Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD.

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.

Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.

The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial.

Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase.Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial.Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase.Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = -1.09), guilt (d = -2.85), shame (d = -2.14), psychopathology and self-criticism.Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).

C-METTA is an intervention that addresses trauma-related guilt and shame and combines cognitive interventions with loving-kindness meditations.A proof-of-concept study was conducted examining C-METTA in a wait-list randomized controlled trialC-METTA led to reductions in trauma-related guilt and shame and PTSD symptoms.

BLAME-LESS STUDY: a two-arm randomized controlled trial evaluating the effects of an online psychoeducation programme for adolescents who have experienced physical/sexual violence or sexual abuse. Rationale, study design, and methods.

Background: Victims of physical/sexual violence or sexual abuse commonly experience defense responses that result in feelings of guilt and shame. Although trauma-focused interventions are effective in treating post-traumatic stress disorder symptoms, the presence of trauma-related shame and guilt can potentially hinder the process of disclosure during treatment, thus diminishing their overall effectiveness. It is hypothesized that providing psychoeducation about common defense responses will reduce feelings of shame and guilt, thereby increasing receptivity to trauma-focused treatment.Objective: This paper describes the rationale, study design, and methods of the BLAME-LESS study. The effects of a brief online psychoeducation program will be compared with a waiting-list control group. The intervention aims to reduce feelings of trauma-related shame and guilt that adolescents experience regarding their own defense responses during and after physical/sexual violence or sexual abuse.Methods: Adolescents (12 - 18 years old) with a history of physical/sexual violence or sexual abuse who suffer from trauma-related feelings of shame and guilt can participate in the study. The study follows a two-arm RCT that includes 34 participants. The primary outcomes includes trauma-related feelings of shame and guilt. The secondary outcomes includes PTSD symptoms, anxiety and depression symptoms, traumatic cognitions, readiness to disclose details of memories of the trauma, and motivation to engage in trauma-focused therapy. Assessments take place after screening, at baseline, two weeks after allocation to the intervention or waiting-list, and, only for the waiting-list participants, seven weeks after allocation to the intervention.Conclusions: There is a need for treatment approaches that target trauma-related feelings of shame and guilt. A recently developed brief online psychoeducation program on defense responses during and after trauma offers victims of physical/sexual violence or sexual abuse a free and accessible way to obtain reliable and valid information. The proposed RCT will evaluate the effectiveness of this online psychoeducation program.Trial Registration: Request is pending.

Some defense responses to physical/sexual violence or sexual abuse, such as tonic immobility and appeasement behaviour, are common but unknown and raise feelings of shame and guilt.BLAME-LESS (In Dutch: On(t)schuldig) is a newly developed online psychoeducation programme that aims to reduce feelings of trauma-related shame and guilt. This programme includes explanatory animations, in-depth interviews with experts and victims, and written information accompanied by case reports.The proposed study examines the effectiveness of the brief online psychoeducation programme BLAME-LESS in a well-controlled study.

Emociones autoconscientes relacionadas con el cuerpo y la apariencia y sintomatología de trastornos de la conducta alimentaria en una muestra de hombres adultos / Body and appearance-related self-conscious emotions and eating disorder symptoms in a sample of adult men

Abstract: In recent years, the number of men suffering from an Eating Disorder (ED) has increased. However, very few studies on ED have been conducted in samples of men. This paper aims to shed some light on this issue by exploring the following questions in a sample of adult men: 1) to analyse the relationships between body and appearance-related self-conscious emotions and ED symptomatology and, 2) to study the differences between a group of men who are at risk of developing an ED and another group of men who are not at risk of developing an ED in body and appearance-related self-conscious emotions. A total of 207 Spanish or Latin American men aged 18-50 years participated. Men who were at risk of developing an ED had more body shame and body guilt than those who were not at risk. However, no statistically significant differences were found between the two groups in body pride. These findings show that, unlike in women, body pride does not seem to play as important a role in these disorders as body shame or body guilt.

Resumen: En los últimos años, ha aumentado el número de hombres que padecen un Trastorno de la Conducta Alimentaria (TCA). Sin embargo, apenas se han realizado estudios sobre TCA con muestras de hombres. Este trabajo pretende arrojar algo de luz a este respecto, explorando las siguientes cuestiones en una muestra de hombres adultos: 1) analizar las relaciones entre las emociones autoconscientes asociadas al cuerpo y a la apariencia y la sintomatología de TCA y, 2) estudiar las diferencias entre un grupo de hombres que están en riesgo de desarrollar un TCA y otro grupo de hombres que no presentan dicho riesgo en las emociones autoconscientes asociadas al cuerpo y a la apariencia. Participaron 207 hombres de entre 18 y 50 años de nacionalidad española o latinoamericana. Los hombres que estaban en riesgo de desarrollar un TCA presentaron más vergüenza corporal y culpa corporal que aquellos que no tenían dicho riesgo. Sin embargo, no se encontraron diferencias estadísticamente significativas entre ambos grupos en el orgullo corporal. Estos hallazgos muestran que, a diferencia de lo que ocurre en mujeres, el orgullo corporal no parece desempeñar un papel tan relevante en estos trastornos como el que tienen la vergüenza corporal o la culpa corporal.

La fragmentación de la identidad en la disociación y en las psicosis / Identity fragmentation in dissociation and psychoses

En la psiquiatría actual tenemos mucho interés en dilucidar las semejanzas y las diferencias existentes entre las experiencias psicóticas y las experiencias disociativas, y en especial las dinámicas patogénicas que dan lugar a unas y a otras, y los abordajes terapéuticos más eficaces en cada caso. Desde el punto de vista de la identidad plural, estas dos experiencias constituyen las dos grandes crisis biográficas funcionales que dan lugar a la fragmentación de la identidad, con la pérdida de su unidad y continuidad, además de su autonomía y autoestima. Ambas se diferencian por los mecanismos de represión y disociación que están en el origen de las mismas. Ahora bien, cualquier enfoque o hipótesis con la que tratemos de entender estos dos tipos de experiencias no debe limitarse a comprenderlas en sus representaciones actuales y en las claves que hoy llamaríamos “científicas”, porque experiencias de este tipo han existido a lo largo de la historia de la humanidad reconceptualizadas de forma distinta, en otras claves culturales, espirituales, religiosas o morales. (AU)

In current psychiatry, there is a great interest in elucidating the existing similarities and differences between psychotic experiences and dissociative ones; especially, the pathogenic dynamics that give rise to both of them, as well as the most effective therapeutic approaches in each case. From the point of view of plural identity, these two experiences make up the two great functional biographic crises that give rise to identity fragmentation, with the loss of their unity and continuity, in addition to the loss of their autonomy and self-esteem. Both of them are differentiated by the repression and dissociation mechanisms that exist in their origin. That said, any approach or hypothesis that we may use to try to understand these two types of experiences should not be limited to understanding them in their current representations and with the keys that we currently call “scientific”, because experiences of this type have existed throughout the history of humanity, reconceptualized differently in other cultural, spiritual, religious or moral keys. (AU)

Neuroscientific account of Guilt- and Shame-Driven PTSD phenotypes.

Background: Guilt and Shame, two core self-related emotions, often emerge following trauma and play an important role in the development and maintenance of post-traumatic stress disorder (PTSD). Importantly, Guilt and Shame exhibit specific focal and non-specific global impacts of trauma on self-perception, respectively.Objective and Methods: Integrating psychological theories with neuroscientific knowledge, we suggest a scheme of two diverging clinical phenotypes of PTSD, associated with distinct self-related processes and differential functionality of relevant neural networks.Proposal: The Guilt-driven phenotype is characterized by preoccupation with negative self-attributes of one's actions in the traumatic event. It involves altered functionality of both the salience network (SN) and the default-mode network (DMN), associated with heightened interoceptive signalling and ruminative introspection which may lead to hyperarousal and intrusive symptoms, respectively. On the contrary, the Shame-driven phenotype is characterized by global, identity-related negative self-attributions. It involves altered functionality of both the SN and the DMN, associated with blunted interoceptive signalling and diminished introspection which may result in withdrawal and anhedonia symptoms together with dissociative experiences, respectively.Conclusion: The proposed PTSD phenotypes may inform neuropsychological therapeutic interventions (e.g. self-focused psychotherapy and neuromodulation) aiming to restore the function of large-scale self-related neural processing.

Guilt and Shame are two self-related emotions that often emerge following traumatic events and may contribute to the clinical profile of post-traumatic stress disorder (PTSD).Our framework suggests Guilt and Sham driven phenotypes of post-traumatic psychopathology, associated with two self-processing deficiencies related to specific action or global identity, respectively.The proposed phenotypes may inform neuropsychological treatments aiming to restore dysfunctional neural networks, later to be evident in alleviating Guilt and Shame and improving clinical outcomes.

Widening the scope: defining and treating moral injury in diverse populations.

Moral injury is an emerging concept that captures the psychosocial consequences of involvement in and exposure to morally transgressive events. In the past decade, research on moral injury has grown exponentially. In this special collection we review papers on moral injury published in the European Journal of Psychotraumatology from its inception until December 2022, that have a primary focus on moral injury as evidenced by the words 'moral injury' in the title or abstract. We included 19 papers on quantitative (n = 9) and qualitative (n = 5) studies of different populations including (former) military personnel (n = 9), healthcare workers (n = 4) and refugees (n = 2). Most papers (n = 15) focused on the occurrence of potentially morally injurious experiences (PMIEs), moral injury and associated factors, while four papers primarily concerned treatment. Together, the papers offer a fascinating overview of aspects of moral injury in different populations. Research is clearly widening from military personnel to other populations such as healthcare workers and refugees. Focal points included the impact of PMIEs involving children, the association of PMIEs and personal childhood victimisation, the prevalence of betrayal trauma, and the relationship between moral injury and empathy. As for treatment, points of interest included new treatment initiatives as well as findings that PMIE exposure does not impede help-seeking behaviour and response to PTSD treatment. We further discuss the wide range of phenomena that fall under moral injury definitions, the limited diversity of the moral injury literature, and the clinical utility of the moral injury construct. From conceptualisation to clinical utility and treatment, the concept of moral injury matures. Whether or not moral injury becomes a formal diagnosis, the need to examine tailored interventions to alleviate moral injury is clear.

Moral injury is increasingly studied outside military populations, such as in healthcare workers and refugees.Among the most impactful potentially morally injurious experiences (PMIEs) are those involving children, but betrayal trauma may be the most prevalent type of PMIE.There is a need for tailored, evidence-based interventions to alleviate moral injury.

Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas / Guilt and well-being in institutionalized family caregivers of dependent older adult people

Antecedentes y objetivo: La experiencia de los cuidadores familiares tras el ingreso en una residencia de personas mayores ha recibido escasa atención, probablemente porque muchos cuidadores experimentan una sensación inicial de alivio emocional inicial. Sin embargo, para algunos cuidadores el ingreso en una residencia de mayores es un factor de estrés a pesar de la reducción de la carga física de los cuidados. La angustia del cuidador tras la institucionalización se ha relacionado con las nuevas cargas y retos que se encuentran en la residencia de mayores. La ambivalencia y la culpa relacionados con la decisión de institucionalización se han identificado como fuentes de estrés. Por eso, este estudio examinó el efecto de la culpa y el bienestar en el estrés percibido de cuidadores familiares de personas dependientes institucionalizadas. Materiales y métodos: Participaron 201 cuidadores familiares de personas institucionalizadas en una residencia de mayores (La Rioja, España). Se evalúo el estrés percibido, la culpa para el cuidado y el bienestar subjetivo, variables sociodemográficas y relacionadas con el cuidado. Se realizaron análisis de regresión lineal y correlaciones entre las variables. Resultados: La culpa y 5 dimensiones de bienestar (ansiedad, vitalidad, autocontrol y depresión, excepto salud general) predijeron significativamente el estrés (R2adj=0,552 [F (6, 198)=41,71; p<0,001]). El tamaño del efecto fue grande (IC del 95%: 0,461). Conclusiones: Prestar atención a los sentimientos de culpa de los cuidadores familiares durante la institucionalización es fundamental. Ello permitirá diseñar e implementar intervenciones psicosociales que mejoren la adaptación del cuidador inmediatamente después de la institucionalización. (AU)

Introduction and objective: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. Materials and methods: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. Results: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). Conclusions: Paying attention to family caregivers’ feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization. (AU)

[Guilt and well-being in institutionalized family caregivers of dependent older adult people]. / Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas.

INTRODUCTION AND OBJECTIVE: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. MATERIALS AND METHODS: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. RESULTS: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). CONCLUSIONS: Paying attention to family caregivers' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

Muito além do trauma: uma investigação sobre o papel das reações peritraumáticas sobre o transtorno de estresse pós-traumático / Beyond the trauma: an investigation of the role of peritraumatic reactions on posttraumatic stress disorder

O Transtorno de Estresse Pós-Traumático (TEPT) é uma condição debilitante que impacta significativamente a qualidade de vida dos seus portadores. Dentre vários fatores de risco para o TEPT, as reações peritraumáticas (RP), como a imobilidade tônica peritraumática (ITP), dissociação (DP) e reações físicas de pânico (RFP), estão entre as mais investigadas. No entanto, a maioria dos estudos avaliou essas RP separadamente, e o elo entre elas e o TEPT ainda não foi bem compreendido. Portanto, essa tese teve como objetivos: (i) estimar simultaneamente o efeito das três RP sobre o TEPT utilizando um instrumento validado; e (ii) avaliar se há efeito indireto da ITP sobre o TEPT mediado pelo sentimento de culpa/vergonha. Utilizamos modelagem de equações estruturais para analisar dados de 3211 participantes do Rio de Janeiro e de São Paulo. Tratamos as RP como variáveis latentes, selecionando desconfundidores específicos para cada reação. Nossas exposições foram as RP, sendo TEPT o desfecho. Calculamos odds ratios e intervalos de confiança de 95%. Utilizamos o Bayesian Information Criterion para comparar o ajuste de modelos não aninhados. Quando analisadas separadamente, todas as RP alcançaram significância estatística. No entanto, apenas DP (ORDP=1,8; IC95%:1,3-2,4) e RFP (ORRFP=2,5; IC95%:1,8-3,4) permaneceram estatisticamente significativas quando incluímos as três reações em um modelo com seus respectivos desconfundidores e correlações entre elas. Os resultados sugeriram um possível efeito da ITP sobre o TEPT (ORITP=1,4; IC95%:1,0-1,9). As interações entre as RP não foram estatisticamente significativas. Ao investigarmos o sentimento de culpa/vergonha como mediador entre ITP e TEPT, o efeito indireto alcançou apenas significância estatística limítrofe (ORITP(TNIE)=1,1; IC95%:1,0-1,2). Os efeitos direto (ORITP(PNDE)=1,3; IC95%: 0,8-1,8) e total (ORITP(TE)=1,4; IC95%:0,9-1,9) para ITP perderam significância quando todas as RP, seus desconfundidores e correlações entre elas fizeram parte do mesmo modelo. As demais RP, no entanto, permaneceram estatisticamente significativas (ORDP=1,7; IC95%:1,3-2,3 e ORRFP=2,5; IC95%:1,8-3,4). Nossos resultados mostraram que a DP e as RFP aumentaram o risco de TEPT mesmo quando consideradas em conjunto. A ITP pode ter efeito sobre o risco de TEPT, mas esse achado deve ser interpretado com cautela devido a significância limítrofe dessa RP em nosso modelo final. Também não identificamos uma mediação significativa entre ITP e TEPT pelos sentimentos de culpa/vergonha. Contudo, a significância limítrofe encontrada para o efeito indireto demanda investigações adicionais. Nossos achados reforçam a ideia de que as reações peritraumáticas devem ser analisadas e compreendidas como ocorrências simultâneas. Também seria oportuno que estudos envolvendo culpa/vergonha, ITP e TEPT focalizassem traumas caracterizados por aprisionamento e impossibilidade de escapar, dado que estas experiências são apontadas como mais susceptíveis para desencadear a ITP. (AU)

Posttraumatic stress disorder (PTSD) is a debilitating condition that greatly impacts quality of life. Among several PTSD risk factors, peritraumatic reactions (PR) such as peritraumatic tonic immobility (PTI), dissociation (PD) and physical panic reactions (PPR) are some of the most investigated. However, several studies have assessed these PR separately, and the pathway connecting them to PTSD is not well understood. Therefore, this thesis aimed to: (i) simultaneously estimate the effect of the three PR on PTSD using a validated instrument; and (ii) assess if there is an indirect effect of PTI on PTSD mediated by feelings of guilt/shame. We used structural equation modelling to analyse data from 3211 participants from Rio de Janeiro and São Paulo. We treated the PR as latent variables and selected specific confounders for each reaction. Our exposures were the PR, and PTSD was the outcome. We calculated odds ratios and 95% confidence intervals for each analysis. We also employed the Bayesian Information Criterion to compare the goodness of fit between non-nested models. Separately, all PR achieved statistically significant results. However, only PD (ORPD=1.8; 95%CI:1.3-2.4) and PPR (ORPPR=2.5; 95%CI:1.8-3.4) remained statistically significant when all three were included in a model with their respective confounders and correlations among all PR. Our findings suggested a possible effect of PTI on PTSD (ORPTI=1.4; 95%CI:1.0-1.9). Interactions between the PR were not statistically significant. When we investigated feelings of guilt/shame as the mediator between PTI and PTSD, the indirect effect achieved a borderline statistical significance (ORPTI(TNIE)=1.1; 95%CI:1.0-1.2). Direct (ORPTI(PNDE)=1.3; 95%CI:0.8-1.8) and total (ORPTI(TE)=1.4; 95%CI:0.9-1.9) effects lost their significance when all PR, their confounders and correlations were included in the same model. The other PR remained statistically significant (ORPD=1.7; 95%CI:1.3-2.3 and ORPPR=2.5; 95%CI:1.8-3.4). Our findings showed PD and PPR to increase the risk of PTSD even when considered in tandem. PTI could have an effect on PTSD, but this must be considered cautiously, as this PR only reached borderline significance in our final model. Feelings of guilt/shame did not significantly mediate PTI's effect on PTSD. However, a borderline statistical significance in the indirect effects warrants further investigation. Our findings reinforce the hypothesis that peritraumatic reactions should be analysed and understood as simultaneous occurrences, not as separate entities. It would also be appropriate for studies concerning guilt/shame, PTI and PTSD to focus on traumas characterized by imprisonment and feelings of inescapability, given that these experiences are allegedly more likely to trigger PTI. (AU)

Análise ao conceito de culpa: Da divergência conceptual à sua implicação para a investigação em enfermagem / Analysis of the concept of guilt: From conceptual divergence to its implications for nursing research / Análisis del concepto de culpa: De la divergencia conceptual a sus implicaciones para la investigación en enfermería

Resumo Enquadramento: A culpa apresenta-se como um fenómeno alvo de estudo em várias áreas do conhecimento, inclusive em enfermagem. Contudo, a definição do seu conceito apresenta divergências entre as várias disciplinas, e tal emerge como um dos principais obstáculos à realização de estudos sobre o tema. Objetivo: O presente estudo, resultante de uma revisão narrativa da literatura, tem como objetivo apresentar uma análise conceptual ao conceito de culpa, refletindo concomitantemente sobre a necessidade de realizar um estudo sobre a definição do conceito face à vivência do fenómeno nos pós-cuidadores. Principais tópicos em análise: Definição do conceito de culpa à luz da filosofia, ciências jurídicas e enfermagem, e apresentação da necessidade de mapear o conceito como ponto de partida fundamental para a produção de conhecimento científico. Conclusão: O conceito de culpa é apresentado na literatura científica como um conceito multidisciplinar com múltiplos significados. O mapeamento do conceito de culpa numa população e contexto específicos apresenta-se como um ponto de partida fundamental para a condução de estudos futuros sobre a problemática.

Abstract Background: Guilt has been an object of study in several areas of knowledge, including nursing. However, this concept is defined differently across disciplines, which is one of the main obstacles to developing studies on this topic. Objective: This study results from a narrative literature review. It aims to present a conceptual analysis of guilt while reflecting on the need to study the definition of the concept based on the former carers' experience of this phenomenon. Main topics of analysis: Definition of the concept of guilt in the light of philosophy, legal sciences, and nursing, and presentation of the need to map the concept as a key starting point for the production of scientific knowledge. Conclusion: The literature describes the concept of guilt as a multidisciplinary concept with multiple meanings. Mapping the concept of guilt in a specific population and context is a key starting point for developing future studies on this topic.

Resumen Marco contextual: El sentimiento de culpa es un fenómeno estudiado en varias áreas del conocimiento, entre ellas la enfermería. Sin embargo, la definición de su concepto presenta divergencias entre las distintas disciplinas, lo que se perfila como uno de los principales obstáculos para la realización de estudios sobre el tema. Objetivo: Este estudio, fruto de una revisión narrativa de la literatura, tiene como objetivo presentar un análisis conceptual del concepto de culpa, a la vez que reflexionar sobre la necesidad de realizar un estudio sobre la definición del concepto en relación con la vivencia del fenómeno en los poscuidadores. Principales temas en análisis: Definición del concepto de culpa según la filosofía, las ciencias jurídicas y la enfermería, y presentación de la necesidad de mapear el concepto como punto de partida fundamental para la producción de conocimiento científico. Conclusión: El concepto de culpa se presenta en la literatura científica como un concepto multidisciplinar con múltiples significados. El mapeo del concepto de culpa en una población y un contexto específicos es un punto de partida fundamental para la realización de futuros estudios sobre la problemática.

Análise ao conceito de culpa: Da divergência conceptual à sua implicação para a investigação em enfermagem / Analysis of the concept of guilt: From conceptual divergence to its implications for nursing research / Análisis del concepto de culpa: De la divergencia conceptual a sus implicaciones para la investigación en enfermería

Resumo Enquadramento: A culpa apresenta-se como um fenómeno alvo de estudo em várias áreas do conhecimento, inclusive em enfermagem. Contudo, a definição do seu conceito apresenta divergências entre as várias disciplinas, e tal emerge como um dos principais obstáculos à realização de estudos sobre o tema. Objetivo: O presente estudo, resultante de uma revisão narrativa da literatura, tem como objetivo apresentar uma análise conceptual ao conceito de culpa, refletindo concomitantemente sobre a necessidade de realizar um estudo sobre a definição do conceito face à vivência do fenómeno nos pós-cuidadores. Principais tópicos em análise: Definição do conceito de culpa à luz da filosofia, ciências jurídicas e enfermagem, e apresentação da necessidade de mapear o conceito como ponto de partida fundamental para a produção de conhecimento científico. Conclusão: O conceito de culpa é apresentado na literatura científica como um conceito multidisciplinar com múltiplos significados. O mapeamento do conceito de culpa numa população e contexto específicos apresenta-se como um ponto de partida fundamental para a condução de estudos futuros sobre a problemática.

Abstract Background: Guilt has been an object of study in several areas of knowledge, including nursing. However, this concept is defined differently across disciplines, which is one of the main obstacles to developing studies on this topic. Objective: This study results from a narrative literature review. It aims to present a conceptual analysis of guilt while reflecting on the need to study the definition of the concept based on the former carers' experience of this phenomenon. Main topics of analysis: Definition of the concept of guilt in the light of philosophy, legal sciences, and nursing, and presentation of the need to map the concept as a key starting point for the production of scientific knowledge. Conclusion: The literature describes the concept of guilt as a multidisciplinary concept with multiple meanings. Mapping the concept of guilt in a specific population and context is a key starting point for developing future studies on this topic.

Resumen Marco contextual: El sentimiento de culpa es un fenómeno estudiado en varias áreas del conocimiento, entre ellas la enfermería. Sin embargo, la definición de su concepto presenta divergencias entre las distintas disciplinas, lo que se perfila como uno de los principales obstáculos para la realización de estudios sobre el tema. Objetivo: Este estudio, fruto de una revisión narrativa de la literatura, tiene como objetivo presentar un análisis conceptual del concepto de culpa, a la vez que reflexionar sobre la necesidad de realizar un estudio sobre la definición del concepto en relación con la vivencia del fenómeno en los poscuidadores. Principales temas en análisis: Definición del concepto de culpa según la filosofía, las ciencias jurídicas y la enfermería, y presentación de la necesidad de mapear el concepto como punto de partida fundamental para la producción de conocimiento científico. Conclusión: El concepto de culpa se presenta en la literatura científica como un concepto multidisciplinar con múltiples significados. El mapeo del concepto de culpa en una población y un contexto específicos es un punto de partida fundamental para la realización de futuros estudios sobre la problemática.

El efecto de la desvinculación moral sobre el acoso escolar, el ciberacoso y otros comportamientos disruptivos en niños(as) y adolescentes. Una revisión de la literature / The Effect of moral disengagement on bullying, cyberbullying, and other disruptive behaviors in children and adolescents. A review of the literatura

Resumen Introducción: Un creciente número de estudios han demostrado vínculos consistentes entre la teoría de la desvinculación moral de Bandura y los comportamientos disruptivos e inhumanos. Recientemente se han explorado las relaciones directas e indirectas de la desvinculación moral con el acoso escolar, el ciberacoso y otros comportamientos agresivos en niños(as) y adolescentes, lo cual amerita una revisión de los principales hallazgos. Objetivo: Revisar la literatura y evidencia empírica sobre el efecto de la desvinculación moral en la participación de niños(as) y adolescentes en el acoso escolar, el ciberacoso y otros comportamientos agresivos. Método: Se trató de un estudio de revisión documental. La búsqueda bibliográfica se efectuó en la Web of Science. Se incluyeron 45 estudios empíricos para el análisis. Resultados: Se encontró que la desvinculación moral y sus diferentes estrategias sociocognitivas tienen efectos directos e indirectos que predicen la participación de niños(as) y adolescente en el acoso escolar, el ciberacoso, comportamientos agresivos y antisociales. Adicionalmente, la empatía, las relaciones de amistad, la crianza, las tendencias prosociales, la ira y los rasgos insensibles-no emocionales son factores que, en conjunto, contribuyen al desarrollo, mantenimiento o disminución de conductas de acoso y ciberacoso. También se reportó que los hombres presentan una mayor tendencia que las mujeres al acoso escolar, el ciberacoso, la agresión y uso de la desvinculación moral. Conclusiones: Se señala la importancia de los procesos de cognición moral para el desarrollo de estrategias de intervención psicoeducativa y psicosocial destinadas a prevenir y reducir el acoso y ciberacoso en niños(as) y adolescentes.

Abstract Introduction: A growing number of studies have demonstrated consistent links between Bandura's moral disengagement theory and disruptive and inhumane behaviors. The direct and indirect relation- ships of moral disengagement with bullying, cyberbullying, and other aggressive behaviors in children and adolescents have recently been explored, ensuring a review of key findings. Objective: To review the literature and empirical evidence on the effect of moral disengagement on children's and adolescents' engagement in bullying, cyberbullying, and other aggressive behaviors. Method: This was a documentary review study. The literature search was carried out in the Web of Science. Forty-five empirical studies were included for analysis. Results: Were found that moral disengagement and its different socio-cognitive strategies have direct and indirect effects that predict child and adolescent involvement in bullying, cyberbullying, aggressive and antisocial behaviors. Additionally, empathy, friendship relationships, parenting, prosocial tendencies, anger and callous-unemotional traits are factors that together contribute to the development, maintenance or decrease of bullying and cyberbullying behaviors. It was also reported that males present a greater tendency than females to bullying, cyberbullying, aggression, and use of moral disengagement. Conclusions: The importance of moral cognition processes for the development of psychoeducational and psychosocial intervention strategies aimed at preventing and reducing bullying and cyberbullying in children and adolescents is pointed out.

Exu e a psicanálise: da culpa à ilusão / Exu and psychoanalysis: from guilt to illusion / Exu y el psicoanálisis: de la culpa a la ilusión

Muito embora psicanálise e religião não se confundam, o pensamento religioso perpassa boa parte da obra freudiana. Trata-se, no entanto, de uma concepção religiosa que tem como centralidade a culpa, uma vez que se articula ao paradigma neurótico e à morte do pai, sendo considerada como uma ilusão análoga à fantasia neurótica. Assim como outras configurações subjetivas provocam a psicanálise na contemporaneidade, as religiões de matriz africana, tal como o candomblé, também provocam a psicanálise e a experiência analítica, posto que se distanciam da centralidade da culpa. O objetivo do artigo consiste em abrir os caminhos para uma discussão ainda incipiente entre a psicanálise e o candomblé e, para tal, parte da figura de Exu, mais especificamente assinalando o lugar plural da corporeidade e das fronteiras com o mundo. Por fim, em diálogo com algumas considerações de Winnicott, a ilusão é tomada não como análoga à fantasia neurótica, mas como um campo de potencialidades que comportam a atualização do passado, do presente e do futuro e a corporeidade. Delineiam-se, a partir dessas considerações, alguns questionamentos que o candomblé implica para a própria experiência analítica.

Although psychoanalysis and religion are not confounded, religious thought permeates much of Freud's work. It is, however, a religious conception that has as centrality guilt, since it is articulated with the neurotic paradigm and death of the father, being considered as an illusion analogous to neurotic fantasy. Just as other subjective configurations provoke psychoanalysis in contemporary times, religions of African matrix, such as candomblé, also provoke psychoanalysis and analytical experience, since they distance themselves from the centrality of guilt. The aim of this article is to open the paths to a still incipient discussion between psychoanalysis and candomblé and, to this end, part of the figure of Exu, more specifically, pointing out the plural place of corporeity and borders with the world. Finally, in dialogue with some of Winnicott's considerations, the illusion is taken not as analogous to neurotic fantasy, but as a field of potentialities that involve the updating of the past, present, and future and corporeity. From these considerations, some questions that candomblé implies for the analytical experience itself are outlined.

Aunque el psicoanálisis y la religión no están confundidos, el pensamiento religioso impregna gran parte de la obra de Freud. Es, sin embargo, una concepción religiosa que tiene como centralidad la culpa, ya que se articula con el paradigma neurótico y la muerte del padre, siendo considerada como una ilusión análoga a la fantasía neurótica. Así como otras configuraciones subjetivas provocan el psicoanálisis en los tiempos contemporáneos, las religiones de matriz africana, como el candomblé, también provocan el psicoanálisis y la experiencia analítica, ya que se distancian de la centralidad de la culpa. El objetivo de este artículo es abrir los caminos a una discusión aún incipiente entre psicoanálisis y candomblé y, para ello, formar parte de la figura de Exu, más concretamente, señalando el lugar plural de corporeidad y fronteras con el mundo. Finalmente, en diálogo con algunas de las consideraciones de Winnicott, la ilusión no se toma como análoga a la fantasía neurótica, sino como un campo de potencialidades que implican la actualización del pasado, presente y futuro y la corporeidad. A partir de estas consideraciones, se esbozan algunas preguntas que el candomblé implica para la propia experiencia analítica.

Culpa por percibirse como una carga. Una variable relevante asociada al malestar psicológico de las personas mayores / Guilt for perceiving oneself as a burden: A relevant variable associated with the psychological distress of older adults

Objetivos: Analizar la relación entre la culpa por percibirse como una carga y la percepción negativa del envejecimiento, el control percibido y la sintomatología ansiosa y depresiva en personas mayores de 60 años sin limitaciones cognitivas o funcionales. Método: Participaron 351 personas mayores de 60 años residentes en la comunidad y sin deterioro cognitivo o funcional aparente. Se llevaron a cabo dos análisis de efectos indirectos de la percepción subjetiva del envejecimiento a través de 1) el control percibido y la sintomatología ansiosa y 2) el control percibido y la sintomatología depresiva en la culpa por percibirse como una carga. Resultados: Ambos modelos mostraron una relación indirecta entre la percepción subjetiva del envejecimiento y la culpa por percibirse como una carga a través de 1) el control percibido y la sintomatología ansiosa y 2) el control percibido y la sintomatología depresiva, explicando un 26,37% de la sintomatología ansiosa, un 48,51% de la sintomatología depresiva y un 13,73% y un 14,44% de la culpa por percibirse como una carga, respectivamente. Discusión: Los resultados obtenidos sugieren que una mayor percepción negativa del envejecimiento se asocia a una menor percepción de control y mayor malestar psicológico (ansiedad y depresión), y que este proceso incrementa el sentimiento de culpa por ser una carga para otros familiares en personas mayores sin problemas funcionales o cognitivos. (AU)

Aims: To analyze the relationship between guilt for perceiving oneself as a burden and negative self-perceptions of aging, perceived control and anxious and depressive symptomatology in older people without cognitive or functional limitations. Methods: Participants were 351 community-dwelling people over 60 years without explicit cognitive or functional limitation. Indirect effet analysis were conducted that examined the indirect effect of negative self-perceptions of aging through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology in guilt for perceiving oneself as a burden. Results: Both models showed an indirect relationship between negative self-perceptions of aging and guilt for perceiving oneself as a burden through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology, explaining 26.37% of anxious symptomatology, 48.51% of depressive symptomatology and 13.73% and 14.44% of guilt for perceiving oneself as a burden, respectively. Discussion: The results obtained suggest that higher negative self-perceptions of aging is associated with a lower perception of control and greater psychological distress (anxiety and depression), and this process increases the feeling of guilt for perceiving oneself as burden to family members in older people without functional or cognitive limitations. (AU)

[Guilt for perceiving oneself as a burden: A relevant variable associated with the psychological distress of older adults]. / Culpa por percibirse como una carga. Una variable relevante asociada al malestar psicológico de las personas mayores.

AIMS: To analyze the relationship between guilt for perceiving oneself as a burden and negative self-perceptions of aging, perceived control and anxious and depressive symptomatology in older people without cognitive or functional limitations. METHODS: Participants were 351 community-dwelling people over 60 years without explicit cognitive or functional limitation. Indirect effet analysis were conducted that examined the indirect effect of negative self-perceptions of aging through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology in guilt for perceiving oneself as a burden. RESULTS: Both models showed an indirect relationship between negative self-perceptions of aging and guilt for perceiving oneself as a burden through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology, explaining 26.37% of anxious symptomatology, 48.51% of depressive symptomatology and 13.73% and 14.44% of guilt for perceiving oneself as a burden, respectively. DISCUSSION: The results obtained suggest that higher negative self-perceptions of aging is associated with a lower perception of control and greater psychological distress (anxiety and depression), and this process increases the feeling of guilt for perceiving oneself as burden to family members in older people without functional or cognitive limitations.

Neuroética: comienza el reinado de las neurociencias en la fundamentación de la ética / Neuroethics: the reign of neuroscience begins in the foundation of the ethics / Neuroética: começa o reinado das neurociências na fundamentação da ética

Resumen: 1] La neurociencia de la ética constituye un progreso al aplicar la ciencia empírica en la investigación del fenómeno moral. 2] Resaltar la importancia de afectos y sentimientos representa una compensación a la excesiva importancia dada a la razón en la formación de los juicios morales. 3] Existen graves dificultades metodológicas al no precisar los conceptos de "intuición", "afectos", "deber" y especialmente qué se entiende por "ética". 4] Pero la investigación científica aprehende al hombre como una "entidad" en sí (presente) y no como una "existencia" (futuro), vale decir, ser-en-el-mundo. 5] En lugar de "tener" una moral el ser humano "es" moral y, como tal, es un proyecto lanzado hacia su más auténtica posibilidad que consiste en apropiarse de su ser-para-la-muerte.

Abstract: 1] The Neuroscience of Ethics constitutes a progress when applying empirical science in the investigation of the moral phenomenon. 2] Emphasizing the importance of affects and feelings represents a compensation for the excessive importance given to reason in the formation of moral judgments. 3] There are serious methodological difficulties by not specifying the concepts of intuition, affections, duty and especially what is understood by ethics. 4] But scientific research apprehends man as an "entity" in himself (present) and not as an "existence" (future), that is, being-in-the-world. 5] Instead of "having" a moral, the human being "is" moral and as such is a project thrown towards its most authentic possibility that consists of appropriating its being-for-death.

Resumo: 1] A neurociência da ética constitui um progresso ao aplicar a ciência empírica na investigação do fenômeno moral. 2] Ressaltar a importância de afetos e sentimentos representa uma compensação à excessiva importância dada à razão na formação dos juízos morais. 3] Existem graves dificuldades metodológicas ao não precisar os conceitos de "intuição", "afetos", "dever" e especialmente o que se entende por "ética". 4] Porém a investigação científica apreende o homem como uma "entidade" em si (presente) e não como una "existência" (futuro), vale dizer, ser-no-mundo. 5] Em lugar de "ter" uma moral o ser humano "é" moral e, como tal, é um projeto lançado à sua mais autêntica possibilidade, que consiste em apropriar-se de seu ser-para-a-morte.

Ego-dystonia: a review in search of definitions.

The ego-dystonic experience refers to the negative assessment that the subject makes of some of their thoughts or emotions, in the context of a conserved state of consciousness, as well as other aspects of their social and intrapersonal life that are relatively intact. Ego-dystonia is a widely used construct, but one that has not been defined in reasonably operational terms. Perhaps this explains why it is no longer used in contemporary classifications of mental disorders such as the ICD-11 and DSM-5. It is related to the awareness of the mental illness, with feelings of guilt and shame, but intuitively we perceive relevant differences between all these experiences. Psychoanalytic theory conceives the ego-dystonic as an alteration in the early structuring of the ego. Cognitive psychology conceives it as a dysfunction of the corrective mechanisms that harmonise the cognitive and the metacognitive. Evolutionary theory has not addressed the issue directly, but through the analysis of guilt, to which it attributes a high adaptive value, since it limits aggression and promotes reparative behaviours. Given the importance of the concept of self-attunement, it is surprising how little theoretical and empirical research there is on the subject, the clarification of which could represent a considerable advance in the field of mental health.

Egodistónico: Una Revisión en Busca de Definiciones / Ego-Dystonia: a Review in Search of Definitions

RESUMEN La vivencia egodistónica se refiere a la valoración negativa del sujeto sobre algunos de sus pensamientos o emociones, en el contexto de un estado de conciencia conservado, al igual que otros aspectos de su vida social e intrapersonal que se encuentran relativamente intactos. La egodistonía es un constructo ampliamente utilizado, pero que no ha sido definido en términos razonablemente operativos. Tal vez ello explica por qué ha dejado de utilizarse en las clasificaciones contemporáneas de los trastornos mentales, como la ICD-11 y el DSM-5. Lo egodistónico se relaciona con la conciencia de enfermedad mental, con los sentimientos de culpa y la vergüenza, pero intuitivamente percibimos diferencias relevantes entre todas estas vivencias. La teoría psicoanalítica concibe lo egodistónico como una alteración en la estructuración temprana del Yo. La psicología cognitiva lo concibe como una disfunción de los mecanismos correctivos que armonizan lo cognitivo y lo metacognitivo. La teoría evolutiva no ha abordado el tema directamente, sino a través del análisis de la culpa, a la cual atribuye un alto valor adaptativo, dado que limita la agresión y promueve conductas reparativas. Dada la importancia del concepto de egosintonía, es sorprendente la escasa investigación teórica y empírica sobre el tema, cuyo esclarecimiento podría representar un avance considerable en el campo de la salud mental.

ABSTRACT The ego-dystonic experience refers to the negative assessment that the subject makes of some of their thoughts or emotions, in the context of a conserved state of consciousness, as well as other aspects of their social and intrapersonal life that are relatively intact. Ego-dystonia is a widely used construct, but one that has not been defined in reasonably operational terms. Perhaps this explains why it is no longer used in contemporary classifications of mental disorders such as the ICD-11 and DSM-5. It is related to the awareness of the mental illness, with feelings of guilt and shame, but intuitively we perceive relevant differences between all these experiences. Psychoanalytic theory conceives the ego-dystonic as an alteration in the early structuring of the ego. Cognitive psychology conceives it as a dysfunction of the corrective mechanisms that harmonise the cognitive and the metacognitive. Evolutionary theory has not addressed the issue directly, but through the analysis of guilt, to which it attributes a high adaptive value, since it limits aggression and promotes reparative behaviours. Given the importance of the concept of self-attunement, it is surprising how little theoretical and empirical research there is on the subject, the clarification of which could represent a considerable advance in the field of mental health.

Sentimiento de culpa y malestar psicológico en víctimas de violencia de género / Feeling of guilt and psychological discomfort in victims of gender violence

Resumen. La violencia de género tiene graves consecuencias para la salud de las mujeres y sus efectos se agravan cuando el maltrato se ha producido a lo largo del ciclo vital. Además, puede desarrollar en las víctimas sentimientos de culpa que influyen negativamente en su salud mental. El objetivo del presente trabajo consiste en analizar la influencia de la polivictimización (infantil, intrafamiliar y de pareja) en el desarrollo de sentimientos de culpa y las implicaciones que dicha culpa tiene en el malestar psicológico en una muestra de víctimas nicaragüenses. La muestra, con una edad media de 31.7 años (DT = 8.9), está formada por 129 víctimas de violencia de género de Nicaragua, un colectivo de difícil acceso que ha padecido distintas formas de polivictimización desde la infancia. Para el trabajo se utilizó la escala Kessler y el Listado de Sucesos Vitales Estresantes. Los resultados muestran que el desarrollo de sentimientos de culpa se asocia al historial de maltrato e influye en la salud de las víctimas, quienes presentan mayores niveles de ansiedad y depresión que quienes no se sienten culpables. Conocer la problemática permite su consideración en los procesos de intervención en quienes han padecido violencia de género y diversas formas de polivictimización a lo largo de su ciclo vital.

Abstract. Gender-based violence has serious consequences for women's health and its effects are aggravated when abuse has occurred throughout the life cycle. In addition, it can develop in victims' feelings of guilt that negatively influence their mental health. The objective of this study is to analyze the influence of polyvictimization (child, intrafamily, and partner) on the development of feelings of guilt and the implications that such guilt has on psychological distress in a sample of Nicaraguan victims. The sample, with a mean age of 31.7 years (SD = 8.9), is made up of 129 victims of gender-based violence from Nicaragua, a group of difficult access that has suffered different forms of polyvictimization since childhood. For the work, the Kessler scale and the List of Stressful Life Events were used. The results show that the development of feelings of guilt is associated with the history of abuse and influences the health of the victims, who present higher levels of anxiety and depression than those who do not feel guilty. Knowing the problem allows its consideration in the intervention processes in those who have suffered gender violence and various forms of polyvictimization throughout their life cycle.