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Survivor Guilt Analyzing the Concept and Its Contexts

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Abstract

Survivor guilt, a concept associated with the interpersonal process of "surviving" harm while others do not, increasingly appears in nursing, medicine, and psychology literature. Paradoxically, the phenomenon is rarely defined and often poorly described. Combining Rodger's evolutionary concept analysis with a comprehensive literature review, we explain the attributes, antecedents, consequences, related concepts, and surrogate terms of survivor guilt. A new definition emerged from the evolving use of the concept in new contexts. Survivor guilt is a valid form of suffering for which effective interventions need to be developed. This analysis extends the concept, laying the foundation for comprehensive treatment strategies.

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... Furthermore, Williams et al. (2000) mentioned that survivor guilt was a common experience in their study of ten non-carriers. A recent concept analysis of survivor guilt has divided the consequences into four main reactions: altered identity, altered relationships, mental health and physical symptoms and resolution (Hutson et al. 2015). Among the participants in our study, we could identify all reactions except resolution (i.e. when the feelings of survivor guilt dissipate), which could imply that the participants had already resolved possible guilt feelings. ...
... An expression of altered relationships was stated by a participant who avoided contact with the rest of the family due to feelings of guilt. On the other hand, Hutson et al. (2015) also showed that a person can successfully recover from survivor guilt by changing behaviour in a positive way (an example of altered identity). In the present study, one of the participants started to take a greater responsibility of her affected sibling's care and also exhibited positive changes in personal health behaviour. ...
... Furthermore, Hutson et al. (2015) describes the antecedents of the occurrence of survivor guilt: personal characteristics such as empathy or perfectionism, feelings of belonging and identification with others, sense of fairness and sociocultural expectations. The participants in the present study elaborated on the issue of unfairness towards the affected sibling. ...
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Little is known about how people's lives are influenced when going from a 50% risk status of Huntington's disease (HD) to no risk after performing predictive testing. In this study, 20 interviews were conducted to explore the long-term (> 5 years) experiences after receiving predictive test results as a non-carrier of HD. The results showed a broad variety of both positive and negative reactions. The most prominent positive reaction reported was feelings of relief and gratitude, of not carrying the HD mutation for themselves and for their children. Also, the non-carrier status promoted in some individuals' significant life changes such as a wishing to have (more) children, pursuing a career or breaking up from an unhappy relationship. However, negative reactions on their psychological well-being were also described. Some had experienced psychological pressure of needing to do something extraordinary in their lives; others expressed feelings of guilt towards affected or untested siblings, resulting in sadness or clinical depression. The new genetic risk status could generate a need of re-orientation, a process that for some persons took several years to accomplish. The results of the present study show the importance of offering long-term post-result counselling for non-carriers in order to deal with the psychological consequences that may follow predictive testing.
... The present study also identified feelings of survivor's guilt in both those who could and could not tolerate the therapy, a concept similarly reported in other life-limiting diseases [34,35]. The concept of survivor's guilt has been defined into four specific areas: altered identity, altered relationships, mental health and physical symptoms, and resolution [26,36]. The narrative identified each of these depictions aside from resolution (e.g., the feelings of guilt disappearing). ...
... Indeed, individuals manifested feelings of guilt due to the fact that they could now begin a life less compromised by CF, whereas others are not able to have that luxury. Similarly, as described in Hutson et al. [36], this shift in identity may have further repercussions when considering identification with others and feelings of belonging within the CF community. Alternatively, where the treatment failed, feelings of guilt centred around the idea that they were ungrateful or had wasted a treatment from which others could have benefited. ...
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Background: Modulator therapy represents a significant step forward in CF care and is expected to have a significant impact on the health and mortality of many individuals with CF. Studies have predominantly explored the physiological effects of modulator therapy on clinical outcomes, with little consideration of the individual lived experience of modulator therapy among adults with Cystic Fibrosis. Methods: To explore this, semi-structured interviews were conducted with 12 individuals currently taking Kaftrio, which were subsequently thematically analysed. Results: Three overarching themes were identified: (i) positive perception of Kaftrio, (ii) negative perception of Kaftrio, and (iii) the relationships with the clinical team. The experience of modulator therapy should be recognised as being unique to the individual, with perceptions of illness, self-identity, and outcomes strongly dictating the lived experience. Conclusions: There is a consensus that, while for many, the quality of life is evidently increased through the use of Kaftrio, this is not without its own challenges. This highlights the need for both individuals with CF and their clinical teams to learn to navigate this new disease landscape.
... Since Niederland coined the term it has been applied in a wide variety of situations where guilt is experienced by survivors. For example, remaining workers feeling guilty when co-workers have lost their jobs (Brockner et al., 1986); HIV-negative gay men with friends who have died of Aids (Ashman, 1995); where people survive disasters (Mallimson, 2003); and where people have tested negative for a genetic health condition and other family members have not (Hutson, Hall, & Pack 2015). Symptoms include grief, sadness, anxiety, stress, fatigue, headaches, insomnia, and self-harm including substance abuse, smoking, (Hutson et al., 2015) and overeating in my case. ...
... For example, remaining workers feeling guilty when co-workers have lost their jobs (Brockner et al., 1986); HIV-negative gay men with friends who have died of Aids (Ashman, 1995); where people survive disasters (Mallimson, 2003); and where people have tested negative for a genetic health condition and other family members have not (Hutson, Hall, & Pack 2015). Symptoms include grief, sadness, anxiety, stress, fatigue, headaches, insomnia, and self-harm including substance abuse, smoking, (Hutson et al., 2015) and overeating in my case. ...
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In this paper I explore the research process I undertook to recover from research. For three years from 2013 I was involved in a research project exploring the history of foster care in Australia. At the end I was exhausted and suffering trauma symptoms I initially attributed to the difficulties of juggling a major research project while teaching and undertaking key administrative tasks. Reluctance to write up the research findings, however, made me reconsider this attribution and at the end of 2016 I set out to make sense of what had happened to make me feel so bad while undertaking a research project I was thrilled to be involved with. Recovery came through identifying as a survivor-researcher, exploring the literature on trauma and recovery from trauma, and thinking through a “wish list” of protocols and self-care activities I should have put in place earlier. I conclude the paper with recommendations for ways by which survivor researchers can look after themselves, and ways for others to support survivor-researchers.
... Rosoman wrote in 1945 'I have my depressions but work goes on' [9]. Of course, the term PTSD didn't appear until 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders [10]. Because they survived and for Rosoman especially whose replacement at the hose was killed they could easily have experienced survivor guilt, a rarely defined and often poorly described phenomenon [10]. ...
... Of course, the term PTSD didn't appear until 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders [10]. Because they survived and for Rosoman especially whose replacement at the hose was killed they could easily have experienced survivor guilt, a rarely defined and often poorly described phenomenon [10]. At the same time, we should recognize that in workforces at risk there are factors such as camaraderie that might protect against the development of psychological sequelae [7]. ...
... The feeling of survivor guilt, while not anticipated, was not surprising. Although not well documented in the nursing literature, especially during a pandemic, others have reported feelings of survivor guilt after the loss of a loved one, a traumatic event, or in clinical practice settings such as oncology (Hutson et al., 2015). Emotional fluctuations associated with serving as a frontline nurse and experiencing persistent and prolonged exposure to the virus but not becoming infected with the virus could be a precursor to these feelings or other manifestations of posttraumatic stress disorder. ...
Article
The purpose of this phenomenological study was to describe the experience of frontline nurses working during the COVID-19 pandemic. The first author conducted two individual audiotaped interviews with 23 qualified staff nurses. All the authors analyzed the professionally transcribed data according to hermeneutic principles. The researchers identified five major themes: (a) we are family; (b) heroes work here; (c) fear of contagion; (d) mental health and well-being; and (e) new reality. Given the uncertainties of working during the COVID-19 pandemic, findings revealed the value of supportive collegial relationships and the need to support the mental health and well-being needs of frontline nurses during the pandemic. Nurses need supportive environments to help ease the challenges associated with serving on the frontline during times of crisis. Findings have implications for future public health preparedness and response efforts.
... Quite contrarily, the consciously guilty subject is able to better distinguish between self and behavior when reparative action along with remorse and apology serve for rehabilitation (Lewis, 1971;Tangney et al., 2007). Importantly, traumatic biographical experiences, early life stress and drastic losses can elicit pathologic guilt and shame (Wilson et al., 2006;Hutson et al., 2015;Lopez-Castro et al., 2019;Shi et al., 2021). ...
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INTRODUCTION: The aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation. METHODS: Three independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/shamadministration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced. RESULTS: A consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition (p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups (p<0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated. CONCLUSION: Although guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions. KEYWORDS chronic pain, trauma, stress, moral emotions, emotional memory, pain-proneness
... Quite contrarily, the consciously guilty subject is able to better distinguish between self and behavior when reparative action along with remorse and apology serve for rehabilitation (Lewis, 1971;Tangney et al., 2007). Importantly, traumatic biographical experiences, early life stress and drastic losses can elicit pathologic guilt and shame (Wilson et al., 2006;Hutson et al., 2015;Lopez-Castro et al., 2019;Shi et al., 2021). ...
Article
Full-text available
Introduction: The aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation. Methods: Three independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/sham administration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced. Results: A consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition (p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups (p<0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated. Conclusion: Although guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions. KEYWORDS chronic pain, trauma, stress, moral emotions, emotional memory, pain-proneness
... In these testimonies, it is evident that survivor guilt is the result of a conflict between the need to preserve one's own life and ensure one's own survival and the need to preserve bonds, based on a human prosocial sensitivity that promotes altruism and cooperation (Gazzillo et al., 2020a). Furthermore, these testimonies highlight how survivor guilt emerges even when the individual has no real power to influence the situation (Hutson, Hall, & Pack, 2015;Tangney & Dearing, 2002), suggesting that it is not necessary to have the intention to hurt in order to feel guilty, and that it is sufficient to recognize each other as fellow human beings Survivor guilt: Theoretical, empirical, and clinical features 3 and the other as equally deserving of a different fate than the one that befell them (Baumeister et al., 1994). ...
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The aim of this paper is to give the reader an overview of several theoretical, empirical, and clinical features of survivor guilt, and to integrate recent contributions of psychodynamic theory and, in particular, of control-mastery theory into the understanding of the concept alongside the latest findings in social psychology about it. After introducing the concept of survivor guilt and its origins in clinical observations on the consequences of having survived severe traumas (e.g., internment in concentration camps), we will discuss the findings in social psychology on the concept of survivor guilt in everyday social interactions, which is based on a conception that does not connect it strictly to severe traumas. We will then focus our attention on clinical observations and empirical research studies about survivor guilt, discussing the hypotheses developed by several control-mastery theorists about its role in psychopathology. Finally, we will illustrate some manifestations of survivor guilt with a brief clinical vignette.
... Although different disciplines have defined this term in disparate ways, it is viewed as a process by which a person experiences distress following being spared from harmful events that happened to others. The guilt experienced by the survivor is often viewed as a way to sustain a connection to loved ones who suffered or died [28]. The negative consequences of witnessing traumatic events that occur to another may also relate to collectivistic values, which are common in countries in Asia, Latin America, and Africa [29]. ...
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Refugees who settle in Western countries exhibit a high rate of mental health issues, which are often related to experiences throughout the pre-displacement, displacement, and post-displacement processes. Early detection of mental health symptoms could increase positive outcomes in this vulnerable population. The rates and predictors of positive screenings for mental health symptoms were examined among a large sample of refugees, individuals with special immigrant visas, and parolees/entrants (N = 8149) from diverse nationalities. Logistic regression analyses were used to determine if demographic factors and witnessing/experiencing violence predicted positive screenings. On a smaller subset of the sample, we calculated referral acceptance rate by country of origin. Refugees from Syria, Iraq, and Afghanistan were most likely to exhibit a positive screening for mental health symptoms. Refugees from Sudan, Iraq, and Syria reported the highest rate of experiencing violence, whereas those from Iraq, Sudan, and the Democratic Republic of Congo reported the highest rate of witnessing violence. Both witnessing and experiencing violence predicted positive Refugee Health Screener-15 (RHS-15) scores. Further, higher age and female gender predicted positive RHS-15 scores, though neither demographic variable was correlated with accepting a referral for mental health services. The findings from this study can help to identify characteristics that may be associated with risk for mental health symptoms among a refugee population.
... HIV + PWH, who were in the educational system in 1988 may have dropped out or decided not to pursue higher education in light of their perceived low life expectancy. In subsequent years where life expectancy dramatically improved for HIV + PWH, they may have experienced 'survivors guilt' [24] and felt undeserved of pursuing opportunities such as higher education, despite their life expectancy being the same as for HIV − PWH. ...
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Background: Between 1975 and 1985 a total of 91 Danish patients with moderate and severe hemophilia (PWH) was infected with HIV constituting a major scandal in the Danish health care system. This study describes the burden of HIV infection among Danish PWH by evaluating changes from 1988 to 2012 in well-being, social function, experiencing stigma and openness about disease among Danish HIV+ PWH. Methods: Three anonymous surveys were conducted in 1988, 2001 and 2012 targeting all Danish patients with moderate to severe hemophilia. Survey responses were received from 53, 21 and 18 HIV+ PWH respectively. A matched comparison sample of HIV- PWH was identified for each survey-year, using propensity score matching. Differences for each survey-year and trends over time were analyzed using ordinal logistic regression. Results: In 1988, HIV+ PWH had more psychosomatic symptoms than HIV- PWH, but in 2001 life satisfaction was higher among HIV+ PWH than among HIV- PWH. Tests of differences in trend over time showed larger improvements in life satisfaction among HIV+ PWH than HIV- PWH, while HIV- PWH showed an increase in educational level compared to HIV+ PWH. Analysis restricted to HIV+ PWH showed an increase in perceived stigmatization. Conclusions: Differences between Danish HIV+ and HIV- PWH regarding well-being and psychosomatic symptoms seem to have evened out between 1988 and 2012. However, results suggest that HIV+ PWH still experience stigmatization and lower levels of education.
... On the one hand, guilt is not conducive to the integration of individual post-traumatic core beliefs (Kubany and Manke, 1995). Survivors from the trauma may develop guilt behavior patterns, such as alexithymia, irritability and self-deprecation, which can lead to PTSD (Hutson et al., 2015). Some empirical studies have found that guilt is one of the predictive factors leading to the development of PTSD (Kubany et al., 1996;Beck et al., 2011;Norman et al., 2014). ...
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Objective: This study aims to examine the mediating roles of gratitude and social support in the relationship between survivor guilt and posttraumatic stress disorder (PTSD) as well as the relationship between survivor guilt and posttraumatic growth (PTG). Methods: The current study used self-report questionnaires to investigate 706 adolescent survivors of Lushan county three and a half years after the Ya’an earthquake. The structural equation model was used to evaluate the relations between survivor guilt, gratitude and social support in PTSD and PTG. Results: The results indicated that survivor guilt had a positive effect on both PTSD and PTG. Gratitude partly mediated the relation between survivor guilt and both PTSD and PTG; social support partly mediated the relation between survivor guilt and PTG but not PTSD as well as the relation between gratitude and PTG. Conclusion: Survivor guilt has a double-edged sword effect. Survivor guilt affects PTSD and PTG through gratitude, and it could affect PTG but not PTSD through social support. Gratitude decreases PTSD and increases PTG, whereas social support only increases PTG.
... It is not known if never-deployed soldiers experience vicarious traumatization through secondary exposure to traumas experienced by their deployed peers. It is also possible that these nondeployment emotions are akin to "survivor's guilt," in which an individual experiences negative emotional states when others were physically or psychologically injured, but the individual remained alive and uninjured (Hutson et al., 2015). Additionally, never being deployed may interfere with unit connectedness, which has been shown to be important for overall service member well-being (Kline et al., 2013;Vest et al., 2017;Walsh et al., 2014). ...
Article
Background Limited research shows that mental health problems are prevalent among never‐deployed soldiers and many experience negative emotions related to their nondeployment. U.S. Army Reserve/National Guard (USAR/NG) soldiers are also at high risk for alcohol misuse. However, it is not known if nondeployment emotions contribute to an increased risk of alcohol misuse among never‐deployed USAR/NG soldiers. Methods Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study of USAR/NG soldiers. We used regression models to examine the relations between nondeployment emotions, assessed by the Non‐Deployment Emotions (NDE) Questionnaire, and a range of alcohol use outcomes, assessed by the Alcohol Use Disorders Identification Test and standard quantity and frequency questions, among a sample of never‐deployed soldiers who were partnered at baseline (N = 174). Final models controlled for years of military service, current number of close military friends in the social network, marital satisfaction, and depression. We also tested for potential differences in these associations by sex. Results Nondeployment emotions were associated with frequency of getting drunk (adjusted risk ratio [aRR] = 1.02, 95% CI: 1.01, 1.04; p < 0.05) and typical number of drinks consumed during a drinking episode (aRR = 1.03, 95% CI: 1.01, 1.04; p < 0.01). Nondeployment emotions had a trend‐level association with percent of days drinking (adjusted odds ratio = 1.05, 95% CI: 1.00, 1.11; p = 0.055). Nondeployment emotions had a significant interaction with sex (p < 0.05) on the likelihood of alcohol problems, such that only male soldiers experienced a greater likelihood of alcohol problems when they had highly negative nondeployment emotions. There was no relation between nondeployment emotions and alcohol problems among female soldiers. Conclusions Findings demonstrate that greater nondeployment emotions are associated with increased alcohol use among never‐deployed USAR/NG soldiers. The NDE Questionnaire may assist in identifying those at highest risk for alcohol problems.
... Sleep disturbance is a hallmark sign of PTSD that drives individuals to use substances As a nurse caring for Adam, it is crucial to identify nursing diagnoses relevant to the coexisting conditions to initiate care. The distressing symptoms of PTSD and SUD ultimately put Adam at risk for self-harm behaviors including self-mutilation, suicide, and para-suicidal acts (Hutson et al., 2015). Nursing diagnoses relevant to this behavior include risk for selfdirected violence, the risk for suicide, and risk for self-mutilation (Halter, 2014). ...
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Background: Living with a dual diagnosis such as posttraumatic stress disorder and substance use disorder is extremely challenging to individuals with mental illness. Reexperiencing the trauma, avoidance of stimuli exaggerated startled responses, irritability, and alterations in mood, especially chronic depression, are common in post-traumatic stress. Individuals with substance use problems have loss of behavioral control and the inability to abstain. Purpose: The purpose of this review is to describe the concept of dual diagnosis to promote understanding of this condition and discuss potential interventions for patient care in psychiatric nursing. Method: A thorough review of the literature for peer reviewed studies on dual diagnosis, post traumatic stress disorder, and substance use disorder resulted in several articles. Results: A comprehensive assessment and provisions for management of anxiety are necessary to improve selfesteem and coping skills. Interventions for coexisting mental illness and substance use disorders are more effective with integrative interventions that address the disorders concurrently.
... 19 Survivor guilt is a phenomenon described in other populations in which an individual experiences feelings of guilt for having remained alive and uninjured when others were physically or psychologically injured. 20 However, it is not known if survivor guilt is universally experienced by never-deployed soldiers and if this phenomenon contributes to PTSD among never-deployed soldiers. ...
Article
Introduction In the UK, primary healthcare practices choose from a series of Read codes to detail certain characteristics onto a patient’s medical documentation. One of these codes is for military veterans indicating a history relating to military service. However, veterans are poor at seeking help, with research indicating that this code is only applied in 7.9% of cases. Clinical staff have a clear role in motivating veterans to declare their ex-Forces status or register with a primary healthcare center. The aim of this study was to motivate veterans to notify primary healthcare staff of their armed forces status or register with a general practitioner, and to improve primary healthcare staff’s understanding of veterans’ health and social care issues. Materials and Methods Data were provided by four primary healthcare centers’ containing 40,470 patients in Lancashire, England during 2017. Pre- and post-patient medical record Read Code searches were conducted either side of a 6-wk intervention period centered on an advertising campaign. The data identified those veterans with the military specific Read code attached to their medical record and their age, gender, marital status and mental health disorders. Further information was gathered from interviews with eight members of staff, some of whom had completed an e-learning veteran healthcare academic module. The study was approved by the University of Chester’s Research Ethics Committee. Results The pre-intervention search indicated that 8.7% (N = 180) of veterans were registered and had the correct military specific code applied to their medical record. Post-intervention, this figure increased by nearly 200% to N = 537. Mental health disorders were present in 28% (N = 152) of cases, including 15% (N = 78) with depression. Interviews revealed the primary healthcare staff’s interpretation of the factors that motivated patients to declare their ex-Forces status and the key areas for development. Conclusion The primary healthcare staff took ownership and responsibility for this initiative. They were creative in introducing new ways of engaging with the local armed forces community. Many veterans’ and staff were unaware of veterans’ entitlement to priority medical services, or the wider provisions available to them. It is probable that veterans declaring their military status within primary healthcare, or registering with a general practitioner for the first time is likely to increase. Another review will be undertaken after 12 mo, which will provide a better indication of success. There remains however an ongoing need to reach out to those veterans who never access a primary healthcare practice. This paper adds to the limited international empirical evidence undertaken to explore help-seeking behavior in an armed forces community. The positive outcomes of increased awareness and staff commitment provide a template for improvement across the UK, and will potentially stimulate similar initiatives with international colleagues.
... 19 Survivor guilt is a phenomenon described in other populations in which an individual experiences feelings of guilt for having remained alive and uninjured when others were physically or psychologically injured. 20 However, it is not known if survivor guilt is universally experienced by never-deployed soldiers and if this phenomenon contributes to PTSD among never-deployed soldiers. ...
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Background Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers’ well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions. Methods We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174). Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing survey-based study examining the health of USAR/NG soldiers and their partners. The protocol was approved by the Institutional Review Board at the State University of New York at Buffalo. The relationship between each of the items was examined by calculating correlation and alpha coefficients. Latent class analyses tested for the existence of distinct levels of negative emotions related to non-deployment. Negative binomial regression models examined the cross-sectional associations between NDE summary score and each of the following outcomes, separately: anger, anxiety, depression, and post-traumatic stress. Findings More than half of never-deployed USAR/NG soldiers expressed negative emotions for having not been deployed. “Guilt,” “value,” “camaraderie,” and “connectedness” were each positively correlated with each other (p < 0.001) and the internal consistency reliability was high (male soldier α = 0.90, female soldier α = 0.93). Latent class analyses revealed a superior three-class model with well-delineated class membership (entropy = 0.93): “Class 1” (low NDE; 47.6%), “Class 2” (moderate NDE; 33.8%), and “Class 3” (high NDE; 18.6%). Regression models demonstrated that greater non-deployment emotions were independently associated with more severe anger (RR = 1.02, 95% CI: 1.01, 1.03, p < 0.001), anxiety (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), depression (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), and PTSD (RR = 1.10, 95% CI: 1.04, 1.16, p < 0.01). Discussion Findings demonstrate that negative emotions regarding non-deployment are prevalent among never-deployed USAR/NG soldiers and that these emotions are related to a mental health. The NDE provides a measure of “guilt,” “value,” “camaraderie,” and “connectedness” specific to non-deployed soldiers and is able to well discriminate between soldiers that have low, moderately, and highly negative non-deployment emotions. These findings suggest that all military personnel, regardless of deployment status, could be at risk for negative outcomes. As with any survey-based study, there is a potential for response bias; however, given the range of responses collected with the NDE, social desirability is unlikely. Further work is needed to confirm our findings in other components of the military and to examine soldiers in the rear detachment.
... Perhaps a better analogy, then, is survivor's guilt. Survivor's guilt refers to a form of suffering resulting from "surviving" harm while others do not (Hutson, Hall, and Pack 2015). Someone who experiences this form of guilt has remained alive, uninjured, or otherwise unharmed in circumstances where others have not. ...
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Do neurosurgical procedures ever result in the patient prior to the procedure not being identical with the individual who wakes up postsurgery in the hospital bed? We address this question by offering an analysis of the persistence of persons that emphasizes narrative, rather than numerical, identity. We argue that a narrative analysis carries the advantage of highlighting what matters to patients in their ordinary lives, explaining the varying degrees of persistence of personal identity, and enhancing our understanding of patients' experiences. We illustrate these points in cases involving temporal lobectomy for treatment of refractory epilepsy and deep brain stimulation for refractory Parkinson's disease.
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With more than 25 million refugees around the globe and forced displacement an intractable issue, how can social workers provide mental health services that account for refugee families’ complex displacement narratives and needs? In this article, we argue for a global perspective on mental health, seeking to go beyond the immediate, local context which is too often bounded by the nation-state, and for going beyond the individual level to consider family, community, and culture as sources of strength and connections. Specifically, this article introduces a transnational collectivist approach (TCA) to mental health service delivery with refugee families. This approach acknowledges that even after resettlement in the United States, refugees continue to engage with and support members of their immediate and/or extended family in their country of origin and in other host countries, including those in refugee campus. Furthermore, this approach also builds on the insight that family, extended family members, and cultural communities may have shared experiences of both trauma and healing. Our article defines a TCA framework and concludes with practical elements and recommendations for mental health practitioners and clinicians to consider when working with refugee families.
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Поняття моральної травми (МТ) здебільшого розглядається як стан, при якому людина не змогла адаптуватися до стресової ситуації та її наслідків через порушення власних етичних переконань. Попри дослідження МТ переважно у військових чи професійних груп зони ризику, у науковій літературі відсутні дані щодо ефективних психологічних інтервенцій при моральній травматизації. Метою цього дослідження є теоретичне вивчення існуючих психологічних інтервенцій, які рекомендуються для роботи з МТ, а також розробка та впровадження цілісної психологічної програми, спрямованої на роботу з МТ у військових та цивільних під час воєнного стану. Для досягнення мети у роботі використовувалися методи теоретичного аналізу та моделювання МТ та її наслідків, метод кейс аналізу, а також природний експеримент з впровадження програми «Дорога до себе», яка реалізовувалася у форматі групової роботи з військовими та їхніми сім’ями (n=10), а також онлайн ресурсу самодопомоги цивільному населенню під час воєнного стану (n=48). Результати дослідження впровадження експериментальної програми «Дорога до себе» свідчать про те, що вона є ефективною для цивільного населення для зменшення проявів депресії в умовах тривалого травматичного стресу під час війни (t=2,04, p=0,04 в експериментальній групі до і після впровадження програми), а також для наповнення власного життя смислом (t=1,94, p=0,04 в експериментальній групі до і після впровадження програми), що є важливим чинником при роботі з МТ. Водночас для ефективності психологічної допомоги при моральній травматизації, вважаємо, що у програму слід додати модулі, присвячені природі МТ, а також роботі із синдромом «вцілілого», який загострений під час воєнного стану. Аналіз кейсів із психологічної допомоги ветеранам та їхнім дружинам свідчить про те, що програма «Дорога до себе» є ефективною для адаптації учасників бойових та їхніх сімей до цивільного життя. Ключові слова: моральна травма, військове та цивільне населення, експериментальна програма «Дорога до себе».
Article
Phenomenon: Transformative learning is a theory in which individuals construct new or revised interpretations of the meaning of an experience. COVID-19 offers a rare opportunity to better understand how individuals respond to and make meaning within the shared context of an extraordinary event. We aimed to examine if and how residents and fellows engaged in transformative learning when caring for COVID-19 positive patients during the initial peak of the pandemic (Spring 2020). Approach: We conducted an interpretive qualitative study to identify themes pertaining to transformative learning. We used semi-structured interviews of residents and fellows who were directly or indirectly involved in the care of COVID-19 positive patients admitted to the inpatient wards or the intensive care units during the first peak of the pandemic (defined as March 11th – May 28th, 2020) at our Mid-Atlantic academic health system. We used the medium of comics to depict select interviewees’ experiences during the pandemic as a novel way to represent themes from the interviews. Findings: Three main themes arose from our qualitative analysis. These included “a sense of guilt,” “the impact on training,” and “venues and processes for reflection.” In comparing their experiences with colleagues and friends at other institutions with higher COVID-19 case volume, trainees reflected on how they felt lucky, and this led to guilt, although not necessarily transformation. The impact of COVID-19 on the training environment had transformative potential. Trainees challenged their previously held assumptions on the necessity of various surgeries, in-person visits, and physical examination maneuvers when COVID-19 posed a barrier. Finally, while trainees recalled multiple situations throughout the pandemic when they believed they were engaging in reflection, such reflection did not appear to reach so deep as to alter participants’ underlying assumptions until the research interview itself, suggesting that transformation was incomplete. Insights: Our purposive sample of residents and fellows who cared for COVID-19 positive patients during the initial peak of the pandemic made meaning of their experience in multiple ways. The largest shift in worldview due to the pandemic appeared to be related to the instrumental utility of certain common medical practices or procedures. This, in turn, was the most prominent influence on how these trainees felt they would practice in the future, and translated to a shift in how they appraised evidence. However, lack of opportunity for reflection may have adversely impacted the ability for transformation to take place. Given that multiple trainees showed appreciation for the critical reflection venue that was the research interview, academic leadership should ensure similar venues exist during training, even after the pandemic ends.
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BACKGROUND: Natural disasters continue to occur worldwide, influencing the economy, finances, and psychological problems. Traumatic on children is an impact of the catastrophe likely a burden on the family, especially mothers who accompany their children as caregivers. AIM: The purpose of the study was to explore children’s traumatic experiences from mothers in a family in a rural community in Indonesia. METHODS: We conducted six focus groups with mothers to explore their traumatic children’s experiences using a qualitative research design. Thirty mothers with children 3−10 years old contributed to the focus groups across all sites. We formed focus groups with six mothers and continued in-depth interviews, including nine mothers. RESULTS: The mothers had similar experiences understanding their children’s trauma due to natural tornado disasters. This study revealed three overarching themes shaping the mothers’ experience: anxiety in children, trauma trigger, and lingering distress. All themes lead to the main theme is psychological distress in the face of a child suffering from PTSD. From the hermeneutical perspective, topics can be identified as terms, including being-thrownness, being-fallenness and being-alongside. CONCLUSION: Children with post-traumatic stress disorder may impact family physiological problems, especially the mother. The study found that may place the burden of care for children on the person’s families.
Article
Objective This scoping review describes the existing literature which examines the breadth of healthcare providers’ (HCP's) experiences with the provision of medical assistance in dying (MAiD). Method This study employed a scoping review methodology: (1) identify research articles, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize the results. Results In total, 30 papers were identified pertaining to HCP's experiences of providing MAiD. Fifty-three percent of the papers were from Europe ( n = 16) and 40% of studies were from the USA or Canada ( n = 12). The most common participant populations were physicians ( n = 17) and nurses ( n = 12). This scoping review found that HCPs experienced a variety of emotional responses to providing or providing support to MAiD. Some HCPs experienced positive emotions through helping patients at the end of the patient's life. Still other HCPs experienced very intense and negative emotions such as immense internal moral conflict. HCPs from various professions were involved in various aspects of MAiD provision such as responding to initial requests for MAiD, supporting patients and families, nursing support during MAiD, and the administration of medications to end of life. Significance of results This review consolidates many of the experiences of HCPs in relation to the provision of MAiD. Specifically, this review elucidates many of the emotions that HCPs experience through participation in MAiD. In addition to describing the emotional experiences, this review highlights some of the roles that HCPs participate in with relation to MAiD. Finally, this review accentuates the importance of team supports and self-care for all team members in the provision of MAiD regardless of their degree of involvement.
Book
Do emotions happen inside separate hearts and minds, or do they operate across the spaces between individuals? This book focuses on how emotions affect other people by changing their orientation to what happens in the social world. It provides the first sustained attempt to bring together literature on emotion's social effects in dyads and groups, and on how people regulate their emotions in order to exploit these effects in their home and work lives. The chapters present state-of-the-art reviews of topics such as emotion contagion, social appraisal and emotional labour. The book then develops an innovative and integrative approach to the social psychology of emotion based on the idea of relation alignment. The implications not only stretch beyond face-to-face interactions into the wider interpersonal, institutional and cultural environment, but also penetrate the supposed depths of personal experience, making us rethink some of our strongly held presuppositions about how emotions work.
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Attributes of survivor guilt are present in the cancer survivorship population, including the presence of distress and loss, identification with a community, and surviving a situation that others have not. Oncology social workers must be aware of feelings and experiences that may be evoked when individuals witness fellow patients suffering and/or dying. In response, survivors may compare their own lives with the lives of those who have died and struggle to justify their existence. Often underlying feelings of guilt can be a sense of overwhelming helplessness, loss of control, grief, mourning, and a deep sense of injustice. This paper will explore the clinical manifestations and therapeutic interventions used to support individuals experiencing survivor guilt through discussion and case examples. The importance of addressing survivor guilt experienced by the clinician and within medical teams will be highlighted and future recommendations for research and program planning in this area will be discussed.
Article
Objectives: Historically, long-term survival following diagnosis of lung cancer has been a rare occurrence. An overall poor prognosis and the low likelihood of long-term survival are thought to precipitate survivors experiencing what is referred to as survivor guilt. This study explored the prevalence and nature of survivor guilt among lung cancer survivors. Methods: Lung cancer survivors (n = 108) completed an online survey through a national organization’s online community platform. This survey included a commonly used measure of survivor guilt targeting lung cancer and a single item that asked about whether they had experienced survivor guilt associated with lung cancer. Additionally, survivors were asked to provide open-ended descriptions of survivor guilt. In-depth thematic analysis was used to analyze these in-depth responses from those with the highest guilt scores on the survey measure (top quartile). Results: Survey responses revealed a majority of study respondents endorsed survivor guilt with 55% reporting an experience of survivor guilt associated with lung cancer. In addition, 63.9% of respondents scored above the mean on the survivor guilt scale. Qualitative analysis revealed five recurring themes among respondents with the highest survivor guilt scores (top quartile): 1) mentioning the death of others, 2) questioning “why not me?” 3) the role of the passage of time on emotions experienced, 4) the role of demographic and clinical characteristics’ on survivor guilt, and 5) strategies for coping with survivor guilt. Conclusions: This study identifies survivor guilt in lung cancer survivors and raises clinical awareness that managing survivor guilt is a psychosocial challenge for lung cancer survivors. Results highlight the need for addressing this critical issue.
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The American Board of Genetic Counseling (ABGC) certification examination (often referred to as "the board exam") has become a milestone within the field of genetic counseling. For many, it is the final standardized test taken and indicates the examinee has met "the standards of minimal competence to practice as a genetic counselor" (Bulletin 2015). Although voluntary, certification is strongly encouraged, and in some employment situations, required. Although recent statistics indicate the majority of those who take the test pass, each year there are those who sit for the test unsuccessfully. Despite this fact, exam failure and tools for dealing with this experience are not often broached in the literature. This essay recalls my experiences with a failed exam attempt and the subsequent emotional turmoil. It also aims to start the conversation regarding the difficulty of coping with the "secret" shame of public, professional failure, and suggests there is room for further discussion and resource development in this area.
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Recent research has focused on the positive consequences of guilt as opposed to shame. The present studies investigated the relationship between interpersonal guilt related to the fear of harming others, shame, and various measures of psychological distress and symptoms. The Interpersonal Guilt Questionnaire, The Guilt Inventory, the Test of Self-Conscious Affect, the Brief Symptom Inventory, the Beck Depression Inventory, and the Coopersmith Self-Esteem Inventory were administered to samples of college students. These results suggest that interpersonal guilt, when elevated and linked to pathogenic beliefs, may also be associated with psychological problems and indicate that there may be a down side to guilt.
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Various authors hold that some emotions (i.e., moral emotions) have the function of orienting people toward ethical actions. In addition to embarrassment, shame and pride, the moral emotion of guilt is believed to affect humans' behavior when they carry out transgressions that violate social and cultural standards. Over the past century, many studies (including controversial ones) have been conducted on guilt. In this study, we analyzed and summarized mainly the most recent literature on this emotion. On one side, the destructiveness of guilt is emphasized. It inflicts punishment and pain on individuals for their errors and can lead to psychopathology (e.g., depression). On the other side, it is described as a "friendly" emotion that motivates behavior adapted to social and cultural rules. How can this asymmetry be explained? Different existing views on guilt are presented and discussed, together with recent proposals, supported by research data. Finally, we discussed some systematic models that try to incorporate these different views in a single framework that could facilitate future researches.
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In prior research submissive behaviour has been studied in relation to social comparison. Evolutionary theory conceptualized submissive behaviour as a fear-based self-protective strategy when in a subordinate position. In this study we hypothesized that survivor guilt, the type of guilt associated with feeling better off than others, is also linked to submissive behaviour. The Interpersonal Guilt Questionnaire, the Submissive Behaviour Inventory, the Eysenck Personality Questionnaire-Revised and the Automatic Thoughts Questionnaire were administered to a sample of 199 college students. Submissive behaviour was found to be significantly correlated with survivor guilt. Introversion, used as an indirect measure of the fear of being put down, was also correlated with submissive behaviour. A principal components analysis found two components: the first was composed of high loadings of submissiveness, survivor guilt and omnipotent responsibility guilt; the second was composed of high loadings of submissiveness and introversion. This supports the hypothesis that there may be two motivational states related to submissive behaviour, the fear of harm to the self, as described in prior studies, and the fear of harm to another or guilt-based submissive behaviour. We propose that survivor guilt has been selected by evolution as a psychological mechanism supporting group living, and that it may be considered from the perspective of inclusive fitness, reciprocal altruism, and multilevel selection theory.
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Although studies have suggested a disproportionate rate of suicide among war veterans, particularly those with postservice psychiatric illness, there has been little systematic examination of the underlying reasons. This study aimed to identify factors predictive of suicide among Vietnam combat veterans with posttraumatic stress disorder (PTSD). Of 187 veterans referred to the study through a Veterans Administration hospital, 100 were confirmed by means of a structured questionnaire and five clinical interviews as having had combat experience in Vietnam and as meeting the DSM-III criteria for PTSD. The analysis is based on these 100 cases. Nineteen of the 100 veterans had made a postservice suicide attempt, and 15 more had been preoccupied with suicide since the war. Five factors were significantly related to suicide attempts: guilt about combat actions, survivor guilt, depression, anxiety, and severe PTSD. Logistic regression analysis showed that combat guilt was the most significant predictor of both suicide attempts and preoccupation with suicide. For a significant percentage of the suicidal veterans, such disturbing combat behavior as the killing of women and children took place while they were feeling emotionally out of control because of fear or rage. In this study, PTSD among Vietnam combat veterans emerged as a psychiatric disorder with considerable risk for suicide, and intensive combat-related guilt was found to be the most significant explanatory factor. These findings point to the need for greater clinical attention to the role of guilt in the evaluation and treatment of suicidal veterans with PTSD.
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Forty-four veterans with posttraumatic stress disorder (PTSD) from World War II and Vietnam were compared. The groups were comparable on many socioeconomic and combat measures and age at onset of PTSD. Vietnam veterans exhibited more severe PTSD symptoms, higher Hamilton depression scores, and higher scores on the hostility, psychoticism, and "additional symptom" Symptom Checklist-90 (SCL-90) scales. They also had more survivor guilt, impairment of work and interests, avoidance of reminders of trauma, detachment/estrangement from others, startle response, derealization, and suicidal tendencies. Differences were noted between the groups as to the nature of upsetting experiences. Vietnam veterans had a greater lifetime frequency of panic disorder and an earlier age of onset for alcoholism. In other respects, the two groups were diagnostically similar, with PTSD being related to the sequential emergence of psychiatric diagnoses in similar manner for World War II and Vietnam patients.
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Multiple sets of empirical research findings on guilt are reviewed to evaluate the view that guilt should be understood as an essentially social phenomenon that happens between people as much as it happens inside them. Guilt appears to arise from interpersonal transactions (including transgressions and positive inequities) and to vary significantly with the interpersonal context. In particular, guilt patterns appear to be strongest, most common, and most consistent in the context of communal relationships, which are characterized by expectations of mutual concern. Guilt serves various relationship-enhancing functions, including motivating people to treat partners well and avoid transgressions, minimizing inequities and enabling less powerful partners to get their way, and redistributing emotional distress.
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We describe the development of a new measure to assess guilt related to concern about harming others. The two versions of the Interpersonal Guilt Questionnaire, a 45-item and 67-item version, include theoretically-based and clinically relevant categories of guilt: survivor guilt, separation/disloyalty guilt, omnipotent responsibility guilt, and self-hate guilt. Preliminary reliability and validity studies for both versions are presented, based on clinical and nonclinical samples of subjects. Subscales on both versions show good internal consistency; however, the second version, which expanded on the first, is more psychometrically sound overall. Both versions demonstrated predicted correlations with previously published measures of guilt and related affects, such as shame and depression, and with attributional style. Differences between clinical and nonclinical samples are reported and the relevance of survivor guilt and shame to psychopathology is noted.
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Among the victims of floods, earthquakes, and hurricanes, there is an increased prevalence of post-traumatic stress disorder and depression, which are risk factors for suicidal thinking. We conducted this study to determine whether natural disasters affect suicide rates. From a list of all the events declared by the U.S. government to be federal disasters between 1982 and 1989, we selected the 377 counties that had each been affected by a single natural disaster during that period. We collected data on suicides during the 36 months before and the 48 months after the disaster and aligned the data around the month of the disaster. Pooled rates were calculated according to the type of disaster. Comparisons were made between the suicide rates before and those after disasters in the affected counties and in the entire United States. Suicide rates increased in the four years after floods by 13.8 percent, from 12.1 to 13.8 per 100,000 (P<0.001), in the two years after hurricanes by 31.0 percent, from 12.0 to 15.7 per 100,000 (P<0.001), and in the first year after earthquakes by 62.9 percent, from 19.2 to 31.3 per 100,000 (P<0.001). The four-year increase of 19.7 percent after earthquakes was not statistically significant. Rates computed in a similar manner for the entire United States were stable. The increases in suicide rates were found for both sexes and for all age groups. The suicide rates did not change significantly after tornadoes or severe storms. Our study shows that suicide rates increase after severe earthquakes, floods, and hurricanes and confirms the need for mental health support after severe disasters.
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This study compares self-focused motivations (fear of negative evaluation, social comparison, and fear of envy) and other-focused motivations (empathy and interpersonal guilt) in submissive behavior and depression. The Beck Depression Inventory, Submissive Behavior Scale, Fear of Negative Evaluation Scale, Social Comparison Scale, Interpersonal Guilt Questionnaire, and Interpersonal Reactivity Inventory were administered to 50 patients hospitalized for depression and 52 students. Depressed patients were significantly higher in survivor guilt, omnipotent responsibility guilt, submissive behavior, fear of negative evaluation, fear of envy, and empathic distress, and lower in social comparison. This research was limited in that it was a correlational study. This study suggests that altruistic concern about others may be an important factor in depression and submissive behavior. Evolutionary implications of these findings are discussed.
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The familial context plays an important role in psychosocial responses to genetic testing. The purpose of this study was to compare sibling pairs with different combinations of BRCA1/BRCA2 test results on measures of affect, interpersonal responses, and physiological reactions. Forty-nine sibling dyads with different combinations of BRCA1/BRCA2 test results (i.e., mixed, positive, negative) completed a questionnaire, and 35 of the dyads also participated in a laboratory-based discussion of genetic testing. The primary outcome variables included participant reports of supportive actions toward their sibling, state anger and anxiety, perceptions of sibling behavior, and electrodermal responses. Compared to positive and negative dyads, mixed pairs reported less friendly general support actions, noted more anger, and perceived their sibling to be less friendly and more dominant during the interactions. In comparisons between same-result (i.e., positive, negative) pairs, positive dyads reported more dominant support behaviors and perceived their sibling to be friendlier during the interactions. Data suggest that siblings who have different test results may experience more interpersonal strain than siblings who have the same test result. Future research on genetic testing and family relationships can expand upon these findings.
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Compared a group of 52 concentration camp and other survivors of World War II with a control group of 29 persons of similar European and religious background. 47 children of these survivors and 16 children from the comparison group were also evaluated. The psychological adjustment (MMPI; Parent and Children's version of the Current Life Functioning Form) of both groups of adults and their children was within the normal range. Cultural rather than specific survivor influences were noted in the present attitudes and behaviors of the parents. There were no significant differences between the survivor and control group children on any of the psychological variables or in their attitudes and behaviors toward their parents. Based on these findings, the authors question notions of survivor guilt, the manifestation of emotional blunting in the survivors, and the extremely maladaptive psychological influence of their parents' experiences on the children of survivors. (21 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Article
Objective. —To provide guidance on informed consent to clinicians offering cancer susceptibility testing.Participants. —The Task Force on Informed Consent is part of the Cancer Genetics Studies Consortium (CGSC), whose members were recipients of National Institutes of Health grants to assess the implications of cancer susceptibility testing. The 10 task force members represent a range of relevant backgrounds, including various medical specialties, social science, genetic counseling, and consumer advocacy.Evidence. —The CGSC held 3 public meetings from 1994 to 1996. At its first meeting, the task force jointly established a list of topics. The cochairs (G.G. and J.R.B) then developed an outline and assigned each topic to an appropriate writer and reviewer. Writers summarized the literature on their topics and drafted recommendations, which were then revised by the reviewers. The cochairs compiled and edited the entire manuscript. All members were involved in writing this report.Consensus Process. —The first draft was distributed to task force members, after which a meeting was held to discuss its content and organization. Consensus was reached by voting. A subsequent draft was presented to the entire CGSC at its third meeting, and comments were incorporated.Conclusions. —The task force recommends that informed consent for cancer susceptibility testing be an ongoing process of education and counseling in which (1) providers elicit participant, family, and community values and disclose their own, (2) decision making is shared, (3) the style of information disclosure is individualized, and (4) specific content areas are discussed.
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With an increasing number of women surviving breast cancer beyond treatment, the focus of care has shifted from the acute treatment-related side effects to long-term effects associated with changes in quality of life (QOL). Part I of this article described the impact of breast cancer on the domains of physical and social well-being of 21 long-term survivors of breast cancer through qualitative analysis. Part II explores the impact of breast cancer on the domains of psychological and spiritual well-being.
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Since 1981, Acquired Immunodeficiency Syndrome (AIDS) has affected the lives of many Americans, particularly the lives of gay males. There is little research on the effects of grief and bereavement this community continues to experience. Therefore, an investigation was undertaken to find whether survivor guilt was evident in gay males in a large metropolitan community. Fifteen gay men were interviewed on their experiences of grief and survivor guilt and 77 questionnaires containing a subset of interview questions were completed. Results indicate that a modest amount of survivor guilt is experienced in the gay community; those with more experience of HIV or AIDS related illnesses and deaths had less survivor guilt than those who had experienced fewer illnesses and deaths. Gay men who are involved with gay/AIDS organizations have a significant reduction in survivor guilt feelings. The majority of gay men think about persons suffering or dying from AIDS a great deal of the time; thus therapists should explore the history of AIDS loss in gay male clients. The denial that some gay men use in relation to their feelings about those who have died from AIDS should be examined carefully. Furthermore, the need for gay bereavement groups and resocialization groups will continue to expand.
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With an increasing number of women surviving breast cancer beyond treatment, the focus of care has shifted from the acute treatment-related side effects to long-term effects associated with changes in quality of life (QOL). Part I of this article described the impact of breast cancer on the domains of physical and social well-being of 21 long-term survivors of breast cancer through qualitative analysis. Part II explores the impact of breast cancer on the domains of psychological and spiritual well-being.
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A patient with posttraumatic stress disorder (PTSD) had a major depressive episode that was responsive to treatment with the antidepressant fluoxetine. In contrast to the remission of other symptoms of depression, the associated feature of survivor guilt became more dramatically obvious. Individualized treatment of survivor guilt may be needed for patients with PTSD and major depression.
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By January 1, 1991 a total of 388 persons had enrolled in the Canadian collaborative study of predictive testing for Huntington disease (HD). Of these participants, 105 persons have been given a decreased risk result. Contrary to expectations, approximately 10% of persons with a decreased risk result have had psychological difficulties coping with their new status. Here, we describe the individual responses of 6 such persons and experiential themes emerging after following these persons for up to 2 years. Individuals who are more likely to suffer an adverse reaction to a decreased risk result include those persons who have made irreversible decisions based on the belief they would develop HD or those who had unrealistic overoptimistic expectations of the positive effects of a decreased risk result. In contrast to those receiving an increased risk result, the most vulnerable time for persons receiving a decreased risk result is between 2 and 12 months after learning the outcome. The need for assessment and counselling of participants in predictive testing programs, even when there is a decreased risk result, is emphasized.
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Within the context of their new constructivist self-development theory, the authors discuss therapists'' reactions to clients'' traumatic material. The phenomenon they term vicarious traumatization can be understood as related both to the graphic and painful material trauma clients often present and to the therapist''s unique cognitive schemas or beliefs, expectations, and assumptions about self and others. The authors suggest ways that therapists can transform and integrate clients'' traumatic material in order to provide the best services to clients, as well as to protect themselves against serious harmful effects.
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Emerging adulthood is the life stage between adolescence and young adulthood, and it has been associated with several important developmental milestones. A cancer diagnosis has the potential to disrupt the normal achievement of these milestones. Many psychosocial themes relevant to emerging adults living with cancer have been identified, but there has been only limited research into the needs of this group. The present study seeks to contribute to this limited research base and inform our understanding of the needs of emerging adults with a diagnosis of cancer from a developmental perspective that appreciates the key transitional tasks of emerging adulthood. This needs-based qualitative study was conducted with 14 young people with a diagnosis of cancer, aged 20 to 25 years. Nine participated in a focus group, and the remaining 5 participated in 1-on-1 telephone interviews. The needs of these emerging adults in relation to their cancer experience were grouped into 6 themes: information, healthcare provision, daily living, interpersonal support, identity renegotiation, and emotional distress. A cancer experience poses the potential for significant impact on the 4 main requirements for the achievement of adulthood: accepting responsibility for oneself, deciding on personal beliefs and values, establishing relationships with parents as equals, and becoming financially independent. This study provides a useful framework for understanding the needs of emerging adults with a diagnosis of cancer that will assist healthcare professionals in the development and delivery of more targeted supportive care and interventions.
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The present study explored the effect of layoffs on the subsequent productivity of “survivors”. All participants performed a proofreading task either after witnessing the dismissal of a co-worker (Layoff condition) or not (No-Layoff condition). Consistent with equity theory, the quantity of workers' performance was greater in the Layoff than in the No-Layoff condition. A Worker Self-Esteem × Layoff interaction effect revealed that the Layoff effect was entirely attributable to the low, rather than the medium or high, self-esteem participants. Additional analyses revealed that the layoff caused participants to (1) experience increased feelings of remorse and (2) develop more negative attitudes toward their co-worker, both of which are also consistent with equity theory. Practical and theoretical implications are discussed.
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The broad application of cancer survivorship research offers excellent templates for psychosocial assessment and intervention in the specialized population of adult neuro-oncology. However, by exclusively utilizing a cancer model of survivorship, clinicians might overlook vital, relevant work in the field of neurology. Preference for a cancer lens in survivorship programming is understandable given that most neuro-oncology workers identify the field of oncology as their foundation for care. To counteract this trend, a summary of relevant research in related populations (stroke, brain injury) is offered with the premise that consideration of similarities across populations has much to offer.
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Introductory remarks are directed toward a brief review of the literature on the psychological problems of the survivors of the Nazi Holocaust, and the paucity of research on offspring of these survivors. A discussion of three adolescents who were in a residential treatment program in Jerusalem, Israel, is proffered. Biographical data, diagnostic categories, review of TAT responses, their ability or inability in forming relationships, and some examples of dreams are presented. A section is devoted to some general underlying assumptions--including an analysis of the concepts "survivor guilt," "repressed agression," and "isolation of affect".
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This review summarizes recent systematic research literature regarding psychological factors as they affect chronic renal disease. Special attention is devoted to depression, quality of life, noncompliance, outcome studies, withdrawal from dialysis, and directions for future research.
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Nursing currently evidences concern with the development and clarification of its knowledge base. As a part of this focus, attention has often been directed towards concepts and methods of clarification. Although the method of concept analysis has been employed often to provide conceptual clarity, the foundations and implications of conducting an analysis of a concept have not been well explored in nursing. In this article, the philosophical foundations of the approach to concept analysis popularized by Walker & Avant (1983) are examined. Modifications of this method are offered, along with a framework for interpreting the findings of an analysis. The result is a view of concepts and an approach to analysis that may be of use in the clarification of a variety of concepts of interest in nursing.
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Previous research has demonstrated a relation between depression and attributional style. In the present study we evaluated the extent to which self-esteem may be an important determinant of attributional style. Subjects completed measures of self-esteem, depression, and anxiety and responded to the Attributional Style Questionnaire. Maximum R2 analyses revealed that for significant one-variable and multivariable regression models, self-esteem accounted for the variation in attributional style on the majority of outcome measures. Depression and anxiety added little beyond the contribution of self-esteem. These findings were consistent for both positive and negative events. In addition, self-esteem accounted for variation in attributional evenhandedness. Results are discussed in terms of the role of self-esteem maintenance in attributional style.
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The purposes of this paper are (1) to contribute to an understanding of the crucial role of unconscious guilt in the pathogenesis of anorexia nervosa and (2) to contribute to an appreciation of the importance of the concept of survivor guilt by demonstrating its usefulness in describing and explaining aspects of the pathogenesis, psychopathology and psychotherapy of anorexia.
Article
Progress in the description and therapy of Holocaust survivors and their children has been hampered by unsatisfactory terminology, denial on the part of the therapist, and occasionally hostility to the survivor. The author suggests that the therapist's inability to comprehend the extent of Nazi sadism has unwittingly led clinical researchers to attempt to understand the perpetrators by investigating survivors. To survivors are attributed “Nazi-like” behaviors through such mechanisms as identification with the aggressor. These behaviors are then scrutinized as if they belonged to the victim, rather than the persons who committed the original aggression. Aggression has been misunderstood in the context of Holocaust survivors, as has the concept of survivor guilt, which is less commonly present than has been assumed. The failure to refine survivor terminology has at times misdirected treatment and obscured the remarkable adaptations and coping styles of the majority of the survivor generation and its offspring.
Article
Patients hospitalized for bone marrow transplantation tend to deny the significance for them of the death of another transplant patient. Patients emphasize, often with encouragement from the medical staff, the differences between their conditions. Interviews held after discharge with the survivors of five pairs of patients hospitalized together in which one patient died show that the death of another patient having bone marrow transplantation has a major impact on the surviving patient. Early identification develops between patients, and after one patient dies there are attempts at distancing and denial of identification, survivor guilt, and fears of a similar fate that continue after transplantation. Healthy reactions are differentiated from nonadaptive reactions. Similarities to other forms of survivor guilt are discussed, including the guilt of the medical staff.
Article
Clinical experience over three and a half decades in the evaluation, diagnosis and treatment of close to 2000 concentration camp survivors indicates that we are dealing with a type of massive traumatization of such magnitude and severity as to cause a recognizable clinical entity I have named "the survivor syndrome," which develops irrespective of age, sex, and individual or sociocultural background. The clinical symptoms and characteristic features of this syndrome are described in some detail. The condition is chronic, in many cases severe, and presents unique difficulties to both patient and therapist. The influence of the psychic disturbances on the offspring is frequent and notable. Further research on the syndrome and comparative studies on its occurrence in survivors of natural disasters is suggested. But one fact can be stated with certainty: The effects of the holocaust on the survivors linger on.
Article
This article provides a description of the eight phases of the Mental Health Outreach Program (MHOP) cofounded by the author to address the needs of the surviving community following the 1988 earthquake in Armenia. For the purposes of the MHOP, the nursing process was expanded from five to eight phases: 1) preassessment, 2) assessment, 3) analysis, 4) community diagnosis, 5) planning, 6) implementation, 7) evaluation, and 8) remodification. A framework for assessing the level of trauma in an unfamiliar community (with its mnemonic acronym COPE), which was formulated by the author to expedite the assessment and implementation phases, is described. The article concludes with a set of recommendations for psychiatric mental health nurses in mitigating the negative impact and consequences of disasters.
Article
There is little understanding of adolescent appraisal of stress and crisis intervention for adolescents who are exposed to major stress such as that of a natural disaster. A description of the psychological evaluations, referrals, and follow-up assessments made by nurse practitioners (NPs) and a nurse psychotherapist (NPT) of adolescents (N = 507) in two South Carolina high schools who experienced Hurricane Hugo. The NPs' evaluations concluded that 63 adolescents (12%) exhibited symptoms of psychological distress. The NPs referred 36 of these adolescents to high school counselors for minor distress or school-related problems and 27 for more intensive clinical evaluation by an NPT. Of the 27 adolescents who were referred to the NPT, 10 had symptoms associated with adolescent adjustment reaction, 8 showed symptoms of depression, 5 revealed symptoms of posttraumatic stress disorder, and 4 complained of serious family problems. Based on these data and the mental processes described by these adolescents, the authors propose a model and suggest adolescent appraisal of stress and crisis is a critical issue to consider when intervening with adolescents who are exposed to major stressors, including those associated with a disaster.
Article
To provide guidance on informed consent to clinicians offering cancer susceptibility testing. The Task Force on Informed Consent is part of the Cancer Genetics Studies Consortium (CGSC), whose members were recipients of National Institutes of Health grants to assess the implications of cancer susceptibility testing. The 10 task force members represent a range of relevant backgrounds, including various medical specialties, social science, genetic counseling, and consumer advocacy. The CGSC held 3 public meetings from 1994 to 1996. At its first meeting, the task force jointly established a list of topics. The cochairs (G.G. and J.R.B) then developed an outline and assigned each topic to an appropriate writer and reviewer. Writers summarized the literature on their topics and drafted recommendations, which were then revised by the reviewers. The cochairs compiled and edited the entire manuscript. All members were involved in writing this report. The first draft was distributed to task force members, after which a meeting was held to discuss its content and organization. Consensus was reached by voting. A subsequent draft was presented to the entire CGSC at its third meeting, and comments were incorporated. The task force recommends that informed consent for cancer susceptibility testing be an ongoing process of education and counseling in which (1) providers elicit participant, family, and community values and disclose their own, (2) decision making is shared, (3) the style of information disclosure is individualized, and (4) specific content areas are discussed.
Article
A patient with posttraumatic stress disorder (PTSD) had a major depressive episode that was responsive to treatment with the antidepressant fluoxetine. In contrast to the remission of other symptoms of depression, the associated feature of survivor guilt became more dramatically obvious. Individualized treatment of survivor guilt may be needed for patients with PTSD and major depression.
Article
The intent of this study was to evaluate the effect that an awareness of being a BRCA1 or BRCA2 mutation carrier has on the attitude towards prophylactic surgery and on developing depression symptoms. Thirty-five families were selected on the basis of previously detected BRCA1 or 2 mutations and 90 family members were given the appropriate questionnaires. Prophylactic mastectomy (PM) was considered by 21% of the Austrian mutation carriers (29% affected and 8% non-affected carriers). The majority of affected and non-affected carriers expected PM to impair the quality of their life. Fifty per cent would undergo prophylactic oophorectomy (53% affected and 46% non-affected carriers). The self-rating depression scale indicated that following mutation result disclosure the depression scores of carriers decreased (40 baseline vs 38 after result disclosure, P = 0.3), whereas, for non-carriers, scores increased (36 baseline vs 40 after result disclosure, P = 0.05). We conclude that information about carrier status is not associated with increased depression symptoms in mutation carriers. In non-carriers, depression scores increased slightly, probably reflecting survivor guilt. The option of having PM was associated with a negative impact on the quality of life and was declined by the majority of Austrian mutation carriers.
Article
The AIDS epidemic has resulted in an unprecedented death toll among young adults, many of whom are survived by siblings. Whereas the circumstances surrounding deaths from AIDS place survivors at risk for intense bereavement, no reported studies have examined the pattern or intensity of grief among adult siblings. One hundred and two adults who had experienced the death of a sibling from AIDS were recruited into this study in which grief reactions were measured using the Grief Experience Inventory. Time since the sibling's death ranged from 3 months to 11 years. Grief reactions were found to exceed those previously reported. A positive relationship was found between the level of closeness of the survivor to the deceased and the intensity of grief reactions. No relationship was found between time since the sibling's death and intensity of grief.
Article
Combat-related Post-traumatic Stress Disorder (PTSD) is often highly debilitating and affects nearly all areas of psychosocial functioning. Veterans with PTSD re-experience their traumas in the form of haunting intrusive memories, nightmares and flashbacks, and have chronic difficulty modulating arousal. As a way to cope with these symptoms, many survivors live isolated and avoidant lives, self-medicate with alcohol and substances of abuse, and numb themselves to emotional experiences and relationships with family and friends. Additionally, many combat veterans report survivor guilt, depression, affect dysregulation, and an altered world view in which fate is seen as uncontrollable and life is viewed as devoid of meaning. In this report we describe the use of logotherapy (healing through meaning) for the treatment of combat-related PTSD
Article
: The decision to undergo BRCA testing is very complex and emotionally laden. This decision can be further complicated by the loss of a mother at an early age. The following personal account by a genetic counselor discusses the testing process and the struggle to accept the results and reframe one's self-identity. The sensitive nature of this testing and the implications for other family members is explored.
Why me Why not me J Genet Couns.
  • Valverde
Interpersonal guilt: the development of a new measure.
  • OConnor