schemas. For example, it proposes that first-order negative emotions are attributable mainly to infants and young children in distress and to older individuals in emergency or highly challenging situations. Emotion schemas are (...) defined as emotion feelings interacting with cognition in motivating the decision making and actions of everyday life. (shrink)

This investigation examined how people’s beliefs about the functionality of emotion shape their emotional response and regulatory strategies when encountering distressing events. In Study 1, we present data supporting the reliability and validity of an 8-item instrument, the Help and Hinder Theories about Emotion Measure (HHTEM), designed to assess an individual’s beliefs about the functionality of emotion. Participants who more strongly endorsed a Help Theory reported greater wellbeing, emotional acceptance, and use of reappraisal to regulate emotion. Participants who (...) more strongly endorsed a Hinder Theory reported less wellbeing and more expressive suppression and substance use. In Study 2, we demonstrate that encouraging participants to view emotion as helpful affected their physiological and regulatory response to a distressing event. Participants in the Help Theory condition showed greater physiological reactivity (SCL) during a distressing film than control participants but were more accepting of their emotional response. Shortly after the film, SCL decreased for participants in the Help Theory condition. Compared to control participants, they engaged in less suppression and reported less lingering effect of the film on their mood. Together, these studies suggest that people’s theories about the functionality of emotion influence their reactivity, the strategies they adopt to regulate emotion, and their ability to rebound after distressing events. (shrink)

BackgroundVerbal autopsy is a pragmatic approach for generating cause-of-death data in contexts without well-functioning civil registration and vital statistics systems. It has primarily been conducted in health and demographic surveillance systems (HDSS) in Africa and Asia. Although significant resources have been invested to develop the technical aspects of verbal autopsy, ethical issues have received little attention. We explored the benefits and burdens of verbal autopsy in HDSS settings and identified potential strategies to respond to the ethical issues identified.MethodsThis research was (...) based on a case study approach centred on two contrasting HDSS in Kenya and followed the Mapping-Framing-Shaping Framework for empirical bioethics research. Data were collected through individual interviews, focus group discussions, document reviews and non-participant observations. 115 participants were involved, including 86 community members (HDSS residents and community representatives), and 29 research staff (HDSS managers, researchers, census field workers and verbal autopsy interviewers).ResultsThe use of verbal autopsy data for research and public health was described as the most common potential benefit of verbal autopsy in HDSS. Community members mentioned the potential uses of verbal autopsy data in addressing immediate public health problems for the local population while research staff emphasized the benefits of verbal autopsy to research and the wider public. The most prominent burden associated with the verbal autopsy was emotional distress for verbal autopsy interviewers and respondents. Moral events linked to the interview, such as being unsure of the right thing to do (moral uncertainty) or knowing the right thing to do and being constrained from acting (moral constraint), emerged as key causes of emotional distress for verbal autopsy interviewers.ConclusionsThe collection of cause-of-death data through verbal autopsy in HDSS settings presents important ethical and emotional challenges for verbal autopsy interviewers and respondents. These challenges include emotional distress for respondents and moral distress for interviewers. This empirical ethics study provides detailed accounts of the distress caused by verbal autopsy and highlights ethical tensions between potential population benefits and risks to individuals. It includes recommendations for policy and practice to address emotional and moral distress in verbal autopsy. (shrink)

Most researchers of emotions agree that although cognitive evaluations such as beliefs, thoughts, etc. are essential for emotion, bodily feelings and their behavioral expressions are also required. Yet, only a few explain how all these diverse aspects of emotion are related to form the unity or oneness of emotion. The most prevalent account of unity is the causal view, which, however, has been shown to be inadequate because it sees the relations between the different parts of emotion as external and (...) contingent. I argue that an adequate account of unity would require internal or conceptual relations between the aspects of emotion, and I suggest that such an account can be found in Aristotle's metaphysics and theory of emotion, and specifically, in his form and matter distinction. After I show that emotions are intentional pleasures and pains or distresses, I argue that the characteristic intentional pleasure and pain of an emotion, along with its other intentional elements , are the form of the emotion, whereas the bodily feelings are its matter. Form and matter constitute a conceptual unity, which cannot be accounted for in conglomeration accounts that see emotions as mixtures of different parts related only through efficient causation. (shrink)

These are strange and unprecedented times in the wake of the COVID-19 pandemic. Most frontline healthcare professionals have never witnessed anything like this before. As a result, staff may experience numerous and continuous traumatic events, which in many instances, will negatively affect their psychological well-being. Particularly, nurses face extraordinary challenges in response to shifting protocols, triage, shortages of resources, and the astonishing numbers of patients who require care in expedited time constraints. As most healthcare workers are passionate nursing professionals, frustration (...) and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. The overwhelming number of deaths, patients isolated and dying alone, and the ever-present fear of being infected and then infecting colleagues, family, friends due to the lack of protective gear or known protocols takes its toll on emotional and psychological well-being. For nurses, the experience of this significant (hopefully once-in-a-lifetime) event can inflict on-going moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Institutions must provide these resources to tend to the well-being of their healthcare staff, during and beyond the pandemic. This article aims to investigate moral distress—considering it as a moral injury—and offer tools and recommendations to support healthcare nurses as they respond to this crisis and its aftermath. (shrink)

We examined the role of emotion- versus fact-focused conversations in the details children reported about a stressful event and whether the details provided were prompted or spontaneously offered. We also tested how these conversational strategies, in conjunction with children’s emotion regulation skills, influenced children’s event-related distress. Children (N = 100 8- to 13-year-olds) experienced a stressor in the laboratory and were randomly assigned to participate in a fact-focused conversation (prompted about objective event elements) or an emotion-focused conversation (prompted about (...) subjective reactions to the event) with an unfamiliar adult. Caregivers reported on children’s emotion regulation skills. Children reported more overall prompted and spontaneous details in the fact-focused condition, but reported proportionally more spontaneous details than prompted detail in the emotion-focused condition compared to the fact-focused condition. Children with lower emotion regulation skills found the emotion-focused conversation (but not the fact-focused conversation) about the laboratory stressor significantly less distressing than children with high emotion regulation skills (when controlling for initial distress about the task). We propose that combining both fact- and emotion-focused conversational techniques may be most effective for encouraging detailed disclosures from children and for providing a respite from distress for children with emotion-regulation difficulties. (shrink)

In this work, on the one hand, we examined the relationship between emotional intelligence (EI) and empathy and, on the other, the relationship between emotional intelligence and nonverbal sensitivity, through two independent studies. The first study analyzed the relationship between dimensions of emotional intelligence and aspects of empathy, in a sample of 856 participants who completed two measures of EI, the Trait Meta-Mood Scale (TMMS) and the Trait Emotional Intelligence Questionnaire (TEIQue), and a measure of empathy, (...) The Interpersonal Reactivity Index (IRI). The results showed a similar pattern of significant positive relations in all the EI domains with empathic Perspective-taking, and significant negative relationships with empathic Personal Distress, except for the EI domain of Attention, which had a positive relationship. Stepwise multiple regression analyses showed that the dimension that best predicted empathic Perspective-taking and Empathic Concern was the Emotionality Factor; whereas Attention best predicted empathic Fantasy; and the Self-Control Factor best predicted Personal Distress, although negatively. Gender emerged as a predictor of three empathic aspects, Fantasy, Empathic Concern, and Personal Distress, with women obtaining higher scores than men in all of them. Age was the only predictor of Fantasy, with a negative relationship. The second study involved 646 people who completed the same measures of EI as the participants of the first study and the Mini-Profile of Nonverbal Sensitivity (Mini-PONS). The results showed some significant relationships between EI dimensions and the channels and quadrants of the MiniPONS. Stepwise multiple regression analyses showed that very few EI dimensions predicted nonverbal sensitivity, with Attention obtaining the best result. Both gender and age emerged as predictors, some in unique cases, of channels, quadrants and of the total score of nonverbal sensitivity; age had a negative relationship, and women obtained higher scores than men. (shrink)

This article provides a brief overview of scholarship on gender differences in emotion and emotional well-being among adults in the United States, highlighting major substantive findings, methodological innovations, and theoretical developments that have emerged in the sociologies of emotion and mental health. Sociological research consistently finds that men report more frequent positive and less frequent negative feelings than women as well as gender differences in both the experience and expression of emotional distress. Sociologists attribute these gendered patterns (...) of emotion to the larger social, economic, and cultural context surrounding women and men. Overall, by identifying macro- and meso-level social causes of microlevel emotional processes, sociologists have made significant contributions to knowledge about gender differences in emotion and emotional well-being in the US. (shrink)

Background Moral distress is common in neonatal intensive care unit (NICU) nurses. Purpose The purpose of this study was to evaluate the relationships between NICU nurses’ moral foundations, moral emotions, and moral distress. Research design and method This is an observational cross-sectional self-report questionnaire study. Participants and research context One hundred and forty-two (24%) of 585 Level 3–4 NICU nurses completed pen-and-paper self-report measures of moral foundations (harm, fairness, ingroup, authority, and purity) (Moral Foundations Questionnaire-20), proneness to self-conscious (...) moral emotions (guilt and shame) (modified Personal Feelings Questionnaire-2), and moral distress (futile care, compromised care, and untruthful care) (modified Revised Moral Distress Scale). Ethical considerations Participation was voluntary and anonymous. The ethics committees of the participating hospitals approved the study protocol (HREC Reference: LNR/18/SCHN/316). Results Non-parametric statistical analyses showed medium to large correlations between moral foundations and moral emotions. Moral foundations and moral emotions had trivial to small correlations with moral distress. Using a liberal p-value of <.10 for statistical significance because of the small sample size, harm ( rs = 0.22) and fairness ( rs = 0.16) predicted futile care, ingroup predicted compromised care ( rs = 0.19) and untruthful care ( rs = 0.15), and purity predicted untruthful care ( rs = 0.15). Guilt-proneness predicted futile care ( rs = 0.15). Shame-proneness did not predict moral distress. Conclusion The correlations between moral foundations and moral emotions were significant. Moral foundations and guilt-proneness predicted one or more dimensions of moral distress. The smaller than expected effect sizes may have been owing to how moral foundations, moral emotions, and moral distress were conceptualized and measured, or to moral disengagement, including NICU nurses’ possible reluctance to countenance aversive but morally warranted feelings of guilt and especially shame. Understanding the nature of these relationships may complement the efforts of NICU administrators, educators, counsellors, and nurses themselves to mitigate moral distress. (shrink)

The coronavirus disease 2019 health crisis is strongly affecting the psychological well-being of the general population. According to a very recent literature, the imposed lockdown and social distancing measures have generated a series of negative outcomes, including fear of the future, anxiety, and somatization symptoms. Few studies have investigated the impact of the COVID-19 pandemic on the well-being of parents and children, and still fewer studies have assessed the relationship between the psychological health of parents and children. The present study (...) aimed at understanding the effect of parents’ psychological distress and verbal aggression on behavioral and emotional symptoms of children during the COVID-19 lockdown. Using an online survey administered in the first weeks of the lockdown in Italy, we explored the mediating effects of parent verbal hostility and child emotional symptoms on the relationship between parent distress and child hyperactivity/inattention in a sample of 878 Italian parents. Two hypotheses were proposed: parent distress would significantly predict child hyperactivity/inattention, and parent verbal hostility and child emotional symptoms would mediate the association between parent distress and child hyperactivity/inattention. The serial mediated model confirmed both hypotheses, suggesting that higher rates of psychological distress in parents were associated with higher levels of hyperactivity/inattention in children. Parent verbal hostility and child emotional problems were also found to positively mediate this relation. Our results may be used to improve sociopsychological interventions in the general population in the near future. They may also contribute to the clinical definition of therapeutic paths for parents and families. (shrink)

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for (...) emotional disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood, anxiety, obsessive–compulsive disorder, post-traumatic stress disorder, suicidality, and global distress. A total of 1,499 participants completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency ; and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive–compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents. (shrink)

Background The coronavirus disease (COVID-19) pandemic has implications for health professionals. Aim The aim of this study was to explain the relationship between emotional labor levels and moral distress in health professionals during the COVID-19 pandemic using the Structural Equation Modeling (SEM) technique. Research design A descriptive and cross-sectional study was adopted. Participants and research context Data were collected between 7 February and 7 March 2021. 302 health professionals who were not on leave (annual leave, sick leave, prenatal (...) and postnatal leave, etc.) at the time of the research and who volunteered to participate in the research were included. Research data were collected using a “Personal Information Form,” the “Emotional Labor Scale” and the “Moral Distress Thermometer.” Ethical considerations The Ethics Committee approved the study (dated 07.01.2021 and numbered 2021/1-3). The participants were informed of the study aim and written consent was obtained before completing the survey. Findings In the present study, the mediator role of emotional labor in the effect of providing service to a patient with COVID-19 and having had COVID-19 on moral distress was examined in health professionals and it was found that there was a correlation between providing service to a patient with COVID-19 and moral distress regardless of whether or not emotional labor had a role in this relationship. Conclusion In this study, the relationship between the level of emotional labor and moral distress in health professionals during the COVID-19 pandemic was evaluated with a structural equation model. (shrink)

Individuals’ beliefs about the malleability of emotions have been theorised to play a role in their psychological distress by influencing emotion regulation processes, such as the use of emotion regulation strategies. We conducted a meta-analysis to test this idea across studies with a focus on the relationships between emotion malleability beliefs and five distinct emotion regulation strategies: cognitive reappraisal, suppression, avoidance, rumination, and acceptance. Further, using two-stage meta-analytic structural equation modelling (TSSEM), we examined whether the emotion regulation strategies mediate (...) the cross-sectional relationship between emotion malleability beliefs and psychological distress across studies. Thirty-seven studies were included in the meta-analyses and 55 cross-sectional studies were included in the TSSEM. Results demonstrated that, across studies, emotion malleability beliefs were significantly associated with greater use of putatively helpful strategies (particularly with cognitive reappraisal) and less use of putatively unhelpful strategies (particularly with avoidance). The use of cognitive reappraisal and avoidance partially mediated the relationship between emotion malleability beliefs and psychological distress. These results highlight the importance of considering beliefs about the malleability of emotions in the context of emotion regulation. These findings suggest the potential role of emotion malleability beliefs in interventions for individuals with emotion regulation-related difficulties and psychological distress. (shrink)

Recent brain imaging studies using functional magnetic resonance imaging (fMRI) have implicated insula and anterior cingulate cortices in the empathic response to another’s pain. However, virtually nothing is known about the impact of the voluntary generation of compassion on this network. To investigate these questions we assessed brain activity using fMRI while novice and expert meditation practitioners generated a loving-kindness-compassion meditation state. To probe affective reactivity, we presented emotional and neutral sounds during the meditation and comparison periods. Our main (...) hypothesis was that the concern for others cultivated during this form of meditation enhances affective processing, in particular in response to sounds of distress, and that this response to emotional sounds is modulated by the degree of meditation training. The presentation of the emotional sounds was associated with increased pupil diameter and activation of limbic regions (insula and cingulate cortices) during meditation (versus rest). During meditation, activation in insula was greater during presentation of negative sounds than positive or neutral sounds in expert than it was in novice meditators. The strength of activation in insula was also associated with self-reported intensity of the meditation for both groups. These results support the role of the limbic circuitry in emotion sharing. The comparison between meditation vs. rest states between experts and novices also showed increased activation in amygdala, right temporo-parietal junction (TPJ), and right posterior superior temporal sulcus (pSTS) in response to all sounds, suggesting, greater detection of the emotional sounds, and enhanced mentation in response to emotional human vocalizations for experts than novices during meditation. Together these data indicate that the mental expertise to cultivate positive emotion alters the activation of circuitries previously linked to empathy and theory of mind in response to emotional stimuli.. (shrink)

Philosophers of criminal punishment disagree about whether infliction of punishment for negligence can be morally justified. One contending view holds that it cannot be because punishment requires culpability and culpability requires, at a minimum, advertence to the facts that make one’s conduct wrongful. Larry Alexander and Kim Ferzan are prominent champions of this position. This essay challenges that view and their arguments for it. Invoking a conceptual distinction between an agent’s being _blameworthy_ for an act and their _deserving punishment_ (...) (or suffering) for that act, it explains that an agent can be blameworthy for negligent conduct, and thus liable to reasonable blaming practices, even if negligence is not culpable, hence not sufficient to ground negative desert. Turning from conceptual inquiry to substantive questions of political morality, it then argues that a faulty actor’s lack of culpability does not render them immune from just punishment, but does significantly limit the severity of punishment that may be inflicted, for punishment should not be disproportionately severe relative to an agent’s culpability in relation to wrongdoing. (shrink)

Emotions are part of our culture ; particular emotions like resentment andguilt are part of specific cultural heritages. On the other hand, moral judgementsand imperatives have the appearance of objectivity. There lies - or so it seems -a conflict, even a contradiction. Statements like "Slavery is unjust" may beasserted, agreements may be reached concerning what they claim or express,and they may occur as antecedents in conditionals such as "If slavery is unjust,then it must be abolished". When it is claimed that (...) slavery is unjust or that it iswrong to harm others, it is thereby claimed that it is so objectively. We mean bythis (among other things) that it is so independently of the moral emotionsanyone may feel with respect to slavery or the infliction of pain.It will be argued here that there are grounds to believe that emotions must beevaluated cognitively and that they do have cognitive significance, value andcontent. In this cognitive or quasi-cognitive perspective, the appropriatecharacter of an emotion is akin to the truth of a proposition : just as the truth of aproposition may be evaluated in terms of the justifications we are able toprovide in its favour, the correctness of emotions may be evaluated relatively tocognitive bases and classes of available warrants. Some emotions may be ruledout as incorrect or inapproriate, just as some propositions may be rejected asunjustified or in need of a warrant. The parallel relies on the controversial notionof non-propositional forms of moral justification. The notion may be construedin a variety of ways, the most promising construals being, I believe, thoseprovided by the perceptual model.I shall focus on the following point. Moral judgements and imperatives areexpressed with the usual resources of natural languages. These typically includepredicates like "unjust" and "wrong", and deontic sentential operators like"must" and "should". Moral emotions, on the other hand, may be expressed bybodily movements and facial expressions. Although it may be argued thatemotions do not bear the cognitive marks of objectivity when expressed in thisway, there is no reason to think that a reformed language of ethics, i.e. a purelanguage of emotions, free of all the linguistic or symbolic marks of truth,assertability and objectivity, would thereby be free of normative input, or evenbe inadequate to express normative claims. I shall argue that once nonpropositionalforms of justifications are taken into account, the reformingstrategy of emotivists and neo-emotivists is indeed ineffective. (shrink)

Background Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. Objective This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany. Research design A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple (...) linear and logistic regressions, and Rasch analyses were performed. Participants and research context The invitation to participate was sent to every German home-care service ( n = 16,608). Ethical considerations The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Results A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. Conclusions To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector. (shrink)

Despite a staggering body of research demonstrating sex differences in expressed emotion, very few theoretical models (evolutionary or non-evolutionary) offer a critical examination of the adaptive nature of such differences. From the perspective of a socio-relational framework, emotive behaviors evolved to promote the attraction and aversion of different types of relationships by advertising the two most parsimonious properties ofreciprocity potential, or perceived attractiveness as a prospective social partner. These are the individual's (a)perceived capacityor ability to provide expedient resources, or to (...) inflict immediate harm onto others, and their (b)perceived trustworthinessor probability of actually reciprocating altruism (Vigil 2007). Depending on the unique social demands and relational constraints that each sex evolved, individuals should be sensitive to advertise “capacity” and “trustworthiness” cues through selective displays of dominant versus submissive and masculine versus feminine emotive behaviors, respectively. In this article, I introduce the basic theoretical assumptions and hypotheses of the framework, and show how the models provide a solid scaffold with which to begin to interpret common sex differences in the emotional development literature. I conclude by describing how the framework can be used to predict condition-based and situation-based variation in affect and other forms of expressive behaviors. (shrink)

What does it mean to say that an emotional response fits the situation? This question cannot be answered simply by specifying the core relational theme (loss or risk, say) associated with each emotion: we must also explain what constitutes an emotionally significant loss or risk. It is sometimes suggested that emotionally significant situations are those that bear on the subject’s interests or concerns. I accept that this claim is plausible for some emotional responses, and I propose a particular (...) way of interpreting it. I suggest that, for many emotions, emotional significance is determined by the subject’s likes and dislikes – that is, settled dispositions to find a certain situation pleasant or distressing. I contrast this account with other preference-based accounts and with an account that appeals to the subject’s interests. I argue that we should prefer the likes-based account to these rival views. (shrink)