Responding to Bias: Equipping Residents With Tools to Address Microaggressions.

Introduction: Resident physicians frequently experience bias at work, with patients and families often being the source. Women and other trainees underrepresented in medicine are disproportionately impacted by these negative experiences, and experiencing bias contributes to resident physician burnout. Unfortunately, many resident physicians feel inadequately prepared to respond to bias. Methods: We developed a 45-minute, peer-led, case-based workshop that equipped trainees with tools to respond to patient-expressed bias. Our toolkit centered on resident physicians by including an assessment of the trainee's emotional well-being, a team-based response, and an embedded debrief. The toolkit provided resident physicians with possible responses to bias directed towards themselves (bias-towards-self) or bias directed towards others (bias-towards-others). Surveys were administered pre- and postworkshop to assess change in participants' comfort in responding to patient-expressed bias. Results: Thirty-seven residents completed both surveys. The workshop significantly increased comfort in responding to bias-towards-self (p < .001; 95% CI, 1.00-1.50) and bias-towards-others (p < .001; 95% CI, 1.00-1.50). Discussion: We improved resident physicians' comfort responding to patient bias-towards-self and bias-towards-others through a toolkit and workshop designed specifically for trainees. The toolkit centers the resident physician perspective, incorporates clinical context, and embeds a debrief. Our novel approach situates the toolkit's teaching in a highly scalable, case-based workshop.

Exploring Overt Racial and Ethnic Conflict in Resident-to-Resident Aggression in Long-Term Care Facilities.

Objectives: Resident-to-resident aggression (RRA) in long-term care facilities is gaining recognition as a serious problem. Racial/ethnic conflict may be a contributing factor to RRA incidents, but it remains insufficiently studied. Our goal was to explore overt racial/ethnic conflict in RRA. Design: We used quantitative and qualitative secondary analyses of existing data from a large, rigorously conducted study of RRA to describe the involved residents and patterns of overt racial/ethnic conflicts. Setting and Participants: The parent study included information of 2011 residents in 10 randomly selected New York State nursing homes with a wide range of racial/ethnic minority residents (4.2%-63.2%). A subset of 407 residents were involved in RRA. Methods: We re-examined data from the parent study, which used an innovative approach to identify RRA incidents by reconstructing each incident based on residents' self-reports, staff interviews, field observations, and medical chart review. Resident and facility information was collected. Results: A total of 35 residents (8.6% of those involved in RRA incidents) were identified as involved in overt racial/ethnic conflicts. These residents were more likely to have had less education than residents involved in other types of RRA but not in overt racial/ethnic conflicts. More than half (56.9%) of the 51 incidents of RRA involving overt racial/ethnic conflict between a specific pair of residents occurred repeatedly. Manifestation of racial/ethnic conflicts included physical violence, discrimination, racial/ethnic slurs, stereotypes, and microaggression. Acute precipitants of these incidents included various communal-living challenges and unmet needs at the facility, relational, and individual levels. Psychological and behavioral consequences were also described. Conclusion and Implications: We found a broad range of manifestations, acute precipitants, circumstances surrounding, and consequences of overt racial/ethnic conflicts in RRA. Additional research is needed to improve understanding of this phenomenon and how staff may effectively intervene and prevent it.

De-escalating aggression in acute inpatient mental health settings: a behaviour change theory-informed, secondary qualitative analysis of staff and patient perspectives.

BACKGROUND: De-escalation is often advocated to reduce harm associated with violence and use of restrictive interventions, but there is insufficient understanding of factors that influence de-escalation behaviour in practice. For the first time, using behaviour change and implementation science methodology, this paper aims to identify the drivers that will enhance de-escalation in acute inpatient and psychiatric intensive care mental health settings. METHODS: Secondary analysis of 46 qualitative interviews with ward staff (n = 20) and patients (n = 26) informed by the Theoretical Domains Framework. RESULTS: Capabilities for de-escalation included knowledge (impact of trauma on memory and self-regulation and the aetiology and experience of voice hearing) and skills (emotional self-regulation, distress validation, reducing social distance, confirming autonomy, setting limits and problem-solving). Opportunities for de-escalation were limited by dysfunctional risk management cultures/ relationships between ward staff and clinical leadership, and a lack of patient involvement in safety maintenance. Motivation to engage in de-escalation was limited by negative emotion associated with moral formulations of patients and internal attributions for behaviour. CONCLUSION: In addition to training that enhances knowledge and skills, interventions to enhance de-escalation should target ward and organisational cultures, as well as making fundamental changes to the social and physical structure of inpatient mental health wards. Psychological interventions targeting negative emotion in staff are needed to increase motivation. This paper provides a new evidence-based framework of indicative changes that will enhance de-escalation in adult acute mental health inpatient and PICU settings.

Social, not genetic, programming of development and stress physiology of a colonial seabird.

Phenotypic differences often stem from genetic/maternal differences and/or early-life adaptations to local environmental conditions. In colonial animals, little is known on how variation in the social environment is embedded into individual phenotypes, nor what the consequences are on individual fitness. We conducted an experimental cross-fostering study on king penguins (Aptenodytes patagonicus), exchanging eggs among 134 pairs breeding in high-density (67 pairs) or low-density (67 pairs) areas of the same breeding colony. We investigated differences in parent and chick phenotypes and survival in relation to the density of their origin and foster environment. Adults breeding in colony areas of high density exhibited decreased resting behaviour and increased aggression and vigilance, increased hypometabolism during incubation fasts, and more moderate corticosterone responses shaped by exposure to chronic stressors (e.g. constant aggression by neighbours). Chick phenotypes were more influenced by the environment in which they were raised than their genetic/maternal origin. Chicks raised in high-density colonial environments showed enhanced weight gain and survival rates regardless of the density of their genetic parents' breeding areas. Our study experimentally shows advantages to breeding in colonial areas of higher breeder densities in king penguins, and highlights the importance of social settings in shaping phenotype expression in colonial seabirds.

Treating Children and Adolescents with Aggressive Behaviors in the Inpatient Setting.

The mental health crisis in children and adolescents presents a unique challenge for pediatric providers in the inpatient setting. Patients are presenting to the emergency department in acute psychiatric crises, but the increased need for behavioral health services is met with an already limited supply of behavioral health services and facilities. As such, these patients are hospitalized on acute care floors, which can serve to exacerbate symptoms of aggression regardless of cause and complicates treatment and harm prevention strategies. We present a comprehensive management approach to the acutely agitated pediatric patient with aggressive behaviors, including prevention of symptoms in patients with risk factors; nonpharmacological approaches to de-escalation, including the use of restraint; and common oral and parenteral psychopharmacological agents. Such strategies are considered from a medical, ethical, and legal standpoint with the goal of maintaining safety and minimizing harm to patients, families, and staff. [Pediatr Ann. 2024;53(8):e293-e298.].

Sexual Orientation Microaggression Rating Scale (SOMRS): Development and association with alliance ruptures.

Sexual minority clients report experiencing frequent microaggressions during therapy, however, therapists may not recognize those microaggressions or may be reluctant to self-report them. The main aim of the present study was thus to develop an observational measure of in-session therapist-committed microaggressions related to the sexual orientation of sexual minority individuals (e.g., those who identify as lesbian, gay, bisexual, or queer). The present study further examined the association between therapist-committed sexual orientation microaggressions and ruptures in the therapeutic alliance. We hypothesized that clinically significant microaggressions would be positively associated with withdrawal ruptures in the alliance. The sample consisted of 44 gay and bisexual men who participated in a cognitive behavioral treatment designed to reduce depression, anxiety, human immunodeficiency virus-transmission-risk behaviors, and substance use. An observer-based coding measure designed for this study, the Sexual Orientation Microaggression Rating Scale (SOMRS), was utilized to capture sexual minority microaggressions in the initial sessions of treatment. Good interrater reliability was achieved for the SOMRS. Microaggressions were coded in 34% of the sessions. Within the subset of sessions with coded microaggressions, a significant association was found between withdrawal ruptures and microaggression significance ratings. The SOMRS holds potential for supporting research on microaggression as well as future efforts to help clinicians recognize and repair in-session behaviors that negatively impact sexual minority clients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The evolution of democratic peace in animal societies.

A major goal in evolutionary biology is to elucidate common principles that drive human and other animal societies to adopt either a warlike or peaceful nature. One proposed explanation for the variation in aggression between human societies is the democratic peace hypothesis. According to this theory, autocracies are more warlike than democracies because autocratic leaders can pursue fights for private gain. However, autocratic and democratic decision-making processes are not unique to humans and are widely observed across a diverse range of non-human animal societies. We use evolutionary game theory to evaluate whether the logic of democratic peace may apply across taxa; specifically adapting the classic Hawk-Dove model to consider conflict decisions made by groups rather than individuals. We find support for the democratic peace hypothesis without mechanisms involving complex human institutions and discuss how these findings might be relevant to non-human animal societies. We suggest that the degree to which collective decisions are shared may explain variation in the intensity of intergroup conflict in nature.

Brief report: Social comparison, hypercompetitiveness, and indirect aggression: Associations with loneliness and mental health.

Indirect aggression is commonly used in adulthood, but most researchers have focused on this behavior in romantic relationships or from an intrasexual competition perspective. Therefore, we aimed to understand the social characteristics and mental health correlates of indirect aggression by combining perspectives from developmental psychopathology and evolutionary psychology. We examined: (1) whether social characteristics (social comparison, hypercompetitiveness) contributed to indirect aggression (perpetration, victimization) and (2) whether there were indirect effects from indirect aggression (perpetration, victimization) to mental health difficulties through loneliness. In a cross-sectional sample of 475 young adults (57.7% women, 51.6% White, Mage = 20.2, SDage = 2.18), path analyses revealed that social comparison predicted indirect aggression victimization, which indirectly predicted mental health difficulties (depression, anxiety, somatic symptoms) through loneliness. In contrast, indirect aggression perpetration was only predicted by hypercompetitiveness. The findings highlight that reframing cognitions associated with social comparison could help prevent indirect aggression and mental health difficulties among young people.

Pediatric psychiatric inpatients' perspectives of aggression management: Discernment in the doorway.

PROBLEM: Aggressive behavior is common on psychiatric inpatient units. Seclusion and restraint interventions to manage patients' aggressive behavior may have the consequence of being traumatizing for patients. Pediatric psychiatric patients' perspective on the use of seclusion and restraint interventions is not present in the literature. METHODS: This hermeneutic nursing research study asked the question, "How might we understand children's experiences of seclusion and restraints on an inpatient psychiatric unit?" Four past pediatric psychiatric inpatients shared their hospitalization experiences that occurred within the previous year when they were 10 years old. The texts of the research interviews were compared to Attachment Theory for a deeper understanding of the meaning of the message. FINDINGS: Participants commonly described experiences with seclusion and restraints as feeling trapped and alone in a dark room. They recommended the nurses step into the room with them to help them heal. Interpretively, the rooms on inpatient units could be considered as actual and metaphorical spaces of possible harm or healing. CONCLUSION: The participant's voices expand understanding of nurse's use of discernment at the doorway of a patient room to ensure the most therapeutic care is provided to the patient in these spaces through a secure nurse-patient relationship.

The relationship between trait anger and reactive aggressive behavior in middle school students: the mediating role and intervention of hostile attribution bias.

BACKGROUND: The reactive aggressive behavior in individuals typically shows a rapid growth trend as individuals enter adolescence, and peaks during middle-school period. According to the Comprehensive Cognitive Model of Trait Anger, trait anger and hostile attribution bias play important roles in the development of reactive aggressive behavior. Based on this, current study explored the relationship between trait anger and reactive aggressive behavior in middle school students, as well as the mediating role of hostile attribution bias and interventions. METHODS: The current study consisted of three sub-studies. Study 1 recruited 87 middle school students with an average age of 12.367 ± 0.889 years, investigated the relationship between trait anger and reactive aggressive behavior, as well as the mediating role of trait hostile attribution bias. Study 2 recruited 62 middle school students with an average age of 13.376 ± 0.963 years, investigated the relationship between trait anger and reactive aggressive behavior, as well as the mediating role of state hostile attribution bias. Study 3 recruited 80 middle school students with an average age of 13.392 ± 0.977 years, implemented an intervention targeting trait hostile attribution bias in middle school students with high trait anger to reduce their reactive aggressive behavior. In current study, data management was performed using SPSS 22.0. Descriptive statistics, independent samples t-test, paired samples t-test, repeated measures analysis of variance (ANOVA), and path analysis were used for statistical analysis. FINDINGS: The results of Study 1 showed that trait anger predicted reactive aggressive behavior through trait hostile attribution bias. The results of Study 2 indicated that trait and state hostile attribution bias played mediating role intermediary, and trait hostile attribution bias had a stronger mediating effect than state hostile attribution bias. The results of Study 3 suggested that the intervention effectively decreased trait hostile attribution bias and reactive aggressive behavior. CONCLUSIONS: Trait anger can predict the reactive aggressive behavior of junior high school students, with trait hostility attribution bias and state hostility attribution bias mediating this relationship. Intervening in the hostility attribution bias of high-anger junior high school students can effectively reduce their reactive aggressive behavior.

Being on top versus not dangling at the bottom: Popularity motivation and aggression in youth.

Whereas research on aggression and status motivation in youth has predominantly looked at a promotion focus (striving for popularity), a prevention focus (wanting to avoid low popularity) could also be an important determinant of aggression, as youth who fear low popularity may use strategic aggression to secure their position. The aim of the current study was to develop reliable measures for both popularity motivations, and examine how both motivations are uniquely and jointly related to aggression. Participants were 1123 Dutch secondary school students (M age = 14.4 years, 48% girls), who completed a 3-item measure of striving for high popularity based on existing questionnaires (Li & Wright, 2014; Ojanen et al., 2005), and a 3-item measure of avoiding low popularity consisting of an adapted version of the high popularity items. Aggressive behavior was measured through peer nominations. Motivations were moderately correlated (r = .51), but did not always co-occur within the same person, as 17% of the sample belonged to a cluster that scored low on striving for popularity, but moderately high on avoiding low popularity. When considered simultaneously, striving for high popularity was not related to any type of aggression, whereas avoiding affiliation with unpopular peers was related to strategic aggression. For physical and verbal aggression, gossiping, excluding and bullying, the association of avoiding low popularity with aggression was strongest when youth also strived for high popularity. Future work should take both popularity motivations into account to better understand, predict and intervene on youth's aggression toward peers.

Disengagement of somatostatin neurons from lateral septum circuitry by oxytocin and vasopressin restores social-fear extinction and suppresses aggression outbursts in Prader-Willi syndrome model.

Background: Responding to social signals by expressing the correct behavior is not only challenged in autism, but also in diseases with high prevalence of autism, like Prader-Willi Syndrome (PWS). Clinical evidence suggests aberrant pro-social behavior in patients can be regulated by intranasal oxytocin (OXT) or vasopressin (AVP). However, what neuronal mechanisms underlie impaired behavioral responses in a socially-aversive context, and how can they be corrected, remains largely unknown. Methods: Using the Magel2 knocked-out (KO) mouse model of PWS (crossed with CRE-dependent transgenic lines), we devised optogenetic, physiological and pharmacological strategies in a social-fear-conditioning paradigm. Pathway specific roles of OXT and AVP signaling were investigated converging on the lateral septum (LS), a region which receives dense hypothalamic inputs. Results: OXT and AVP signaling promoted inhibitory synaptic transmission in the LS, which failure in Magel2KO mice disinhibited somatostatin (SST) neurons and disrupted social-fear extinction. The source of OXT and AVP deficits mapped specifically in the supraoptic nucleus→LS pathway of Magel2KO mice disrupting social-fear extinction, which could be corrected by optogenetic or pharmacological inhibition of SST-neurons in the LS. Interestingly, LS SST-neurons also gated the expression of aggressive behavior, possibly as part of functional units operating beyond local septal circuits. Conclusions: SST cells in the LS play a crucial role in integration and expression of disrupted neuropeptide signals in autism, thereby altering the balance in expression of safety versus fear. Our results uncover novel mechanisms underlying dysfunction in a socially-aversive context, and provides a new framework for future treatments in autism-spectrum disorders.

The Movement in Resistance against Eye Aggressions by MOCAO as a social movement for justice, reparation and the right to peace and freedom in Colombia.

The collective action of MOCAO, Movimiento en resistencia contra las agresiones oculares del ESMAD (Escuadrón Móvil An-tidisturbios) is a social strateg y to demand access to justice and the fulfilment of guarantees of reparation and non-repetition in Colombia. A brief account of significant events in our trajecto-ry as a social movement is presented, together with our letter of petitions to the national government as victims and survivors of ocular aggressions in the framework of police violence. Al-though ESMAD today has been reformed under the name of the Unit for Dialogue and Maintenance of Order (UNDMO), we consider that there have not yet been structural changes to ensure that its function is related to protecting the constitution-al right to social protest.

Network analysis of trait aggression among community youths and juvenile offenders.

OBJECTIVE: The mainstream view in trait aggression research has regarded the structure as representing the latent cause of the cognitions, emotions, and behaviors that supposedly reflect its nature. Under network perspective, trait aggression is not a latent cause of its features but a dynamic system of interacting elements. The current study uses network theory to explain the structure of relationships between trait aggression features in juvenile offenders and their peers. METHODS: Network analysis was applied to investigate the dynamic system of trait aggression operationalized by the Buss-Perry Aggression Questionnaire in a sample of community youths (Mage = 17.46, N = 715) and juvenile offenders (Mage = 18.36, N = 834). RESULTS: The facet level networks showed that anger is a particularly effective mechanism for activating all other traits. In addition, anger was more strongly associated with physical aggression and the overall network strength was greater in juvenile delinquency networks than in their peers. The item level networks revealed that A4 and A6 exhibited the highest predictability and strength centrality in both samples. Also, the Bayesian network indicated that these two items were positioned at the highest level in the model. There are similarities and differences between juvenile delinquents and community adolescents in trait aggression. CONCLUSION: Trait aggression was primarily activated by difficulty controlling one's temper and feeling like a powder keg.

The impact of artistic and sporting activities on children's levels of digital addiction, aggression, and psychological resilience.

OBJECTIVE: This study aims to investigate the effects of engaging in artistic and sporting activities on children's levels of digital addiction, aggression, and psychological resilience. MATERIAL AND METHOD: This cross-sectional study encompasses children aged 11-12 who are regularly engaged and not engaged in artistic or sporting education. The study involved 623 children. Data collection utilized the "Digital Addiction Scale," "Child and Adolescent Psychological Resilience Scale," and "Reactive and Proactive Aggression Scale." RESULTS: The study found statistically significant effects of engaging in sporting and artistic activities on digital addiction, psychological resilience, and reactive aggression (p < 0.05). Compared to the group with no activity, children engaged in artistic activities scored -4.38 units lower on the digital addiction scale, while those engaged in sports scored -4.23 units lower. Similarly, compared to the group with no activity, children engaged in artistic activities scored 3.32 units higher on the psychological resilience scale, and those engaged in sports scored 3.30 units higher. As children's psychological resilience scores increased, their scores for digital addiction and aggression decreased. CONCLUSION AND RECOMMENDATIONS: Participation in such activities can help children acquire healthy coping skills, strengthen their emotional regulation abilities, and reduce problems associated with anger. Therefore, encouraging children to engage in these activities is crucial for contributing to their overall well-being and promoting a balanced lifestyle. IMPLICATIONS FOR NURSING PRACTICE: Nurses can educate families about the importance of sports and artistic activities for the healthy development of children. Moreover, diversifying the activities offered to children in schools and youth centers and encouraging these activities can help promote healthy lifestyles and reduce digital addiction.

Aggressiveness, inhibitory control, and emotional states: A provocation paradigm.

The current study examines the effects of trait aggressiveness, inhibitory control and emotional states on aggressive behavior in a laboratory paradigm. One hundred and fifty-one adult participants took part (73 men, 71 women, and 7 nondisclosed). Event Related Potentials (ERPs) during a Go/No-Go task were utilized to capture the extent of inhibitory processing, with a laboratory provocation paradigm used to assess aggression. Contrary to the expectations, negative affective responses to provocation were negatively associated only with short-lived aggression and only among those with high past aggressiveness. Furthermore, past aggressiveness was related to a continuous increase in laboratory aggressive behavior regardless of the level of inhibitory control (P3 difference amplitude). However, feeling hostile was associated with short-lived aggressive behavior, only in those with lower levels of inhibitory control. These findings demonstrate the effect of distinct mechanisms on different patterns of aggressive behavior.

Estudio binacional sobre las agresiones de pareja en estudiantes universitarios.

En esta investigación se dimensiona comparativamente la violencia en parejas de estudiantes de nivel universitario de la Argentina y de Ecuador y se explora la asociación con los celos y otras covariables teóricamente relevantes mediante análisis multivariado. Con un diseño de corte transversal se encuestaron 714 estudiantes (528 de la Universidad Nacional de La Plata, Argentina, y 186 de Universidad de Cuenca, Ecuador). Los instrumentos utilizados fueron el Conflict in Adolescents Dating Relationships Inventory, la Multidimensional Jealousy Scale e items ad hoc sobre fidelidad, consumo de sustancias y estrés durante la relación de pareja. Si bien se halló un predominio de la violencia verbal/emocional, el 3,8 % de los participantes alcanzó alto valor en la medida de abuso total cometido y más de la mitad informó haber cometido, por lo menos, un acto violento físico durante la relación índice. En modelo de regresión logística se verificó que la condición de pertenecer al grupo de alta violencia se asoció positiva y significativamente con los factores celos comportamentales, celos cognitivos,estrés y consumo de sustancias, y negativa y significativamente con la edad al comienzo de la relación.

Population variation in signaling behavior and contest outcome in the jacky dragon.

Being aggressive and by extension, dominant, is an important mechanism for determining access to resources such as mates or territories. While predictors of contest outcome and dominance are increasingly studied, we have a poor understanding of how they vary across populations. Here, I use the widely distributed Australian agamid lizard, the Jacky dragon (Amphibolurus muricatus), to quantify variation in features predicting contest outcome among males of different populations. I measured physical attributes, maximal physiological performance capacity (sprint speed, endurance, bite force) and visual displays during staged encounters. I found that morphology, performance capacity and the type and frequency of visual displays used during agonistic interactions varied significantly across populations. Contest winners from the Cann River State Forest population favored tail-flicks and push-up/body-rocks, while those from Royal National Park were more likely to chase and individuals from Yarratt State Forest performed more bite-lunges than other populations. The losers of contests also differed in their displays. Individuals from the Cann River population were dominant over the others based on behavioral attributes (i.e., aggressive visual displays, chases and bite-lunges). I suggest that population differences in signal form and function could have implications for range dynamics as populations come into contact in an era of rapid environmental change.

Investigating social communication in mice: A two-intruders test approach.

Understanding the complex dynamics of social communication behaviors, such as exploration, communication, courtship, mating, and aggression in animal models, is crucial to reveal key neural and hormonal mechanisms underlying these behaviors. The two-intruders test is designed to investigate residents' behavior toward both male and female intruders within the home cage of the test male. During this test imitating natural conditions, several aspects of social interaction were investigated: Exploration, courtship, mating, and aggressive behavior. As mating and aggression involve overlapping neural circuits, the behavioral setup testing both behaviors is best at reflecting their competitive nature. Our findings demonstrate that resident male mice exhibit strong preference to communicate with a female intruder, which correlates with baseline testosterone levels of test males. Relevant female preference in the two-intruders test was also found in BALB/c males. Behavioral breakdown revealed the anogenital sniffing as a key behavioral feature that discriminates resident male behavior toward intruders of different sex. Furthermore, resident male interaction with female intruder was accompanied by neuronal activation in the ventromedial hypothalamus. We demonstrate that odor recognition underlies preference toward females in male residents, as experimental anosmia reduced communication with a female intruder. We conclude the two-intruders test setup to be a useful tool to study the neurological basis of social communication in animal models, which provides detailed analysis of various aspects of the laboratory animals' social behavior in the most natural conditions.