Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain.

Pain invalidation (e.g., having pain discounted) is a risk factor for depression among people with chronic pain, but the mechanisms remain unclear. Shame is a common, yet understudied, aspect of the pain experience. This study investigated whether pain-related shame helps explain the relationship between pain discounting and heightened depressive symptoms. The secondary aim was to examine whether social support can protect against the harmful effects of discounting. Patients with chronic pain (N = 305) were recruited from outpatient pain clinics. Participants completed an online cross-sectional survey and data were analyzed using moderated mediation analysis. Greater discounting was associated with greater depressive symptoms, and pain-related shame significantly mediated this relationship. Perceived social support attenuated the relationship between discounting and depressive symptoms. Greater attention towards pain-related shame as a treatment target is needed. Individual- and system-level interventions are required to address pain invalidation and bolster support for this population.

Examining the validity of eye tracking during the computerized Wisconsin card sorting test in a sample of stroke patients and healthy controls.

INTRODUCTION: Each year, approximately 50,000 Canadians, one million Americans, and millions of people worldwide are hospitalized for stroke. Cognitive impairment is common after experiencing a stroke and is known to affect functioning on daily tasks. While neuropsychological assessments are often employed to assess cognitive abilities and make inferences about functional capabilities, there is growing interest in integrating contemporary technologies to augment assessment. Eye tracking allows previously overlooked information, such as overt visual attention based on fixations and saccades, to be quantified to help elucidate how responses are made during testing. METHOD: The current study investigated the validity of eye tracking during completion of the computerized Wisconsin Card Sorting Test (cWCST), a common test of higher level cognition, in a sample of inpatients recovering from stroke (n= 41) and a control group of healthy individuals (n = 46). RESULTS: Results provided supporting evidence for the construction, criterion, and ecological validity of eye tracking on the cWCST with inpatients recovering from a stroke. Specifically, eye tracking metrics differentiated between inpatients and controls; fixations on cWCST areas of interest differed between type of response (conceptual versus non-conceptual); and average time per fixation predicted functional status early after a stroke as well as recovery during inpatient rehabilitation, above-and-beyond cWCST scores. Time spent on testing negated the effects of fixation and saccade counts for predicting cWCST performance, due to the substantial overlap in variance. CONCLUSION: Current findings of this preliminary study provided support for the validity of eye tracking, integrated with the cWCST, for inpatients recovering from a stroke. Implications and areas for future research are discussed.

Defining and Assessing the Syndrome of Moral Injury: Initial Findings of the Moral Injury Outcome Scale Consortium.

Potentially morally injurious events (PMIEs) entail acts of commission (e.g., cruelty, proscribed or prescribed violence) or omission (e.g., high stakes failure to protect others) and bearing witness (e.g., to grave inhumanity, to the gruesome aftermath of violence), or being the victim of others' acts of commission (e.g., high stakes trust violations) or omission (e.g., being the victim of grave individual or systemic failures to protect) that transgress deeply held beliefs and expectations about right and wrong. Although there is a proliferation of interest in moral injury (the outcome associated with exposure to PMIEs), there has been no operational definition of the putative syndrome and no standard assessment scheme or measure, which has hampered research and care in this area. We describe an international effort to define the syndrome of moral injury and develop and validate the Moral Injury Outcome Scale (MIOS) in three stages. To ensure content validity, in Stage I, we conducted interviews with service members, Veterans, and clinicians/Chaplains in each country, inquiring about the lasting impact of PMIEs. Qualitative analysis yielded six operational definitions of domains of impact of PMIEs and components within domains that establish the parameters of the moral injury syndrome. From the domain definitions, we derived an initial pool of scale items. Stage II entailed scale refinement using factor analytic methods, cross-national invariance testing, and internal consistency reliability analyses of an initial 34-item MIOS. A 14-item MIOS was invariant and reliable across countries and had two factors: Shame-Related (SR) and Trust-Violation-Related (TVR) Outcomes. In Stage III, MIOS total and subscale scores had strong convergent validity, and PMIE-endorsers had substantially higher MIOS scores vs. non-endorsers. We discuss and contextualize the results and describe research that is needed to substantiate these inaugural findings to further explore the validity of the MIOS and moral injury, in particular to examine discriminant and incremental validity.

What twitter can tell us about user experiences of crisis text lines: A qualitative study.

Mental health problems are the leading cause of disability worldwide. Despite the prevalence and cost of mental illness, there are insufficient health services to meet this demand. Crisis hotlines have a number of advantages for addressing mental health challenges and reducing barriers to support. Mental health crisis services have recently expanded beyond telephone hotlines to include other communication modalities such as chat and text messaging services, largely in response to the increased use of mobile phones and text messaging for social communication. Despite the high uptake of crisis text line services (CTLs) and rising mental health problems worldwide, CTLs remain understudied. The current study aimed to address an urgent need to evaluate user experiences with text-based crisis services. This study explored user experiences of CTLs by accessing users' publicly available Twitter posts that describe personal use and experience with CTLs. Data were qualitatively analyzed using thematic analysis. Six main themes were identified from 776 tweets: (1) approval of CTLs, (2) helpful counselling, (3) invalidating or unhelpful counselling, (4) problems with how the service is delivered, (5) features of the service that facilitate accessibility, and (6) indication that the service suits multiple needs. Overall, results provide evidence for the value of text-based crisis support, as many users reported positive experiences of effective counselling that provided helpful coping skills, de-escalation, and reduction of harm. Results also identified areas for improvement, particularly ensuring more timely service delivery and effective communication of empathy. Text-based services may require targeted training to apply methods that effectively convey empathy in this medium. Moving forward, CTL services will require systematic attention in the clinical research literature to ensure their continued success and popularity among users.

Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation: Commentary on Farnsworth (2019).

Farnsworth (2019) proposed that posttraumatic stress disorder (PTSD) and moral injury (MI) can be differentiated using DSM-5 PTSD's Criteria D. It was suggested that PTSD cognitions are descriptions about what the world is like whose accuracy can be targeted by cognitive therapies, whereas MI cognitions are prescriptions about what the world should be like, which cannot be assessed for truth or falsehood and so are unsuitable for cognitive therapies. We believe that this appeal to the is/ought distinction distorts the therapeutic challenge, and misconceptualizes moral thinking as manifested only in thin terms such as "ought/should." In practical usage, it is unlikely that when people express cognitions they are only describing the world and not evaluating it as well. In this commentary, we will critique the prescriptivist view of trauma, suggest the importance of "thick terms," and reconsider the purported differences between MI and PTSD. MI might be meaningfully different from PTSD, but it is premature to differentiate these constructs based on DSM-5's Criteria D. A trauma theory that accounts for the interwoven descriptive and evaluative, cognitive as well as affective, elements of traumatic experiences will clarify both the PTSD diagnosis and MI model and improve treatment development and clinical care.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Aportando la filosofía sobre el daño moral y la validación de construcciones de TEPT: Comentario sobre Farnsworth (2019) COMENTARIO SOBRE FARNSWORTH (2019) Farnsworth (2019) propuso que el Trastorno de Estrés Postraumático (TEPT) y el daño moral (DM) se pueden diferenciar utilizando los Criterios D del TEPT del DSM-5. Se sugiere que las cogniciones del TEPT son descripciones sobre cómo es el mundo cuya precisión puede ser abordada por las terapias cognitivas, mientras que las cogniciones de DM son prescripciones sobre cómo debería ser el mundo, que no pueden ser evaluadas por la verdad o la falsedad y, por lo tanto, no son adecuadas para las terapias cognitivas. Creemos que esta apelación a la distinción es/debería distorsiona el desafío terapéutico, y malinterpreta el pensamiento moral como se manifiesta solo en términos ligeros como "debe / debería". En el uso práctico, es poco probable que cuando las personas expresan cogniciones solo sean describiendo el mundo y no evaluándolo también. En este comentario, criticaremos la visión prescriptivista del trauma, sugeriremos la importancia de los términos contundentes y reconsideraremos las supuestas diferencias entre el DM y el TEPT. El DM podría ser significativamente diferente del TEPT, pero es prematuro diferenciar estas construcciones basados en los Criterios D del DSM-5. Una teoría del trauma que considera los elementos entrelazados descriptivos y evaluativos, cognitivos y afectivos de las experiencias traumáticas aclararán tanto el diagnóstico de TEPT como el modelo de DM y mejorarán el desarrollo del tratamiento y la atención clínica.