It is estimated that one in ten U.S. adults suffers from chronic insomnia. If left untreated, chronic insomnia reduces quality of life and increases risk for psychiatric and medical disease, especially depression and anxiety. There are two forms of insomnia: secondary insomnia, in which it is comorbid with another condition such as psychiatric disorders, chronic pain conditions, or cardiopulmonary disorders, and primary insomnia, which does not coexist with any other disorder. This treatment program uses cognitive-behavioral (...) therapy methods to correct poor sleep habits. CBT has been proven in multiple studies to improve sleep hygiene by reducing time spent in bed before sleep onset, reducing time spent awake after first sleep onset, and increasing the quality and efficiency of sleep. Developed by the authors, this evidence based treatment can be used for both primary and secondary insomnia sufferers. Patients are first given information about healthy sleep and the reasons for improving sleep habits, then a behavioral program is developed to address that patient's specific sleep problems. Use of sleep logs, assessment forms, and other homework allows client and therapist to work together to develop an effective sleep regimen tailored specifically for each client. Finally, several sessions are dedicated to increasing compliance and problem-solving.TreatmentsThatWork represents the gold standard of behavioral healthcare interventions!BL All programs have been rigorously tested in clinical trials and are backed by years of researchBL A prestigious scientific advisory board, led by series Editor-In-Chief David H. Barlow, reviews and evaluates each intervention to ensure that it meets the highest standard of evidence so you can be confident that you are using the most effective treatment available to dateBL Our books are reliable and effective and make it easy for you to provide your clients with the best care availableBL Our corresponding workbooks contain psychoeducational information, forms and worksheets, and homework assignments to keep clients engaged and motivatedBL A companion website offers downloadable clinical tools and helpful resourcesBL Continuing Education Credits are now available on select titles in collaboration with PsychoEducational Resources, Inc. (shrink)

Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined (...) as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea. In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases. (shrink)

Gave 42 19-26 yr. old insomniac Ss placebo pills to take a few min. before going to bed. Some Ss were told that the pills would cause arousal, and others were told that the pills would reduce arousal. As predicted, arousal Ss got to sleep more quickly than they had on nights without the pills, presumably because they attributed their arousal to the pills rather than to their emotions, and as a consequence were less emotional. Also as predicted, relaxation Ss (...) got to sleep less quickly than usual, presumably because they assumed that their emotions were unusually intense since their arousal level was high even after taking an arousal-reducing agent. Results have relevance for S. Schachter's theory of emotions and H. Kelley's attribution theory. Pragmatically, findings suggest the feasibility of a therapy based on reattribution of symptoms, and indicate that traditional suggestion effect practices should be modified. (shrink)

Drawing on conservation of resources (COR) theory, this study examined the underlying mechanism through which workplace bullying (WB) affects employees’ life satisfaction via job-related anxiety and insomnia. Time-lagged data were collected at two points in time from 211 doctor interns working in various hospitals in Pakistan. Our results fully supported a proposed serial multiple-mediator model. Workplace bullying was indirectly related to life satisfaction via job-related anxiety and insomnia. This study provides evidence of a spillover effect as to (...) how workplace bullying increases employees’ job-related anxiety which in turn leads to insomnia resulting in reduced employees’ life satisfaction. The present study extends research on workplace bullying to display its theoretical as well as empirical effects on life satisfaction. It demonstrates that workplace bullying as an occupational and psychological stressor has multiple effects on employees’ life satisfaction through a serial mediation model in the context of a developing country. It further explains that workplace bullying not only affects an employee’s workplace behaviors but also extends to the employee’s overall life satisfaction. (shrink)

ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not (...) in patients with COMISA. We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

ObjectivesResearch has linked mindfulness to improved mental health, yet the mechanisms underlying this relationship are not well understood. This study explored the mediating role of emotion regulation strategies and sleep in the relationship between mindfulness and symptoms of depression, anxiety and psychological distress during the COVID-19 pandemic.MethodsAs detailed in this study’s pre-registration, a cross-sectional research design was used to investigate the impact of mindfulness on mental health and the mediating role of emotion regulation strategies and insomnia. A total of (...) 493 participants from the general population answered an online survey and were included in the final analysis. The online survey consisted of the short form of the Five-Facets Mindfulness Questionnaire, the Impact of Event Scale-revised, the Generalised Anxiety Disorder Scale, the Patient Health Questionnaire, the Emotion Regulation Questionnaire, the short form of the Rumination Response Scale, and the Insomnia Severity Index.ResultsStructural equation modelling revealed that mindfulness was related to lower symptoms of depression, anxiety and psychological distress, both directly and indirectly. Mindfulness was negatively associated with rumination and insomnia. As hypothesised, models revealed that the associations between mindfulness and depression, anxiety and psychological distress were significantly mediated by its negative associations with rumination and insomnia. Our findings also demonstrated that rumination was related to increased insomnia symptoms, which in turn was associated with increased mental health problems, indicating a mediated mediation. Mindfulness was also positively associated with cognitive reappraisal and negatively associated with suppression, which were, respectively, negatively and positively associated with depressive symptoms, and thus functioned as specific mediators of the association between mindfulness and depression.ConclusionOur findings suggest that rumination and insomnia operate transdiagnostically as interrelated mediators of the effects of mindfulness on mental health, whereas cognitive reappraisal and suppression function as specific mediators for depression. These insights emphasise the importance of targeting emotion regulation and sleep in mindfulness interventions for improving mental health. Limitations and implications for practice are discussed. (shrink)

The benzodiazepines can produce a wide variety of abnormal mental responses and hazardous behavioral abnormalities, including rebound anxiety and insomnia, mania and other forms of psychosis, paranoia, violence, antisocial acts, depression, and suicide. These drugs can impair cognition, especially memory, and can result in confusion. They can induce dependence and addiction. Severe withdrawal syndromes with psychosis, seizures, and death can develop. The short-acting benzodiazepines, alprazolam and triazolam , are especially prone to cause psychological and behavioral abnormalities. The sources of (...) data to support these observations and conclusions are discussed in regard to the scientific method. These adverse drug effects can wreck havoc in the lives of individuals and their families. (shrink)

ObjectiveTo investigate the effects of cell phone dependence on mental health among undergraduates during the COVID-19 pandemic and further identify the determinants that may affect their mental health in China.MethodsThe data were collected from 602 students at a medical school in Shanghai via an online survey conducted from December 2021 to February 2022. The Mobile Phone Addiction Index and Depression Anxiety Stress Scale were applied to evaluate CPD and mental health, respectively. Independent sample t-test and one-way analysis of variance were (...) employed to compare the means of continuous variables among categorical groups. Correlations between continuous variables were detected using Pearson's correlation analysis. Univariable and multivariable logistic regressions were employed to identify the determinants of mental health.ResultsAmong the 402 eligible students, 73.88% were women with an average age of 20.19 ± 2.36 years. On average, the DASS score was 32.20 ± 11.07, the CPD score was 36.23 ± 11.89, and the cell phone use duration was 7.67 ± 3.61 h/day. CPD was found to have a negative effect on mental health among college students in Shanghai. Additionally, cell phone use duration, age, being senior students, faculty-student relationship, insomnia, tobacco use, obesity, and life satisfaction were clarified as contributing factors to mental health among college students.ConclusionHigh degree of CPD could have a negative effect on college students' mental health, which might lead to some psychological problems. Appropriate actions and effective interventions are highly needed to prevent severe psychological injuries among college students in China. (shrink)

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA+ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, (...) respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA+ECT groups had markedly greater clinical response rate than controls on SAPS [72.7% and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3% and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% versus 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. (shrink)

Transcutaneous auricular vagus nerve stimulation, a non-invasive alternative to vagus nerve stimulation with implantable devices, has shown promise in treating disorders such as depression, migraine, and insomnia. Studies of these disorders with resting-state functional magnetic resonance imaging have found sustained changes in resting-state functional connectivity in patients treated with low frequency taVNS. A recent study has reported reductions in pain scores in patients with rheumatoid arthritis after a 12-week treatment of high-frequency sub-threshold taVNS. However, no studies to date have (...) examined the effects of high-frequency sub-threshold taVNS on rsFC. The objective of this study was to determine whether high-frequency sub-threshold taVNS induces changes in rsFC using seed regions from the cingulate cortex and insula, brain regions that play a key role in interoception and processing of pain. With a single-blind placebo-controlled repeated measures experimental design, rsfMRI scans were acquired before and after 15 min of either sub-threshold taVNS treatment or a sham control. Significant taVNS-related changes in functional connections to the cingulate cortex were detected between the anterior cingulate cortex and right superior temporal gyrus and between the midcingulate cortex and right inferior parietal lobule. In addition, significant changes in functional connections to the insula were detected between the posterior insula and right precuneus and between the anterior insula and right cuneus gyrus. These results suggest that high-frequency sub-threshold taVNS can lead to sustained effects on the rsFC of brain regions involved in interoception and processing of pain in a cohort of healthy subjects. This study lays the foundation for future rsfMRI studies of high-frequency sub-threshold taVNS in clinical populations. (shrink)

Little is known about how to generate plausible new scientific ideas. So it is noteworthy that 12 years of self-experimentation led to the discovery of several surprising cause-effect relationships and suggested a new theory of weight control, an unusually high rate of new ideas. The cause-effect relationships were: (1) Seeing faces in the morning on television decreased mood in the evening (>10 hrs later) and improved mood the next day (>24 hrs later), yet had no detectable effect (...) before that (0–10 hrs later). The effect was strongest if the faces were life-sized and at a conversational distance. Travel across time zones reduced the effect for a few weeks. (2) Standing 8 hours per day reduced early awakening and made sleep more restorative, even though more standing was associated with less sleep. (3) Morning light (1 hr/day) reduced early awakening and made sleep more restorative. (4) Breakfast increased early awakening. (5) Standing and morning light together eliminated colds (upper respiratory tract infections) for more than 5 years. (6) Drinking lots of water, eating low-glycemic-index foods, and eating sushi each caused a modest weight loss. (7) Drinking unflavored fructose water caused a large weight loss that has lasted more than 1 year. While losing weight, hunger was much less than usual. Unflavored sucrose water had a similar effect. The new theory of weight control, which helped discover this effect, assumes that flavors associated with calories raise the body-fat set point: The stronger the association, the greater the increase. Between meals the set point declines. Self-experimentation lasting months or years seems to be a good way to generate plausible new ideas. Key Words: breakfast; circadian; colds; depression; discovery; fructose; innovation; insomnia; light; obesity; sitting; standing; sugar. (shrink)

_Aims:_ Cognitive and behavioral treatments (CBT) for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT) may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related outcomes. (...) _Methods:_ The study used an observational cohort methodology. Participants were 252 patients (73.8% female) attending a 4-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibility. Pre- to post-treatment, and pre-treatment to follow-up measures were examined for statistically significant differences using paired samples t -tests. Secondarily, hierarchical multiple regression analyses were conducted to examine change in process measures in relation to change in treatment outcome. _Results:_ Participants showed statistically significant improvements (all p d = 0.45), sleep interference ( d = 0.61), and sleep efficiency ( d = 0.32). Significant improvements in insomnia severity and sleep interference were also observed at 9-month follow up. Small to medium effect sizes were observed across the sleep outcomes. Statistically significant changes were also observed on measures of psychological flexibility, and these improvements were significantly associated with improvements on sleep-related outcomes, independently contributing up to 19% of unique variance. _Conclusion:_ This study supports the potential usefulness of ACT-based treatments for chronic pain for addressing co-occurring sleep difficulties. Further research is needed to determine how to improve the impact of this treatment for co-morbid pain and sleep difficulties, possibly using a randomized-controlled trial design. (shrink)

Drawing on Levinasian concepts of sleep, insomnia, and the il y a, this paper examines the liminal states of insomnia and sleep within the Palestinian-Israeli conflict. Sleep and insomnia, being proximates of death as well as displacement and anonymous existence successively, are topics that have not, to the best of our knowledge, received any critical commentary within (post)colonial studies. This paper argues that the Israeli military occupation deprives Palestinians from sleep, casting them into the horror and anonymous (...) existence of insomnia which, like the Israeli occupation, signifies impervious dialogue and is a catalyst for both psychic and physical displacement. As the Israeli occupation deprives Palestinians of place and sleep, two terms in the words of Levinas recognised as intertwined, it is the ethical responsibility of Palestinians and Palestinian leaders to arm themselves with wakefulness so as to secure their homeland (place) and to fortify themselves against displacement and the horror of the night. Sleep reveals an ethical dimension when examined closely within the Israeli-Palestinian conflict due to its subtle proximity to death. Hence, we contend that falling asleep on the part of Palestinians is unethical due to its direct adverse effects, namely, displacement and death. (shrink)

Many prisoners in solitary confinement experience adverse psychological and physical effects such as anxiety, paranoia, insomnia, headaches, hallucinations and other perceptual distortions. Psychiatrists call this SHU syndrome, named after the Security Housing Units [SHU] of supermax prisons. While psychiatric accounts of the effects of supermax confinement are important, especially in a legal context, they are insufficient to account for the phenomenological and even ontological harm of solitary confinement. This paper offers a phenomenological analysis of the lived experience of space (...) in supermax confinement by drawing on Merleau-Ponty’s account of intercorporeal depth. I argue that the prolonged deprivation of concrete experiences of spatial depth in a shared world is a form of violence against the relational structure of embodied (inter)subjectivity, and that it threatens to undermine the prisoner’s capacity for a meaningful relation to the world, to others, and even to herself. Nevertheless, some prisoners have developed strategies for resisting this psychopathology of space. (shrink)

This paper examines the culture, the dynamics and the financial underpinnings that determine how medical research is being conducted on children in the United States. Children have increasingly become the subject of experiments that offer them no potential direct benefit but expose them to risks of harm and pain. A wide range of such experiments will be examined, including a lethal heartburn drug test, the experimental insertion of a pacemaker, an invasive insulin infusion experiment, and a fenfluramine "violence prediction" experiment. (...) Emphasis, however, is given to psychoactive drug tests because of the inherent ethical and diagnostic problems involved in the absence of any objective, verifiable diagnostic tool. Effort is made to provide readers comprehensive reference sources to evidence-based reports about the serious risks these drugs pose for adults and children so that the reader may judge whether the benefits (if any) outweigh the risks for children. The first ethical issue raised by these experiments is: did the severity of illness in these children justify their exposure to short and long-term risks? The ethics of the experiments will be evaluated by referring to existing codes of medical research ethics-the Nuremberg Code, the Declaration of Helsinki, and the federal Code of Regulations. The thirteen cases presented will demonstrate that children are being used in ever more speculative experiments, often in the absence of a therapeutic intent, but a significant chance for causing harm and / or discomfort. Some of the experiments were designed to explore the mechanisms of pathology and pharmacological interventions, or the response of neurological brain receptors to chemical provocation ("challenge"). Others were designed to test the safety or efficacy of new drugs, even to test these drugs on healthy children who were hypothesized to be "at risk." Children and adolescents have been subjected to "forced dose titration" experiments that induced a spectrum of severe adverse effects, including insomnia, extreme restlessness, agitation, (akathisia) and self-injurious behavior. FDA reports show that suicide is a significant issue in psychotropic drug trials-in pediatric trials the problem is even greater. The paper aims to demonstrate how the enactment of the Better Pharmaceuticals for Children Act (incorporated into the Food and Drug Administration Modernization Act, FDAMA), set in motion a radical shift in public policy by providing huge financial incentives to pharmaceutical companies to test new or patented drugs in children. Federal policy shifted from one aimed at protecting children by setting limits on permissible research risks, to a policy aimed at broadening the inclusion of children as test subjects. It will be shown how the FDA and the Department of Health and Human Services lifted regulatory restrictions to permit research involving greater than minimal risk to be conducted on healthy children, claiming that all children are potentially "at risk" of a future condition. Children were in this way deprived of regulatory protections. An argument will be made that the approval of nontherapeutic, harmful experiments-such as exposure of toddlers to lead poison-under the current gate keeping system raises serious doubts about the sustainability of institutional review boards (IRBs) as protectors of human research subjects. Children, who are precluded from exercising the adult human's right to informed consent, are being exploited as commodities for commercial ends. It is the position of the author that nothing less than the enactment of a federal law mandating a radical overhaul of the current research review system, with independent checks and balances, will provide children the legal protections they need. Ten specific recommendations are offered to protect children from harmful experiments. (shrink)

The lockdown imposed in Italy to reduce the spread of COVID-19 posited unusual challenges to people practicing sports and physical activities. The rebooting of activities highlighted the need to cope with new behaviors and routines, such as wearing a face mask while exercising. We conducted a web-based survey in Italy at the start of physical activities’ rebooting, to investigate how people reacted to the new norms. Participants completed the questionnaires assessing insomnia, regulatory self-efficacy, optimism, mood states, and mental toughness. (...) Age, gender, and environment were assumed as design variables. Results showed that in outdoor activities, the younger females as compared to the older manifest less regulatory self-efficacy, while the younger males manifest more regulatory self-efficacy than the older. In indoor activities, a reversed pattern of regulatory-self-efficacy was observed. Regarding life orientation, younger participants showed less optimism and positive expectation for the future and seem to be more exposed to the unexpected effects of the restrictions: they showed more sleep disturbances, confusion, depression, anger, and fatigue and less vigor and mental toughness than older participants. An understanding of the psychological implications of the rebooting phase can support the enactment of more appropriate behaviors to practice sports and physical activities when living at the time of the coronavirus. (shrink)

ObjectiveThe study is an explorative investigation aimed to assess the differences in acute stress response patterns of health workers facing coronavirus disease 2019 (COVID-19) during Italy’s first lockdown.MethodsA cross-sectional investigation using convenience sampling method was conducted in Italy during April 2020. Eight hundred fifty-eight health workers participated in the research filling out self-report measures including Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), and Impact of Event Scale–Revised (IES-R).ResultsModerate/severe depression was found in 28.9% (95% CI, (...) 25.8–32.04), moderate/severe anxiety in 55.4% (95% CI, 51.9–58.8), insomnia in 15% (95% CI, 12.5–17.5), and distress in 52.5% (95% CI, 48.5%–56.6) of participants. The 3% of health workers reported frequent suicidal thoughts. Female sex, working for >15 h/week in a COVID-19 unit, and living apart from family were associated with a significantly higher risk of distress, anxiety, insomnia, depression, and functional impairment. Four profiles were identified on the basis of psychopathological measures: Profile_0 included 44% (N= 270); Profile_1, 25.6% (N= 157); Profile_2, 19.1% (N= 117); and Profile_3, 11.3% (N= 69) of participants. Results showed a significant effect for Profiles X IES-R (η2= 0.079;f= 0.29), indicating that in all profiles, except for Profile_0, avoidance scale is lower than hyperarousal and intrusion symptoms scales of the IES-R. This characteristic could be a probable index of the control exerted by the responders to not fly away from their job.ConclusionThe identification of specific profiles could help psychiatrists and emergency psychologists to build specific interventions in terms of both primary and secondary prevention to face future waves of the COVID-19 outbreak. (shrink)

IntroductionFrontline healthcare workers have faced significant plight during the ongoing Coronavirus disease 2019 pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their “voices” to understand their adversities and conceptualize their resilience framework.MethodsA qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically heterogeneous (...) population of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz’s grounded theory was used for analysis supplemented by NVivo 10 software.ResultsFear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience “framework” emerged as a process while navigating these adversities and consisted of three facets: forming a “resilient identity,” managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.ConclusionThe study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their “unheard voices” explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences. (shrink)

continent. 2.2 (2012): 66–75 ~*~ We’re Doomed. Pessimism is the night-side of thought, a melodrama of the futility of the brain, a poetry written in the graveyard of philosophy. Pessimism is a lyrical failure of philosophical thinking, each attempt at clear and coherent thought, sullen and submerged in the hidden joy of its own futility. The closest pessimism comes to philosophical argument is the droll and laconic “We’ll never make it,” or simply: “We’re doomed.” Every effort doomed to failure, every (...) project doomed to incompletion, every life doomed to be unlived, every thought doomed to be unthought. Pessimism is the lowest form of philosophy, frequently disparaged and dismissed, merely the symptom of a bad attitude. No one ever needs pessimism, in the way that one needs optimism to inspire one to great heights and to pick oneself up, in the way one needs constructive criticism, advice and feedback, inspirational books or a pat on the back. No one needs pessimism, though I like to imagine the idea of a pessimist activism. No one needs pessimism, and yet everyone—without exception—has, at some point in their lives, had to confront pessimism, if not as a philosophy then as a grievance—against one’s self or others, against one’s surroundings or one’s life, against the state of things or the world in general. There is little redemption for pessimism, and no consolation prize. Ultimately, pessimism is weary of everything and of itself. Pessimism is the philosophical form of disenchantment—disenchantment as chanting, a chant, a mantra, a solitary, monophonic voice rendered insignificant by the intimate immensity surrounding it. In pessimism, the first axiom is a long, low, funereal sigh. ~*~ We’re Still Doomed. No one has time for pessimism. After all, there are only so many hours in a day. Whatever our temperament, happy or sad, engaged or disengaged, we know pessimism when we hear it. The pessimist is usually understood as the complainer, forever pointing out what is wrong with the world without ever once offering a solution. But more often than not pessimists are the quietest of philosophers, submerging their own sighs within the lethargy of discontent. What little sound it makes is of interest to no one—“I’ve heard it all before,” “tell me something I don’t know,” sound and fury, signifying nothing. In raising problems without solutions, in posing questions without answers, in retreating to the hermetic, cavernous abode of complaint, pessimism is guilty of that most inexcusable of Occidental crimes—the crime of not pretending it’s for real. Pessimism fails to live up to the most basic tenet of philosophy—the “as if.” Think as if it will be helpful, act as if it will make a difference, speak as if there is something to say, live as if you are not, in fact, being lived by some murmuring non-entity both shadowy and muddied. Had it more self-assurance and better social skills, pessimism would turn its disenchantment into a religion, possibly calling itself The Great Refusal. But there is a negation in pessimism that refuses even such a Refusal, an awareness that, from the start, it has already failed, and that the culmination of all that is, is that all is for naught. Pessimism tries very hard to present itself in the low, sustained tones of a Requiem Mass, or the tectonic rumbling of Tibetan chant. But it frequently lets loose dissonant notes at once plaintive and pathetic. Often, its voice cracks, its weighty words abruptly reduced to mere shards of guttural sound. ~*~ Maybe It’s Not So Bad, After All. If we know pessimism when we hear it, this is because we’ve heard it all before—and we didn’t need to hear it in the first place. Life is hard enough. What you need is a change of attitude, a new outlook, a shift in perspective... a cup of coffee. If we have no ears for pessimism, this is because it is always reducible to something as reliably mutable as a voice. If pessimism is so frequently disparaged, it is because it brings everyone down, determined as it is to view each day as a bad day, if only by virtue of the fact that it is not yet a bad day. For pessimism the world is brimming with negative possibility, the collision of a bad mood with an impassive world. In fact, pessimism is the result of a confusion between the world and a statement about the world, a confusion that also prevents it from fully entering the hallowed halls of philosophy. If pessimism is so often dismissed, this is because it is often impossible to separate a “bad mood” from a philosophical proposition (and do not all philosophies stem from a bad mood?) The very term “pessimism” suggests a school of thought, a movement, even a community. But pessimism always has a membership of one—maybe two. Ideally, of course, it would have a membership of none, with only a scribbled, illegible note left behind by someone long forgotten. But this seems unrealistic, though one can always hope. ~*~ Anatomy of Pessimism. Though it may locate itself at the margins of philosophy, pessimism is as much subject to philosophical analysis as any other form of thought. Pessimism’s lyricism of failure gives it the structure of music. What time is to the music of sorrow, reason is to a philosophy of the worst. Pessimism’s two major keys are moral and metaphysical pessimism, its subjective and objective poles, an attitude towards the world and a claim about the world. For moral pessimism, it is better not to have been born at all; for metaphysical pessimism, this is the worst of all possible worlds. For moral pessimism the problem is the solipsism of human beings, the world made in our own image, a world-for-us. For metaphysical pessimism, the problem is the solipsism of the world, objected and projected as a world-in-itself. Both moral and metaphysical pessimism are compromised philosophically; moral pessimism by its failure to locate the human within a larger context, and metaphysical pessimism by its failure to recognize the complicity in the very claim of realism. This is how pessimism makes its music of the worst, a generalized misanthropy without the anthropos . Pessimism crystallizes around this futility—it is its amor fati , rendered as musical form. ~*~ Melancholy of Anatomy. There is a logic of pessimism that is fundamental to its suspicion of philosophical system. Pessimism involves a statement about a condition . In pessimism each statement boils down to an affirmation or a negation, just as any condition boils down to the best or the worst. With Schopenhauer, that arch-pessimist, the thinker for whom the philosopher and the curmudgeon perfectly overlap, we see a no-saying to the worst, a no-saying that secretly covets a yes-saying (through asceticism, mysticism, quietism), even if this hidden yes-saying is a horizon at the limits of comprehension. With Nietzsche comes the pronouncement of a Dionysian pessimism, a pessimism of strength or joy, a yes-saying to the worst, a yes-saying to this world as it is. And with Cioran yet another variation, futile yet lyrical, a no-saying to the worst, and a further no-saying to the possibility of any other world, in here or out there. With Cioran one approaches, but never reaches, an absolute no-saying, a studied abandonment of pessimism itself. The logic of pessimism moves through three refusals: a no-saying to the worst (refusal of the world-for-us, or Schopenhauer’s tears); a yes-saying to the worst (refusal of the world-in-itself, or Nietzsche’s laughter); and a no-saying to the for-us and the in-itself (a double refusal, or Cioran’s sleep). Crying, laughing, sleeping—what other responses are adequate to a life that is so indifferent? ~*~ Cosmic Pessimism. Both moral and metaphysical pessimism point to another kind, a pessimism that is neither subjective nor objective, neither for-us nor in-itself, and instead a pessimism of the world-without-us. We could call this a cosmic pessimism ... but this sounds too majestic, too full of wonder, too much the bitter aftertaste of the Great Beyond. Words falter. And so do ideas. And so we have a cosmic pessimism, a pessimism that is first and last a pessimism about cosmos , about the necessity and possibility of order. The contours of cosmic pessimism are a drastic scaling-up or scaling-down of the human point of view, the unhuman orientation of deep space and deep time, and all of this shadowed by an impasse, a primordial insignificance, the impossibility of ever adequately accounting for one’s relationship to thought—all that remains of pessimism is the desiderata of affects—agonistic, impassive, defiant, reclusive, filled with sorrow and flailing at that architectonic chess match called philosophy, a flailing that pessimism tries to raise to the level of an art form (though what usually results is slapstick). ~*~ Song of Futility. An ethics of futility pervades pessimism. Futility, however, is different from fatality, and different again from simple failure (though failure is never simple). Failure is a breakage within the heart of relations, a fissure between cause and effect, a fissure hastily covered over by trying and trying again. With failure, there is always plenty of blame to go around; it’s not my fault, it’s a technical difficulty, it’s a miscommunication. For the pessimist, failure is a question of “when,” not “if”—failure as a metaphysical principle. Everything withers and passes into an obscurity blacker than night, everything from the melodramatic decline of a person’s life to the banal flickering moments that constitute each day. Everything that is done undone, everything said or known destined for a kind of stellar oblivion. When scaled up in this way, failure becomes fatality. Fatality is the hermeticism of cause and effect. In fatality, everything you do, whatever you do, always leads to a certain end, and ultimately to the end—though that end, or the means to that end, remain shrouded in obscurity. Nothing you do makes a difference because everything you do makes a difference. Hence the effects of your actions are hidden from you, even as you deceive yourself into thinking that, at last, this time you will outwit the order of things. By having a goal, planning ahead, and thinking things through carefully, we attempt, in a daily Prometheanism, to turn fatality to our advantage, to gain a glimpse of an order that seems buried deeper and deeper in the fabric of the universe. But even fatality has its comforts. The chain of cause and effect may be hidden from us, but that’s just because disorder is the order we don’t yet see; it’s just complex, distributed, and requires advanced mathematics. Fatality still clings to the sufficiency of everything that exists... When fatality relinquishes even this idea, it becomes futility. Futility arises out of the grim suspicion that, behind the shroud of causality we drape over the world, there is only the indifference of what exists or doesn’t exist; whatever you do ultimately leads to no end, an irrevocable chasm between thought and world. Futility transforms the act of thinking into a zero-sum game. ~*~ Song of the Worst. At the center of pessimism lies the term pessimus , “the worst,” a term as relative as it is absolute. The worst is about as bad as it gets, “the worst” as “the best” in disguise, shrouded by the passage of time or the twists and turns of fortune. For the pessimist, “the worst” is the propensity for suffering that gradually occludes each living moment, until it eclipses it entirely, overlapping perfectly in death... which, for the pessimist, is no longer “the worst.” Pessimism is marked by an unwillingness to move beyond “the worst,” something only partially attributable to a lack in motivation. In pessimism “the worst” is the ground that gives way beneath every existent—things could be worse, and , things could be better. “The worst” invariably implies a value judgment, one made based on scant evidence and little experience; in this way, pessimism’s greatest nemesis is its moral orientation. Pessimism’s propositions have all the gravitas of a bad joke. Perhaps this is why the true optimists are the most severe pessimists—they are optimists that have run out of options. They are almost ecstatically inundated by the worst. Such an optimism is the only possible outcome of a prolonged period of suffering, physical or metaphysical, intellectual or spiritual. But does this not also describe all the trials and tribulations of each day—in short, of “life?” It seems that sooner or later we are all doomed to become optimists of this sort (the most depressing of thoughts...) ~*~ Song of Doom. Rather than serving as a cause for despair, gloom and doom are the forms of consolation for any pessimist philosophy. Neither quite affects nor quite concepts, gloom and doom transform pessimism into a mortification of philosophy. Doom is not just the sense that all things will turn out badly, but that all things inevitably come to an end, irrespective of whether or not they really do come to an end. What emerges from doom is a sense of the unhuman as an attractor, a horizon towards which the human is fatally drawn. Doom is humanity given over to unhumanity in an act of crystalline self-abnegation. Gloom is not simply the anxiety that precedes doom. Gloom is literally atmospheric, climate as much as impression, and if people are also gloomy, this is simply the by-product of an anodyne atmosphere that only incidentally involves human beings. Gloom is more climatological than psychological, the stuff of dim, hazy, overcast skies, of ruins and overgrown tombs, of a misty, lethargic fog that moves with the same languorousness as our own crouched and sullen listening to a disinterested world. In a sense, gloom is the counterpoint to doom—what futility is to the former, fatality is to the latter. Doom is marked by temporality—all things precariously drawn to their end—whereas gloom is the austerity of stillness, all things sad, static, and suspended, a meandering smoke hovering over cold lichen stones and damp fir trees. If doom is the terror of temporality and death, then gloom is the horror of a hovering stasis that is life. At times I like to imagine that this realization alone is the thread that connects the charnel ground Aghori and the graveyard poets. ~*~ Song of Spite. There is an intolerance in pessimism that knows no bounds. In pessimism spite begins by fixing on a particular object of spite—someone one hardly knows, or someone one knows too well; a spite for this person or a spite for all of humanity; a spectacular or a banal spite; a spite for a noisy neighbor, a yapping dog, a battalion of strollers, the meandering idiot walking in front of you on their smart phone, large loud celebrations, traumatic injustices anywhere in the world regurgitated as media blitz, spite for the self-absorbed and overly performative people talking way too loud at the table next to you, technical difficulties and troubleshooting, the reduction of everything to branding, spite of the refusal to admit one’s own errors, of self-help books, of people who know absolutely everything and make sure to tell you, of all people, all living beings, all things, the world, the spiteful planet, the inanity of existence... Spite is the motor of pessimism because it is so egalitarian, so expansive, it runs amok, stumbling across intuitions that can only half-heartedly be called philosophical. Spite lacks the confidence and the clarity of hatred, but it also lacks the almost cordial judgment of dislike. For the pessimist, the smallest detail can be an indication of a metaphysical futility so vast and funereal that it eclipses pessimism itself—a spite that pessimism carefully places beyond the horizon of intelligibility, like the experience of dusk, or like the phrase, “it is raining jewels and daggers.” ~*~ Song of Sleep. A paraphrase of Schopenhauer: what death is for the organism, sleep is for the individual. Pessimists sleep not because they are depressed, but because for them sleep is a form of ascetic practice. Sleep is the askesis of pessimism. If, while sleeping, we have a bad dream, we abruptly wake up, and suddenly the horrors of the night vanish. There is no reason to think that the same does not happen with the bad dream we call “life.” ~*~ Song of Sorrow. Nietzsche, commenting on pessimism, once castigated Schopenhauer for taking things too lightly. He writes: ...Schopenhauer, though a pessimist, really —played the flute. Every day, after dinner: one should read his biography on that. And incidentally: a pessimist, one who denies God and the world but comes to a stop before morality—who affirms morality and plays the flute... what? Is that really—a pessimist? We know that Schopenhauer did possess a collection of instruments, and we also know that Nietzsche himself composed music. There is no reason to think that either of them would ever banish music from the Republic of philosophy. But Nietzsche’s jibes at Schopenhauer are as much about music as they are about pessimism. For the pessimist who says no to everything and yet finds comfort in music, the no-saying of pessimism can only be a weak way of saying yes—the weightiest statement undercut by the flightiest of replies. The least that Schopenhauer could’ve done is to play the bass. I’m not a big fan of the flute, or, for that matter, wind instruments generally. But what Nietzsche forgets is the role that the flute has historically played in Greek tragedy. In tragedy, the flute ( aulos ) is not an instrument of levity and joy, but of solitude and sorrow. The Greek aulos not only expresses the grief of tragic loss, but it does so in a way that renders weeping and singing inseparable from each other. The classicist Nicole Loraux calls this the mourning voice . Set apart from the more official civic rituals of funerary mourning, the mourning voice of Greek tragedy constantly threatens to dissolve song into wailing, music into moaning, and the voice into a primordial, disarticulate anti-music. The mourning voice delineates all the forms of suffering—tears, weeping, sobbing, wailing, moaning, and the convulsions of thought reduced to an elemental unintelligibility. In the collapsed space between the voice that speaks and the voice that sings, pessimism discovers its mourning voice. Pessimism: the failure of sound and sense, the disarticulation of phone and logos . Have we rescued Schopenhauer from Nietzsche? Probably not. Perhaps Schopenhauer played the flute to remind himself of the real function of the mourning voice—sorrow, sighs, and moaning rendered indistinguishable from music, the crumbling of the human into the unhuman. Failure par excellence of pessimism. ~*~ Song of Nothing. In Buddhist thought, the First Noble Truth of existence is encapsulated in the Pali term dukkha , conventionally translated as “suffering,” “sorrow,” or “misery.” The Buddhist teachings are clear, however, that this is an objective claim, and not simply one point of view among others. Existence is suffering and sorrow—and yet this is not, the teachings tell us, a pessimistic attitude. It is likely that Schopenhauer, reading the Buddhist texts available to him, recognized some filiation with the concept of dukkha . But dukkha is a multi-faceted term. There is, certainly, dukkha in the usual sense of the suffering, strife, and loss associated with living a life. But this is, in turn, dependent on the finitude and temporality of dukkha , existence as determined by impermanence and imperfection. And this ultimately points to the way in which both suffering and finitude are grounded by the paradoxical groundlessness of dukkha as a metaphysical principle—the insubstantiality and the emptiness of all that is. Beyond what is worse to me, beyond a world ordered for the worst, there is the emptiness of dukkha as an impersonal suffering... the tears of the cosmos. In this context, it is easy to see how Schopenhauer’s pessimism attempts to compress all the aspects of dukkha into a nothingness at the core of existence, a Willlessness coursing through the Will. Though one thing for certain is that with Schopenhauer we do not find the “ever-smiling” countenance of Buddhism—or do we? The texts of the Pali Canon also contain lists of the different types of happiness—including the happiness of renunciation and the strange happiness of detachment. But Buddhism considers even the different types of happiness as part of dukkha , in this final sense of nothingness or emptiness. Perhaps Schopenhauer understood Buddhism better than he is usually given credit for. Thus the experiment of Schopenhauer’s philosophy—the point at which a Western pessimus and an Eastern dukkha overlap or exchange glances. Empty sorrow, a lyricism of indifference. The result is a strange, and ultimately untenable, nocturnal form of Buddhism. ~*~ Cioran once called music a “physics of tears.” If this is true, then perhaps metaphysics is its commentary. Or its apology. ~*~ Pessimism would be more mystical were it not for its defeatism. Mysticism is much too proactive for the pessimist, and pessimism too impassive even for the mystic. At the same time, there is something enviable about mysticism—despite its sufferings. There is a sense in which pessimists are really failed mystics. ~*~ You, the Night, and the Music. In a suggestive passage, Schopenhauer once noted that, “music is the melody to which the world is the text." Given Schopenhauer’s view on life—that life is suffering, that human life is absurd, that the nothingness before my birth is equal to the nothingness after my death—given all this, one wonders what kind of music Schopenhauer had in mind when he described music as the melody to which the world is text—was it opera, a Requiem Mass, a madrigal, or perhaps a drinking song? Or something like Eine kleine Nachtmusik , a little night music for the twilight of thought, a sullen nocturne for the night-side of logic, an era of sad wings sung by a solitary banshee. Perhaps the music Schopenhauer had in mind is music eliminated to non-music. A whisper would suffice. Perhaps a sigh of fatigue or resignation, perhaps a moan of despair or sorrow. Perhaps a sound just articulate enough that it could be heard to dissipate. ~*~ Teach me to laugh through tears. ~*~ Pessimism always falls short of being philosophical. My back aches, my knees hurt, I couldn’t sleep last night, I’m stressed-out, and I think I’m finally coming down with something. Pessimism abjures all pretenses towards system—towards the purity of analysis and the dignity of critique. We didn’t really think we could figure it out, did we? It was just passing time, taking a piss, something to do, a bold gesture put forth in all its fragility, according to rules that we have agreed to forget that we made up in the first place. Every thought marked by a shadowy incomprehension that precedes it, and a futility that undermines it. That pessimism speaks, in whatever voice, is the singing testimony to this futility and this incomprehension—take a chance and step outside, lose some sleep and say you tried... ~*~ Is there a music of pessimism? And would such a music be audible? ~*~ The impact of music on a person compels them to put their experience into words. When this fails, the result is a faltering of thought and language that is itself a kind of music. Cioran writes: “Music is everything. God himself is nothing more than an acoustic hallucination.” ~*~ If a thinker like Schopenhauer has any redeeming qualities, it is that he identified the great lie of Western culture—the preference for existence over non-existence. As he notes: “If we knocked on the graves and asked the dead whether they would like to rise again, they would shake their heads.” In Western cultures it is commonly accepted that one celebrates birth and mourns death. But there must be a mistake here. Wouldn’t it make more sense to mourn birth and celebrate death? Strange though, because the mourning of birth would, presumably, last the entirety of that person’s life, so that mourning and living would the be same thing. ~*~ To the musical idea of the harmony of the universe corresponds the philosophical principle of sufficient reason. Like the music of mourning, pessimism gives voice to the inevitable breakdown of word and song. In this way, music is the overtone of thought. ~*~ The Patron Saints of Pessimism. The patron saints of pessimism watch over suffering. Laconic and sullen, the patron saints of pessimism never seem to do a good job at protecting, interceding, or advocating for those who suffer. Perhaps they need us more than we need them. Lest we forget, there do exist patron saints of philosophy, but their stories are not happy ones. There is, for instance, the fourth century Saint Catherine of Alexandria, or Catherine of the Wheel, named after the torture device used on her. A precocious fourteen year old scholar, Catherine was subject to continual persecution. After all forms of torture failed—including the “breaking wheel”—the emperor finally settled for her decapitation, a violent yet appropriate reminder of the protector of philosophers. There are also patron saints of music and musicians, but theirs too are sad stories. In the second century, Saint Cecilia was also subject to persecution and torture. As she knelt to receive the blade that would separate her head from her body, she ardently sang a song to God. It took three attempts before she was fully decapitated, all the while she continued, perhaps miraculously, to sing. Does pessimism not deserve its own patron saints, even if they are unworthy of martyrdom? But in our search, even the most ardent nay-sayers frequently lapse into brief moments of enthusiasm—Pascal’s love of solitude, Leopardi’s love of poetry, Schopenhauer’s love of music, Nietzsche’s love of Schopenhauer, and so on. Should one then focus on individual works of pessimism? We could include Kierkegaard’s trilogy of horror— Sickness Unto Death , The Concept of Dread , and Fear and Trembling —but all these are undermined by their fabricated and unreliable authors. Besides, how can one separate the pessimist from the optimist in works like Unamuno’s The Tragic Sense of Life , Shestov’s Postetas Clavium , or Edgar Saltus’ under-read The Philosophy of Disenchantment ? Even in cases where the entire corpus of an author is pessimistic, the project always seems incomplete—witness Cioran’s trajectory, from his first book, On the Heights of Despair , to the last unpublished notebooks of acrid and taut aphorisms. And this is to say nothing of literary pessimism, from Goethe’s sorrowful Werther, to Dostoevsky’s underground man, to Pessoa’s disquiet scribbler; Baudelaire’s spleen and ennui, the mystical Satanism of Huysmans and Strindberg, the hauntologies of Mário de Sá-Carniero, Izumi Kyoka, H.P. Lovecraft, grumpy old Beckett... even the great pessimist comedians. All that remains are singular, perhaps anomalous statements of pessimism, a litany of quotes and citations crammed into fortune cookies. Patron saints are traditionally named after a locale, either a place of birth or of a mystical experience. Perhaps the better approach is to focus on the places where pessimists were forced to live out their pessimism—Schopenhauer facing an empty Berlin lecture hall, Nietzsche mute and convalescent at the home of his sister, Wittgenstein the relinquished professor and solitary gardener, Cioran grappling with Alzheimer’s in his tiny writing alcove in the Latin Quarter. ~*~ There’s a ghost that grows inside of me, damaged in the making, and there’s a hunt sprung from necessity, elliptical and drowned. Where the moving quiet of our insomnia offers up each thought, there’s a luminous field of grey inertia, and obsidian dreams burnt all the way down. ~*~ If pessimism has any pedagogical value, it is that the failure of pessimism as a philosophy is inextricably tied to the failure of pessimism as voice. I read the following, from Shestov’s The Apotheosis of Groundlessness : When a person is young he writes because it seems to him he has discovered a new almighty truth which he must make haste to impart to forlorn humankind. Later, becoming more modest, he begins to doubt his truths: and then he tries to convince himself. A few more years go by, and he knows he was mistaken all round, so there is no need to convince himself. Nevertheless he continues to write, because he is not fit for any other work, and to be accounted a superfluous person is so horrible. (shrink)

Background: Strengthening the sense of meaning in life and psychological well-being brings benefits for mental health. The group particularly vulnerable to mental problems are young adults, therefore the aim of our research was to explore how a gratitude intervention will affect the sense of meaning in life, psychological well-being, general health and perceived stress among them. The research also took into account the issue of expressing gratitude.Method: The study involved 80 young adults who were randomly assigned to the experimental group (...) that filled out the specially prepared diaries for a week or the control group. Participants completed the Meaning in Life Questionnaire, the General Health Questionnaire – 28, the Perceived Stress Scale, and the Ryff Scales of Psychological Well-Being twice.Results: In the experimental group significant increases were observed in three areas of psychological well-being: environmental mastery, relationships with others and purpose in life. The significant decrease was also noted in anxiety/insomnia and depression symptoms as well as in perceived stress. There were no differences in the level of meaning in life. There was a positive relationship between expressing gratitude and meaning in life and psychological well-being.Conclusion: Proposed gratitude intervention has the potential to enhance psychological well-being among young adults, however, it may not be effective in enhancing meaning in life. (shrink)

Cranial electrotherapy stimulation is a neuromodulation tool used for treating several clinical disorders, including insomnia, anxiety, and depression. More recently, a limited number of studies have examined CES for altering affect, physiology, and behavior in healthy, non-clinical samples. The physiological, neurochemical, and metabolic mechanisms underlying CES effects are currently unknown. Computational modeling suggests that electrical current administered with CES at the earlobes can reach cortical and subcortical regions at very low intensities associated with subthreshold neuromodulatory effects, and studies using (...) electroencephalography and functional magnetic resonance imaging show some effects on alpha band EEG activity, and modulation of the default mode network during CES administration. One theory suggests that CES modulates brain stem, limbic, and cortical regions and increases relative parasympathetic to sympathetic drive in the autonomic nervous system. There is no direct evidence supporting this theory, but one of its assumptions is that CES may induce its effects by stimulating afferent projections of the vagus nerve, which provides parasympathetic signals to the cardiorespiratory and digestive systems. In our critical review of studies using CES in clinical and non-clinical populations, we found severe methodological concerns, including potential conflicts of interest, risk of methodological and analytic biases, issues with sham credibility, lack of blinding, and a severe heterogeneity of CES parameters selected and employed across scientists, laboratories, institutions, and studies. These limitations make it difficult to derive consistent or compelling insights from the extant literature, tempering enthusiasm for CES and its potential to alter nervous system activity or behavior in meaningful or reliable ways. The lack of compelling evidence also motivates well-designed and relatively high-powered experiments to assess how CES might modulate the physiological, affective, and cognitive responses to stress. Establishing reliable empirical links between CES administration and human performance is critical for supporting its prospective use during occupational training, operations, or recovery, ensuring reliability and robustness of effects, characterizing if, when, and in whom such effects might arise, and ensuring that any benefits of CES outweigh the risks of adverse events. (shrink)

Background: Prenatal and postnatal mental disorders can exert severe adverse influences on mothers, fetuses, and children. However, the effect of the coronavirus disease 2019 pandemic on the mental health of pregnant and postpartum women remains unclear.Methods: Relevant studies that were published from January 1, 2019 to September 19, 2020 were identified through the systematic search of the PubMed, EMBASE, and Web of Science databases. Quality assessment of included studies, random-effects meta-analysis, sensitivity analysis, and planned subgroup analysis were performed.Results: A (...) total of 23 studies conducted with 20,569 participants during the COVID-19 pandemic and with 3,677 pregnant women before the COVID-19 pandemic were included. The prevalence rates of anxiety, depression, psychological distress, and insomnia among pregnant women during the COVID-19 pandemic were 37%, 31%, 70%, and 49%, respectively. The prevalence of postpartum depression was 22%. Multigravida women and women in the first and third trimesters of pregnancy were more vulnerable than other pregnant women. The assessment of the associations between the COVID-19 pandemic and mental health problems revealed that the pooled relative risks of anxiety and depression in pregnant women were 1.65 and 1.08, respectively.Conclusions: The prevalence rates of mental disorders among pregnant and postpartum women during the COVID-19 pandemic were high. Timely and tailored interventions should be applied to mitigate mental problems among this population of women, especially multigravida women and women in the first and third trimesters of pregnancy. (shrink)

The purpose of this study was to examine the effectiveness of a neuro-meditation program to support nurses during the COVID-19 pandemic. Forty-five nurses were classified into three groups based on their systolic blood pressure: normotensive, hypertensive and control. Using a parallel, randomly controlled design across a 4-week period, 10 × 30-min sessions using the Rebalance© Impulse were completed. Sleep was assessed by wrist actigraphy and subjective sleep questionnaires; perceived sleep quality, Ford Insomnia Response to Stress Test questionnaire and the (...) Spiegel Sleep Quality questionnaire. Blood pressure, resting heart rate, mean heart rate, heart rate variability index, cortisol, and alpha-amylase were also measured. Statistical analysis was completed using factorial ANOVA. Sleep improved in the G-hyp group; SSQ ; perceived sleep quality ; sleep efficiency and fragmentation index. In the G-nor group, sleep was improved to a lesser extent; perceived sleep quality. A significant time–group interaction was reported in resting heart rate, systolic blood pressure, and diastolic blood pressure with these measures being significantly reduced in the G-hyp group. RMSSD increased in the G-nor group. This initial evidence suggests that neuro-meditation reduces excessive sympathetic activity, promoting enhanced sleep quality and autonomic control during periods of increased work-related stress.Clinical Trial RegistrationThe study was conducted at Bioesterel, Sophia-Antipolis, France as a clinical trial: Neuro-meditation improves sleep quality, https://www.drks.de/ui_data_web/DrksUI.html?locale=en, DRKS00025731. (shrink)

Consciousness can be studied only if subjective experience is documented and quantified, yet first-person accounts of the effects of brain injury on conscious experience are as rare as they are potentially useful. This report documents the alterations in waking, sleeping, and dreaming caused by a lateral medullary infarct. Total insomnia and the initial suppression of dreaming was followed by the gradual recovery of both functions. A visual hallucinosis during waking that was associated with the initial period of sleep and (...) dream suppression is described in detail. Since the changes in sleep and their recovery are comparable to results of animal experiments, it can be concluded that damage to the medullary brain stem causes extreme but short-lived alterations in conscious state and that substantial recovery occurs even though the damage to the brain stem endures. (shrink)

Consciousness can be studied only if subjective experience is documented and quantified, yet first-person accounts of the effects of brain injury on conscious experience are as rare as they are potentially useful. This report documents the alterations in waking, sleeping, and dreaming caused by a lateral medullary infarct. Total insomnia and the initial suppression of dreaming was followed by the gradual recovery of both functions. A visual hallucinosis during waking that was associated with the initial period of sleep and (...) dream suppression is described in detail. Since the changes in sleep and their recovery are comparable to results of animal experiments, it can be concluded that damage to the medullary brain stem causes extreme but short-lived alterations in conscious state and that substantial recovery occurs even though the damage to the brain stem endures. (shrink)

Matthew Walker's article has prompted us to consider neuropsychiatric disorders and pharmacological effects associated with sleep alterations, and aspects of memory affected. Not all disorders involving insomnia show memory impairment, and hypersomnias can be associated with memory deficits. The use of cholinergic medication in dementia indicates that consideration of the link between sleep and memory is more than academic.

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models (...) of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

This study was designed to investigate the effects of aging on consciousness in recognition memory, using the Remember/Know/Guess procedure . Remembering and Knowing. In E. Tulving & F. I. M. Craik , The Oxford Handbook of Memory. Oxford University Press.). In recognition memory, older participants report fewer occasions on which recognition is accompanied by recollection of the original encoding context. Two main hypotheses were tested: the speed mediation hypothesis . The processing-speed theory of adult age differences in cognition. Psychological Review, (...) 3, 403–428) and the executive-aging hypothesis . An application of prefrontal cortex function theory to cognitive aging. Psychological Bulletin, 120, 272–292). A group of young and a group of older adults took a recognition test in which they classified their responses according to Gardiner, J. M., & Richarson-Klavehn, A. . Remembering and Knowing. In E. Tulving & F. I. M. Craik , The Oxford Handbook of Memory. Oxford University Press. remember-know-guess paradigm. Subsequently, participants completed processing speed and executive function tests. The results showed that among the older participants, R responses decreased, but K responses did not. Moreover, a hierarchical regression analysis supported the view that the effect of age in recollection experience is determined by frontal lobe integrity and not by diminution of processing speed. (shrink)

This study sought to find out the effect of the Hot Seat Strategy on eighth graders’ achievement in Wave Motion and Sound Unit in their Life and Science textbook. The researcher used the quasi-experimental design to achieve the aim of the study. The population of the study was all eighth graders (No=934) in Qalqilya public schools. The study sample, randomly chosen, was 208 students in the eighth grade. Of five eighth-grade sections, the researcher randomly chose two sections: one experimental (...) and another control. After data collection, it was obtained that the Hot Seat Strategy positively impacted students’ achievement. There was a statistically significant difference at α = 0.05 in students’ achievement level as well as level of knowledge, memorization, understanding, and application in favor of the experimental group. (shrink)

This paper examines the relationship between organizational ethical culture in two large international CPA firms, auditors'' personal values and the ethical orientation that those values dictate, and judgments in ethical dilemmas typical of those that accountants face. Using an experimental task consisting of multiple judgments designed to vary in "moral intensity" (Jones, 1991), and unique as well as tried-and-true approaches to variable measurements, this study examined the judgments of more than three hundred participants in our study. ANCOVA and path analysis (...) results indicate that: (1) Ethical judgments in situations of high moral intensity are affected by personal values and by environmental variables, such as the professional code of conduct (direct and indirect effects) and previous ethics instruction (direct effect only). (2) Corporate ethical culture, and a relatively strong firm rules-orientation, affect auditors'' idealism but not relativism, and therefore indirectly affect ethical judgments. Jones'' (1991) moral intensity argument is supported: differences in the characteristics of specific judgment tasks apparently result in different decision processes. (shrink)

Studying the folk concept of intentional action, Knobe (2003a) discovered a puzzling asymmetry: most people consider some bad side effects as intentional while they consider some good side effects as unintentional. In this study, we extend these findings with new experiments. The first experiment shows that the very same effect can be found in ascriptions of intentionality in the case of means for action. The second and third experiments show that means are nevertheless generally judged more intentional than side (...) effects, and that people do take into account the structure of the action when ascribing intentionality. We then discuss a number of hypotheses that can account for these data, using reactions times from our first experiment. (shrink)

The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. According to the principle of double effect, sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause (...) such a harm as a means to bringing about the same good end. Does the principle of double effect play the important explanatory role that has been claimed for it? To consider this question, one must be careful to clarify just what the principle is supposed to explain. Three misinterpretations of the principle’s force or range of application are common. 1. To ensure that Double Effect is not misunderstood as principle issuing a blanket permission on causing any unintended harm that yields a benefit, applications must require that the agent seek to minimize the harm involved. 2. Since it is widely accepted that it is wrong to aim to produce harm to someone as an end, to rule this out is not part of double effect’s distinctive content. 3. Harms that were produced regretfully and only for the sake of producing a good end may be prohibited by double effect because they were brought about as part of the agent’s means to realizing the good end. (shrink)

This study examines the effect of directors’ human and social capital on the level of corporate social responsibility disclosures by drawing on insights from a resource-based view. It also investigates the effect of chief executive officer power on this relationship. Data were obtained from annual reports of companies listed on the Dhaka Stock Exchange in Bangladesh from 2005 to 2013. We employ outside directors’ experiences and expertise as a proxy for board capital and measure CEO power using a (...) ‘power index’ that comprises CEO duality, ownership, tenure and family CEO status. Results show that board capital is positively associated with CSR disclosure levels; however, CEO power is negatively associated with CSR disclosures and reduces the effect of board capital on CSR disclosures. Thus, we conclude that although board capital can improve CSR practices, CEO power can also inhibit these practices. (shrink)

Following an extensive review of the moral intensity literature, this article reports the findings of two studies (one between-subjects, the other within-subject) that examined the effect of manipulated and perceived moral intensity on ethical judgment. In the between-subjects study participants judged actions taken in manipulated high moral intensity scenarios to be more unethical than the same actions taken in manipulated low moral intensity scenarios. Findings were mixed for the effect of perceived moral intensity. Both probable magnitude of consequences (...) (a factor consisting of magnitude of consequences, probability of effect, and temporal immediacy) and social consensus had a significant effect; proximity did not. In the within-subject study manipulated moral intensity had a significant effect on ethical judgment, but perceived moral intensity did not. Regression of ethical judgment on age, gender, major, and the three perceived moral intensity factors was significant between-subjects, but not within-subject. Ethical judgment was found to be a more robust predictor of intention than perceived moral intensity using a within-subject design. (shrink)

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was (...) present. The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

Attitudinal- and stress theory are used to investigate the effect of ethical climate on job outcomes. Responses from 208 service employees who work for a country health department were used to test a structural model that examines the process through which ethical climate (EC) affects turnover intention (TI). This study shows that the EC–TI relationship is fully mediated by role stress (RC), interpersonal conflict (IC), emotional exhaustion (EE), trust in supervisor (TS), and job satisfaction (JS). Results show that EC (...) reduces (RS) and increases TS. Lower stress levels result in lower EE, higher JS, and lower TI. Also, supervisor trust (TS) reduces IC and EE. The structural model predicts 53.9% of the variance of TI. (shrink)

When two actors have the same mental state but one happens to harm another person (unlucky actor) and the other one does not (lucky actor), the latter elicits a milder moral judgement. To understand how this outcome effect would affect post-harm interactions between victims and perpetrators, we examined how the social role from which transgressions are perceived moderates the outcome effect, and how outcome effects on moral judgements transfer to agentic and communal interpersonal goals. Three vignette experiments (N (...) = 950) revealed similar outcome effects on moral judgement across social roles. In contrast, outcome effects on agentic and communal goals varied by social role: victims exhibited the strongest outcome effects and perpetrators the weakest, with bystanders falling in between. Moral judgement did not mediate the effects of outcome severity on interpersonal goals. We discuss the possibility that outcome severity raises normative expectations regarding post-harm interactions that are unrelated to moral considerations. (shrink)

In the last decade, experimental philosophers have documented systematic asymmetries in the attributions of mental attitudes to agents who produce different types of side effects. We argue that this effect is driven not simply by the violation of a norm, but by salient-norm violation. As evidence for this hypothesis, we present two new studies in which two conflicting norms are present, and one or both of them is raised to salience. Expanding one’s view to these additional cases presents, we (...) argue, a fuller conception of the side-effect effect, which can be reversed by reversing which norm is salient. (shrink)

Utterances can convey more information than they explicitly encode, and speakers exploit communicative conventions in order to say more with less. However, the burden this places on perceivers is not well understood. This chapter examines the effect of speaker-specific information on pragmatic inferences using data from an experiment which investigated the time course of the use of pragmatic information in language comprehension. Previous evidence suggests that comprehenders who encounter a referential form, including a modifier that commonly indicates contrastiveness, assume (...) that the referential form is being used contrastively. Thus, they consequently look to the relevant object in the scene very early when processing the referential expression. In this case, people appear to be implicitly following H. P. Grice’s maxim of quantity. This chapter demonstrates that comprehenders stop using contrastive information early in resolving reference when speakers consistently do not use contrastive elements appropriately, consistent with a pragmatic explanation of referential contrast effects. (shrink)

The goal of this paper is to examine the impact of leadership and promotion regulatory focus on employees’ willingness to engage in unethical pro-organizational behavior . Building from a person–situation interactionist perspective, we investigate the interaction of leadership style and how leaders frame messages, as well as test a three-way interaction with promotion focus. Using an experimental design, we found that inspirational and charismatic transformational leaders elicited higher levels of UPB than transactional leaders when the leaders used loss framing, but (...) not gain framing. Furthermore, followers’ promotion regulatory focus moderated this relationship such that the effect held for followers with low promotion focus, but not for individuals with high promotion focus. Our findings extend the understanding of UPB, offer theoretical mechanisms to explain when this behavior occurs, and contribute to leadership theory and research on ethical decision making. (shrink)