Accountability as a Key Virtue in Mental Health and Human Flourishing

We propose that accountability plays an implicit, important, and relatively unexamined role in psychiatry. People generally think of accountability as a relation in which one party is held accountable by another. In this paper, we examine accountability as a virtue, drawing on philosophy, psychiatry, and psychology to examine what it means to welcome being accountable in an excellent way that promotes flourishing. When people manifest accountability as a virtue, they are both responsive to others they owe a response, and they are responsible for their attitudes and actions in light of these relationships. Psychiatric treatment often aims to correct disordered forms of accountability, including difficulties with empathy and self-regulation. Both the process of treatment and the practice of professionalism depend on relationally responsible accountability. We examine accountability as an overlooked complement to healthy autonomy. Whereas acting autonomously in congruence with one’s values is characteristic of mental health, accountability that is interpersonally responsive and responsible is vital to successful treatment as well as professionalism in psychiatry. We review components of accountability and developmental aspects of the virtue; highlight the role of accountability in healthy functioning; and describe implications for psychiatric assessment, treatment, and professionalism. We aim to catalyze awareness of accountability as intrinsic to mental health care and human flourishing

Positive Reappraisals After an Offense: Event-related Potentials and Emotional Effects of Benefit-finding and Compassion

Using a within subjects design, three emotion regulation strategies (compassion‐focused reappraisal, benefit‐focused reappraisal, and offense rumination) were tested for their effects on forgiveness, well‐being, and event‐related potentials (ERPs). Participants (N = 37) recalled a recent interpersonal offense as the context for each emotion regulation strategy. Both decisional and emotional forgiveness increased significantly for the two reappraisal strategies compared to offense rumination. Compassion‐focused reappraisal prompted the greatest increase in both decisional and emotional forgiveness. Furthermore, both reappraisal strategies increased positively oriented well‐being measures (e.g., joy, gratitude) compared to offense rumination, with compassion‐focused reappraisal demonstrating the largest effect on empathy. Late positive potential (LPP) amplitudes in response to unpleasant affect words were larger following the benefit‐focused reappraisal strategy, indicating frontal LPP augmentation due to affective incongruence of the unpleasant stimuli with the positive, silver‐lining orientation of the benefit‐focused reappraisal emotion regulation strategy

The Eschatological Hope Scale: Construct Development and Measurement of Theistic Eschatological Hope

This study aimed to expand psychological research on hope by contributing a construct and scale to measure central dimensions of theistic eschatological hope derived from Christian scriptures. Eschatological hope was conceptualized as the anticipation that God will make all things new, raising people to everlasting life with God in joyful celebration, including people from every culture and nation, ending all personal pain and suffering, eliminating all societal evil and harm, and bringing reconciliation and healing to all of creation. We developed the Eschatological Hope Scale with three studies (N = 1,466). Exploratory and confirmatory factor analyses supported the single-factor structure of a 6-item scale with excellent internal consistency (Cronbach\u27s α \u3e .91) and good test-retest reliability. The Eschatological Hope Scale evidenced construct validity, showing significant non-redundant correlations with measures of temporal hope, religiosity, and spirituality. The Eschatological Hope Scale scores positively correlated with gratitude, forgivingness, and life hardship patience. Scores inversely correlated with depressed and anxious symptoms, negative religious coping, and negative attitudes toward God. Scores were not significantly correlated with extrinsic religiosity and searching for meaning. The Eschatological Hope Scale demonstrated incremental validity beyond other variables (hope and optimism, depression and anxiety, and religiosity) to predict three target variables: perceived presence of meaning in life, ultimate meaning, and flourishing. We offer the Eschatological Hope Scale as a gateway scale to catalyze further developments in measuring eschatological hope. We hope this work will facilitate research on the experience of living with ultimate hope across cultures and faith traditions, in seasons of suffering and celebration

Accountability: Construct Definition and Measurement of a Virtue Vital to Flourishing

Embracing accountability to others for one’s responsibilities within relationships is important for flourishing, yet underexamined. An interdisciplinary team defined the construct of accountability and developed an 11-item single-factor Accountability Scale. In national samples with US census demographic representation (total N = 1257), we conducted psychometric analyses using methods from classical test theory (exploratory and confirmatory factor analyses) and item response theory. The Accountability Scale demonstrated internal consistency, construct validity, test-retest reliability, and incremental validity. Accountability correlated positively with relational variables (agreeableness, empathy) responsibility-oriented variables (conscientiousness, self-regulation), virtues (gratitude, forgiveness, limitations-owning humility), relational repair, perceived meaning presence, and flourishing, inversely with symptoms (personality disorders, temper, anxiety, depression), and weakly with searching for meaning and social desirability. Accountability scores superseded demographic variables, conscientiousness, and agreeableness to predict relational repair, perceived presence of meaning in life, and flourishing. We offer the accountability construct and scale to advance human flourishing research and applied work

Accountability : construct definition and measurement of a virtue vital to flourishing

This work was supported by a grant from the Templeton Religion Trust (TRT0171).Embracing accountability to others for one’s responsibilities within relationships is important for flourishing, yet underexamined. An interdisciplinary team defined the construct of accountability and developed an 11-item single-factor Accountability Scale. In national samples with US census demographic representation (total N = 1257), we conducted psychometric analyses using methods from classical test theory (exploratory and confirmatory factor analyses) and item response theory. The Accountability Scale demonstrated internal consistency, construct validity, test-retest reliability, and incremental validity. Accountability correlated positively with relational variables (agreeableness, empathy) responsibility-oriented variables (conscientiousness, self-regulation), virtues (gratitude, forgiveness, limitations-owning humility), relational repair, perceived meaning presence, and flourishing, inversely with symptoms (personality disorders, temper, anxiety, depression), and weakly with searching for meaning and social desirability. Accountability scores superseded demographic variables, conscientiousness, and agreeableness to predict relational repair, perceived presence of meaning in life, and flourishing. We offer the accountability construct and scale to advance human flourishing research and applied work.Publisher PDFPeer reviewe

A megbocsátás pszichológiája: kialakulása, hatásai és fejlesztése

A megbocsátás az interperszonális sérelmekre adott egyik lehetséges válasznak tekinthető, melynek fókuszában a sérelmet elszenvedő személy kognitív, érzelmi és viselkedéses válaszaiban bekövetkező proszociális változás áll. A megbocsátás mentális és fizikai egészségre kifejtett pozitív hatása jól dokumentált. Magas szintje alacsony szorongás- és depressziószinttel társul, illetve sikeresen csökkenti a stresszre adott fizikai választ (kortizol és kardiovaszkuláris reaktivitás). A megbocsátást - hatásai alapján - olyan emóció fókuszú megküzdési módként definiálhatjuk, mely sikeresen csökkenti az interperszonális sérelem nyomán kialakult stresszreakciót. Az utóbbi években számos intervenciós technikát dolgoztak ki, melyek a megbocsátás támogatását, illetve fejlesztését tűzték ki célként. Ezek a módszerek általában sikeresen növelik a megbocsátásra való hajlandóságot.</o:p

Assessment of Nutritional Status, Digestion and Absorption, and Quality of Life in Patients with Locally Advanced Pancreatic Cancer

Background and Aim. To provide a comprehensive quantitative assessment of nutritional status, digestion and absorption, and quality of life (QoL) in patients with locally advanced pancreatic cancer (LAPC). Methods. Sixteen patients with LAPC were prospectively assessed for weight loss (WL), body mass index (BMI), fat-free mass index (FFMI), handgrip strength (HGS), dietary macronutrient intake, serum vitamin levels, resting and total energy expenditure (REE and TEE, indirect calorimetry), intestinal absorption capacity and fecal losses (bomb calorimetry), exocrine pancreatic function (fecal elastase-1 (FE1)), and gastrointestinal quality of life (GIQLI). Results. Two patients had a low BMI, 10 patients had WL > 10%/6 months, 8 patients had a FFMI < P10, and 8 patients had a HGS < P10. Measured REE was 33% higher (P=0.002) than predicted REE. TEE was significantly higher than daily energy intake (P=0.047). Malabsorption (<85%) of energy, fat, protein, and carbohydrates was observed in, respectively, 9, 8, 12, and 10 patients. FE1 levels were low (<200 μg/g) in 13 patients. Total QoL scored 71% (ample satisfactory). Conclusion. Patients with LAPC have a severely impaired nutritional status, most likely as a result of an increased REE and malabsorption due to exocrine pancreatic insufficiency. The trial is registered with PANFIRE clinicaltrials.gov NCT01939665

Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to non-sensitized patients

Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, determined by extensive laboratory testing. AM patients have superior long-term graft survival compared to highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants 1995-2005, we selected deceased donor single transplants with minimum one HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of one HLA-B plus one HLA-DR, or two HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to non-sensitized patients, independent of other risk factors for rejection. Contrasting to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low risk transplants for highly sensitized patients with rejection rates similar to non-immunized individuals. This article is protected by copyright. All rights reserved.</p

Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

Background: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. Methods: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. Results: In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. Conclusion: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. Level of Evidence: III