The Processing of Moral Transgressions: Investigating the Role of Affective Evaluations

Every day we are confronted with other’s actions which clash with our understanding about what is right and what is wrong. This understanding is summarised here by the concept of morality. For many decades, scientists have been investigating how we evaluate the morality of actions and which brain processes underlie such evaluations. For instance, recently it has been suggested that affective as compared to cognitive processes might play a more fundamental role in moral judgement than previously assumed. So far, however, it is still unclear what the underlying mechanisms exactly are. This dissertation, which is based on three studies, intends to contribute to answering this question. By using a language comprehension approach, moral information processing is taken as a special case of emotional information processing. All three studies are based on the assumption that affective processes play an important role in the processing of moral transgressions. Therefore, in addition to moral texts, the processing of emotional texts was also considered in all studies. In study 1, event-related brain potentials (ERPs) were used to investigate how moral transgressions are processed in the brain during discourse comprehension of everyday scenarios and whether affective pro- cessing is task-dependent. The focus was on the time course of mental mechanisms during a morality and an emotional judgement task. Study 2 aimed at examining whether moral transgressions during reading of the same everyday scenarios trigger embodied responses. By using peripheral psychophysiological measures, we investigated whether embodied pro- cessing takes place when participants perform an emotional judgement task. Finally, Study 3 analysed both, ERPs and peripheral psychophysiological measures to investigate the type of processes involved in moral information processing when participants merely read for comprehension. In summary, the results of the studies reported in this thesis point towards the involve- ment of affective processes in the processing of moral content. This is reflected by ERP correlates indicating affective processing and by peripheral psychophysiological measures suggesting the embodiment of moral content. Moreover, the results suggest a task de- pendency of involved processes. This means that the goals with which one reads a text influence whether moral information is emotionally salient or not. As a result, cognitive processes dominate over affective processes when moral judgements are demanded and vice versa when affective judgements are required or participants merely read for comprehen- sion.Im Alltag passiert es uns oft, dass wir Menschen begegnen, die entgegen unseres Verst ̈andnisses darüber, was richtig und was falsch ist, handeln. Dieses Verständnis soll hier unter dem Begriff der Moralität zusammengefasst werden. Seit vielen Jahrzehnten beschäftigen sich Wissenschaftler mit der Frage, wie wir unsere eigenen und die Handlungen anderer hinsichtlich ihres moralischen Gehalts bewerten, und welche Verarbeitungsprozesse dabei im Gehirn ablaufen. In jüngster Zeit wurde vorgeschlagen, dass affektiven im Vergleich zu kognitiven Prozessen eine wichtige Rolle bei moralischen Entscheidungen zukommt. Bisher fehlt es jedoch an einem tieferen Verständnis über die zugrundeliegenden Verarbeitungsmechanismen. Die vorliegende Dissertationsschrift, welche sich dreier Studien bedient, soll einen Beitrag zur Klärung dieser Frage leisten. Hierfür werden bereits bekannte Paradigmen herangezogen und moralisches Sprachverstehen als Spezialfall des emotionalen Sprachverständnisses betrachtet. Alle drei Studien bauen auf der Vorstellung auf, dass die Verarbeitung moralischer Verletzungen eine wichtige affektive Komponente besitzt. Deshalb wurde in allen Studien neben moralischen Texten zusätzlich die Verarbeitung emotionaler Texte betrachtet. In Studie 1 wurde mittels ereigniskorrelierter Potentiale (EKPs) der Frage nachgegangen, wie während des Lesens kurzer Alltagsszenarien die Verarbeitung moralischer Verletzungen im Gehirn abläuft und ob diese Verarbeitung von der Art der Aufgabe abhängt. Dabei lag der Fokus auf dem zeitlichen Verlauf mentaler Mechanismen bei moralischen und bei affektiven Urteilen. In Studie 2 wurde die Frage untersucht, ob moralische Verletzungen verkörperlicht verarbeitet werden. Mittels der Messung peripherer psychophysiologischer Methoden wurde untersucht, ob beim Lesen konkrete emotionale Zustände simuliert werden. Studie 3 untersuchte sowohl für EKPs, als auch für periphere psychophysiologische Maße die Art der beteiligten Prozesse bei der Verarbeitung moralischer Information beim reinen Lesen. Zusammenfassend weisen die Ergebnisse der vorliegenden Studien auf eine maßgebliche Beteiligung affektiver Prozesse bei der Verarbeitung moralischer Information hin. Dies spiegelt sich sowohl im EKP, als auch in der verkörperten Verarbeitung moralischer In- halte wider. Des Weiteren legen die Ergebnisse eine Aufgabenabhängigkeit der beteiligten Prozesse nahe. Beim Lesen und beim emotionalen Urteil wird moralische Information af- fektiv verarbeitet, wohingegen beim moralischen Urteil kognitive Verarbeitung dominiert

Learning by observing: a systematic exploration of modulatory factors and the impact of observationally induced placebo and nocebo effects on treatment outcomes

IntroductionObservational learning (OL) refers to learning through observing other people’s behavior. OL has been suggested as an effective and simple tool to evoke treatment expectations and corresponding placebo and nocebo effects. However, the exact mechanisms by which OL shapes treatment outcomes, its moderating factors and possible areas of application remain unclear. We thus reviewed the existing literature with two different literature searches to answer the following questions: Which influencing factors contribute to OL-induced placebo and nocebo effects (in healthy volunteers and patients) and how large are these effects (search 1)? In which medical fields has OL been used so far to modulate treatment expectancy and treatment outcomes in patients, their caregivers, and at-risk groups (search 2)? We also aimed to explore whether and how the assessment of treatment expectations has been incorporated.MethodsWe conducted two independent and comprehensive systematic literature searches, both carried out on September 20, 2022.ResultsWe identified 21 studies that investigated OL-mediated placebo and nocebo effects for pain and itch, the (placebo) efficacy of sham treatment on anxiety, and the (nocebo) induction of medication side effects (search 1). Studies showed that OL can efficiently induce placebo and nocebo effects across different presentation modes, with medium effect sizes on average: placebo effects, d = 0.79 (range: d = −0.36–1.58), nocebo effects, d = 0.61 (range: d = 0.04–1.5). Although several moderating factors have been investigated, their contribution to OL-induced effects remains unclear because of inconsistent results. Treatment expectation was assessed in only four studies. Regarding medical applications of OL (search 2), we found 12 studies. They showed that OL was effectively applied in preventive, therapeutic and rehabilitative interventions and that it was mainly used in the field of psychosomatics.DiscussionOL effects on treatment outcomes can be both positive and negative. Future research should investigate which individuals would benefit most from OL and how OL can be implemented most effectively to induce placebo and avoid nocebo effects in clinical settings.Systematic review registrationThis work was preregistered at the Center for Open Science as open-ended registration (doi: 10.17605/OSF.IO/FVHKE). The protocol can be found here: https://archive.org/details/osf-registrations-fvhke-v1

Dopamine has no direct causal role in the formation of treatment expectations and placebo analgesia in humans

Dopamine-based reward and learning mechanisms have been suggested to contribute to placebo effects. However, the exact role of dopaminergic neurotransmission in their generation and maintenance is still unclear. This study aimed to shed light on the causal role of dopamine in establishing positive treatment expectations, as well as on the magnitude and duration of their effect on pain. To this end, we used an established placebo analgesia paradigm in combination with 2 opposing pharmacological modulations of dopaminergic tone, i.e., the dopamine antagonist sulpiride and the dopamine precursor L-dopa which were both applied in an experimental, double-blind, randomized, placebo-controlled trial with a between-subject design in N = 168 healthy volunteers. The study medication successfully altered dopaminergic tone during the conditioning procedure. Contrary to our hypotheses, the medication did not modulate the formation of positive treatment expectation and placebo analgesia tested 1 day later. Placebo analgesia was no longer detectable on day 8 after conditioning. Using a combined frequentist and Bayesian approach, our data provide strong evidence against a direct dopaminergic influence on the generation and maintenance of placebo effects. Further exploration of the neurochemical mechanisms underlying placebo analgesia remains paramount in the quest to exploit these effects for optimal treatment outcomes. Trial registration: ClinicalTrials.gov German Clinical Trials Register, ID: DRKS00029366, https://drks.de/search/en/trial/DRKS00029366

Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

Background Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. Methods As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Results Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Conclusion Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity of improvement. According to rules of quality management correcting measures and subsequent examination of effectiveness were performed. These changes resulted in higher satisfaction of patients, referring colleagues and clinic staff the like. Additionally the clinic is able to cope with an increasing demand for appointments in outpatients' departments, and the clinic's human resources are employed more effectively

Task-dependent evaluative processing of moral and emotional content during comprehension: an ERP study

Recently, we showed that when participants passively read about moral transgressions (e.g., adultery) they implicitly engage in the evaluative (good–bad) categorization of incoming information, as indicated by a larger event-related brain potential (ERP) positivity to immoral than moral scenarios (Leuthold, Kunkel, Mackenzie, & Filik, 2015). Behavioral and neuroimaging studies indicated that explicit moral tasks prioritize the semantic-cognitive analysis of incoming information but that implicit tasks, as used in Leuthold et al. (2015), favor their affective processing. Therefore, it is unclear whether an affective categorization process is also involved when participants perform explicit moral judgments. Thus, in two experiments, we used similarly constructed morality and emotion materials for which their moral and emotional content had to be inferred from the context. Target sentences from negative vs. neutral emotional scenarios and from moral vs. immoral scenarios were presented using rapid serial visual presentation. In Experiment 1, participants made moral judgments for moral materials and emotional judgments for emotion materials. Negative compared to neutral emotional scenarios elicited a larger posterior ERP positivity (LPP) about 200 ms after critical word onset, whereas immoral compared to moral scenarios elicited a larger anterior negativity (500-700 ms). In Experiment 2, where the same emotional judgment to both types of materials was required, a larger LPP was triggered for both types of materials. These results accord with the view that morality scenarios trigger a semantic-cognitive analysis when participants explicitly judge the moral content of incoming linguistic information but an affective evaluation when judging their emotional content

Translating knowledge on placebo and nocebo effects into clinical practice

Abstract. Introduction:. Positive and negative treatment expectations are powerful modulators of health and treatment outcomes. A substantial part of treatment success is due to contextual factors modulating patient's expectations towards a treatment. Consequently, treatment expectations should be a target of therapeutic interventions themselves. Objectives:. This article highlights the neurobiological underpinnings of treatment expectations as well as strategies to modulate contextual factors to optimize treatment outcomes in daily clinical settings. Methods:. This clinical update aligns with the 2022 IASP Global Year Translating Pain Knowledge into Practice and selectively reviews the best available evidence and practice. Results:. The effects of treatment expectations, also known as placebo and nocebo effects, are observed in various clinical conditions and physiological systems. However, most of our knowledge comes from the field of pain, where expectation effects substantially contribute to overall analgesic treatment outcomes. Experimental placebo analgesia paradigms provide the best illustration of how analgesic effects can be attributed not only to a pharmacological or specific treatment, but instead are the result of the expectation towards the treatment. The impact of expectations on treatment outcome is highly variable between individuals, and the identification of factors predicting an individual's response has proven to be challenging. Further research is required to provide personalized treatment strategies for the daily clinical practice. Conclusion:. Patient's previous experiences and expectations are powerful modulators of treatment efficacy, tolerability, and adherence. By providing a comprehensive overview of recent advances in this field, this review offers valuable insights for clinicians and researchers seeking to improve patient–clinician interaction

Online processing of moral transgressions: ERP evidence for spontaneous evaluation

Experimental studies using fictional moral dilemmas indicate that both automatic emotional processes and controlled cognitive processes contribute to moral judgments. However, not much is known about how people process socio-normative violations that are more common to their everyday life nor the time-course of these processes. Thus, we recorded participants’ electrical brain activity while they were reading vignettes that either contained morally acceptable vs unacceptable information or text materials that contained information which was either consistent or inconsistent with their general world knowledge. A first event-related brain potential (ERP) positivity peaking at ∼200 ms after critical word onset (P200) was larger when this word involved a socio-normative or knowledge-based violation. Subsequently, knowledge-inconsistent words triggered a larger centroparietal ERP negativity at ∼320 ms (N400), indicating an influence on meaning construction. In contrast, a larger ERP positivity (larger late positivity), which also started at ∼320 ms after critical word onset, was elicited by morally unacceptable compared with acceptable words. We take this ERP positivity to reflect an implicit evaluative (good–bad) categorization process that is engaged during the online processing of moral transgressions

Study protocol: effects of treatment expectation toward repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder—a randomized controlled clinical trial

Abstract Background Patients’ expectations toward any given treatment are highly important for the effectiveness of such treatment, as has been demonstrated for several disorders. In particular, in major depressive disorder (MDD), one of the most frequent and most serious mental disorders with severe consequences for the affected, the augmentation of available treatment options could mean a ground-breaking success. Repetitive transcranial magnetic stimulation (rTMS), a new, non-invasive, and well-tolerated intervention with proven effects in the treatment of MDD, appears particularly suitable in this context as it is assumed to exert its effect via structures implicated in networks relevant for both expectation and depression. Methods All patients will receive rTMS according to its approval. Half of the patients will be randomized to a psychological intervention, which is a comprehensive medical consultation aiming to improve positive treatment expectations; the control group will receive a conventional informed consent discussion (in the sense of a treatment-as-usual condition). As outcome parameters, instruments for both self-assessment and external assessment of depression symptoms will be applied. Furthermore, psycho-immunological parameters such as inflammation markers and the cortisol awakening response in saliva will be investigated. Resting-state functional magnetic resonance imaging (rs fMRI) will be performed to analyze functional connectivity, including the cerebellum, and to identify neuronal predictors of expectation effects. In addition, possible cerebellar involvement will be assessed based on a cerebellar-dependent motor learning paradigm (i.e., eyeblink conditioning). Discussion In this study, the effects of treatment expectations towards rTMS are investigated in patients with MDD. The aim of this study is to identify the mechanisms underlying the expectation effects and, beyond that, to expand the potential of non-invasive and well-tolerated treatments of MDD. Trial registration German Registry of Clinical Studies (DRKS DRKS00028017. Registered on 2022/03/07. URL: https://www.drks.de/drks_web/