More Physicians Are Experiencing Burnout and Depression

Christine Lehmann

Medscape.com

Originally poste 1 FEB 23

More than half of physicians reported feeling burned out this year and nearly 1 in 4 doctors reported feeling depressed — the highest percentages in 5 years, according to the 'I Cry but No One Cares': Physician Burnout & Depression Report 2023.

"Burnout leaves you feeling like someone you're not," said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.

"When someone is burned out, they experience extreme exhaustion in the workplace, depersonalization, and a sense that their best is no longer good enough. Over time, this may spill into the rest of their lives, affecting their relationships as well as their general health and well-being," said Sánchez.

When feelings of burnout continue without effective interventions, they can lead to depression, anxiety, and more, she said.

Burnout can persist for months to even years — nearly two thirds of doctors surveyed said their burnout lasted for at least 13 months, and another 30% said it lasted for more than 2 years.

The majority of doctors attributed their burnout to too many bureaucratic tasks, although more than one third said it was because their co-workers treated them with a lack of respect.

"This disrespect can take many forms from demeaning comments toward physicians in training to the undermining of a physicians' decade-long education and training to instances of rudeness or incivility in the exam room. Unfortunately, medical professionals can be the source of bad behavior and disrespect. They may be burned out too, and doing their best to work in a broken healthcare system during an extremely difficult time," said Sánchez.

The info is here.

Free Will Is Only an Illusion if You Are, Too

Alessandra Buccella and Tomáš Dominik

Scientific American

Originally posted January 16, 2023

Here is an excerpt:

In 2019 neuroscientists Uri Maoz, Liad Mudrik and their colleagues investigated that idea. They presented participants with a choice of two nonprofit organizations to which they could donate $1,000. People could indicate their preferred organization by pressing the left or right button. In some cases, participants knew that their choice mattered because the button would determine which organization would receive the full $1,000. In other cases, people knowingly made meaningless choices because they were told that both organizations would receive $500 regardless of their selection. The results were somewhat surprising. Meaningless choices were preceded by a readiness potential, just as in previous experiments. Meaningful choices were not, however. When we care about a decision and its outcome, our brain appears to behave differently than when a decision is arbitrary.

Even more interesting is the fact that ordinary people’s intuitions about free will and decision-making do not seem consistent with these findings. Some of our colleagues, including Maoz and neuroscientist Jake Gavenas, recently published the results of a large survey, with more than 600 respondents, in which they asked people to rate how “free” various choices made by others seemed. Their ratings suggested that people do not recognize that the brain may handle meaningful choices in a different way from more arbitrary or meaningless ones. People tend, in other words, to imagine all their choices—from which sock to put on first to where to spend a vacation—as equally “free,” even though neuroscience suggests otherwise.

What this tells us is that free will may exist, but it may not operate in the way we intuitively imagine. In the same vein, there is a second intuition that must be addressed to understand studies of volition. When experiments have found that brain activity, such as the readiness potential, precedes the conscious intention to act, some people have jumped to the conclusion that they are “not in charge.” They do not have free will, they reason, because they are somehow subject to their brain activity.

But that assumption misses a broader lesson from neuroscience. “We” are our brain. The combined research makes clear that human beings do have the power to make conscious choices. But that agency and accompanying sense of personal responsibility are not supernatural. They happen in the brain, regardless of whether scientists observe them as clearly as they do a readiness potential.

So there is no “ghost” inside the cerebral machine. But as researchers, we argue that this machinery is so complex, inscrutable and mysterious that popular concepts of “free will” or the “self” remain incredibly useful. They help us think through and imagine—albeit imperfectly—the workings of the mind and brain. As such, they can guide and inspire our investigations in profound ways—provided we continue to question and test these assumptions along the way.

The entire article is here.

Telehealth Providers Prepare for the Future

Phoebe Kolbert & Charlotte Engrav

msmagazine.com

Originally posted 9 FEB 23

Here is an excerpt:

Telehealth Abortion Care

The Guttmacher Institute reports that, in 2017, medication abortions accounted for 39 percent of all abortions performed. By 2020, medication abortion usage accounted for 53 percent.

Coplon attributes the rise in telehealth medication abortions to COVID, but the continued use of it, she says, “is due to people’s understanding and acceptance, and also providers being more comfortable with providing pills without having the testing that we prior thought we needed.” 

She would know. Since 2016, Coplon has been part of a coalition of researchers, lawyers and other clinicians looking at telehealth medication abortion and ways to increase access to telehealth services. She now serves as the director of clinical operations at Abortion on Demand. 

In 2018, state policies enacted to support reproductive health were almost triple the number restricting reproductive healthcare. It was the first year in at least two decades where protections outpaced restrictions. 

Restrictions were eased even more when the COVID-19 pandemic made social distancing necessary, and lawmakers loosened restrictions, allowing more healthcare to be practiced online via telehealth. However, the landscape completely changed again in June of this year when the Supreme Court overturned the longstanding precedent of Roe in their Dobbs decision. Now, 18 states have abortion bans, 14 of which are total or near total. Eight other states have abortion bans on the books that are currently blocked, and there has been a push from anti-abortion groups to rescind access to telehealth medication abortions altogether. 

Telemedicine abortion has many benefits beyond preventing the spread of COVID-19—which may be why anti-abortion groups have been so quick to target it. Telehealth can make abortions more accessible for those who want and need them, and they tend to be cheaper and easier to schedule quickly. Even before Roe’s fall, patients would sometimes have to travel out of state or drive hours to the only abortion clinic in their state. Now, people living in states with bans must travel an average of 276 miles each way. States without bans have seen a swell of out-of-state patients seeking legal abortions. Bloomberg News estimated Illinois could face an 8,000 percent increase in abortion seekers. Planned Parenthood of Illinois estimated an increase of 20,000-30,000 out-of-state patients. Some clinics are struggling to keep up. For these clinics and patients, Coplon notes, telehealth can make a huge difference in the post-Roe era.

Not only can telehealth provide appointments within just a day or two of scheduling, as opposed to the potentially weeks-long waits at clinics in some overburdened states, it can also help reduce the overall burden on those in-person clinics—freeing up space for their own clients. 

The info is here.

Moralized language predicts hate speech on social media

Kirill Solovev and Nicolas Pröllochs

PNAS Nexus, Volume 2, Issue 1, 

January 2023

https://doi.org/10.1093/pnasnexus/pgac281

Abstract

Hate speech on social media threatens the mental health of its victims and poses severe safety risks to modern societies. Yet, the mechanisms underlying its proliferation, though critical, have remained largely unresolved. In this work, we hypothesize that moralized language predicts the proliferation of hate speech on social media. To test this hypothesis, we collected three datasets consisting of N = 691,234 social media posts and ∼35.5 million corresponding replies from Twitter that have been authored by societal leaders across three domains (politics, news media, and activism). Subsequently, we used textual analysis and machine learning to analyze whether moralized language carried in source tweets is linked to differences in the prevalence of hate speech in the corresponding replies. Across all three datasets, we consistently observed that higher frequencies of moral and moral-emotional words predict a higher likelihood of receiving hate speech. On average, each additional moral word was associated with between 10.76% and 16.48% higher odds of receiving hate speech. Likewise, each additional moral-emotional word increased the odds of receiving hate speech by between 9.35 and 20.63%. Furthermore, moralized language was a robust out-of-sample predictor of hate speech. These results shed new light on the antecedents of hate speech and may help to inform measures to curb its spread on social media.

Significance Statement

This study provides large-scale observational evidence that moralized language fosters the proliferation of hate speech on social media. Specifically, we analyzed three datasets from Twitter covering three domains (politics, news media, and activism) and found that the presence of moralized language in source posts was a robust and meaningful predictor of hate speech in the corresponding replies. These findings offer new insights into the mechanisms underlying the proliferation of hate speech on social media and may help to inform educational applications, counterspeech strategies, and automated methods for hate speech detection.

Discussion

This study provides observational evidence that moralized language in social media posts is associated with more hate speech in the corresponding replies. We uncovered this link for posts from a diverse set of societal leaders across three domains (politics, news media, and activism). On average, each additional moral word was associated with between 10.76 and 16.48% higher odds of receiving hate speech. Likewise, each additional moral-emotional word increased the odds of receiving hate speech by between 9.35 and 20.63%. Across the three domains, the effect sizes were most pronounced for activists. A possible reason is that the activists in our data were affiliated with politically left-leaning subjects (climate, animal rights, and LGBTQIA+) that may have been particularly likely to trigger hate speech from right-wing groups. In contrast, our data for politicians and newspeople were fairly balanced and encompassed users from both sides of the political spectrum. Overall, the comparatively large effect sizes underscore the salient role of moralized language on social media. While earlier research has demonstrated that moralized language is associated with greater virality, our work implies that it fosters the proliferation of hate speech.

The research is here.

Helping the ingroup versus harming the outgroup: Evidence from morality-based groups

Grigoryan, L, Seo, S, Simunovic, D, & Hoffman, W.

Journal of Experimental Social Psychology

Volume 105, March 2023, 104436

Abstract

The discrepancy between ingroup favoritism and outgroup hostility is well established in social psychology. Under which conditions does “ingroup love” turn into “outgroup hate”? Studies with natural groups suggest that when group membership is based on (dis)similarity of moral beliefs, people are willing to not only help the ingroup, but also harm the outgroup. The key limitation of these studies is that the use of natural groups confounds the effects of shared morality with the history of intergroup relations. We tested the effect of morality-based group membership on intergroup behavior using artificial groups that help disentangling these effects. We used the recently developed Intergroup Parochial and Universal Cooperation (IPUC) game which differentiates between behavioral options of weak parochialism (helping the ingroup), strong parochialism (harming the outgroup), universal cooperation (helping both groups), and egoism (profiting individually). In three preregistered experiments, we find that morality-based groups exhibit less egoism and more universal cooperation than non-morality-based groups. We also find some evidence of stronger ingroup favoritism in morality-based groups, but no evidence of stronger outgroup hostility. Stronger ingroup favoritism in morality-based groups is driven by expectations from the ingroup, but not the outgroup. These findings contradict earlier evidence from natural groups and suggest that (dis)similarity of moral beliefs is not sufficient to cross the boundary between “ingroup love” and “outgroup hate”.

General discussion

When does “ingroup love” turn into “outgroup hate”? Previous studies conducted on natural groups suggest that centrality of morality to the group’s identity is one such condition: morality-based groups showed more hostility towards outgroups than non-morality-based groups (Parker & Janoff-Bulman, 2013; Weisel & Böhm, 2015). We set out to test this hypothesis in a minimal group setting, using the recently developed Intergroup Parochial and Universal Cooperation (IPUC) game.  Across three pre-registered studies, we found no evidence that morality-based groups show more hostility towards outgroups than non-morality-based groups. Instead, morality-based groups exhibited less egoism and more universal cooperation (helping both the ingroup and the outgroup) than non-morality-based groups. This finding is consistent with earlier research showing that salience of morality makes people more cooperative (Capraro et al., 2019). Importantly, our morality manipulation was not specific to any pro-cooperation moralnorm. Simply asking participants to think about the criteria they use to judge what is right and what is wrong was enough to increase universal cooperation.

Our findings are inconsistent with research showing stronger outgroup hostility in morality-based groups (Parker & Janoff-Bulman, 2013; Weisel & Böhm, 2015). The key difference between the set of studies presented here and the earlier studies that find outgroup hostility in morality-based groups is the use of natural groups in the latter. What potential confounding variables might account for the emergence of outgroup hostility in natural groups?

A pdf of the research is here.

Belief in Persistent Moral Decline

West, B., & Pizarro, D. A. (2022, June 27).

https://doi.org/10.31234/osf.io/9swjb

Abstract

Across four studies (3 experimental, total n = 199; 1 archival, n = 186,000) we provide evidence that people hold the belief that the world is growing morally worse, and that this belief is consistent across generational, political, and religious lines. When asked directly about which aspects of society are getting better and which are getting worse, people are more likely to list the moral (compared to non-moral) aspects as getting worse (Studies 1-2). When provided with a list of items that are either moral or non-moral, people are more likely to report that moral (compared to non-moral) items are worsening (Study 3). Finally, when asked the question “What is the most important problem facing America today?” participants in a nationally representative survey (Heffington et al., 2019), disproportionately listed problems that fall within the moral domain (Study 4).

General Discussion

We found consistent and strong evidence that people think of social decline in more moral terms than they do social improvement (see Figure1). Participants in our studies consistently listed more morally relevant items (Studies 1-2) when asked what they thought has gotten worse in society compared to what has gotten better.Participants also categorized items pre-coded for moral relevance as declining more frequently than improving (Study 3). Study 4 provided further evidence for our hypothesis that those things people think are problems in society tend to be morally relevant. The majority of the “most important problem[s]” facing America from1939-2015 were issues relevant to moral values.

These findings provide evidence that in general, people tend to believe that our moral values are getting worse over time. We propose that this moral pessimism may serve a functional purpose. Moral values help bind us together and facilitate social cohesion (Graham et al.,2009), cooperation, and the strengthening of ingroup bonds(Curry,2016; Curry et al.,2019). Concern about declining morality (believing that morally relevant things have gotten worse in society over time) could be viewed as concern for maintaining those values that help keep society intact and functioning healthily. To “rest on our laurels” when it comes to being vigilant for moral decline may be unappealing, and people who try to claim that we are doing great, morally speaking, may be viewed as suspect, or not caring as much about our moral values.

A pdf of the research is here.

The scientific study of consciousness cannot, and should not, be morally neutral

Mazor, M., Brown, S., et al. (2021, November 12). 

Perspectives on psychological science.

Advance online publication.

Abstract

A target question for the scientific study of consciousness is how dimensions of consciousness, such as the ability to feel pain and pleasure or reflect on one’s own experience, vary in different states and animal species. Considering the tight link between consciousness and moral status, answers to these questions have implications for law and ethics. Here we point out that given this link, the scientific community studying consciousness may face implicit pressure to carry out certain research programmes or interpret results in ways that justify current norms rather than challenge them. We show that since consciousness largely determines moral status, the use of non-human animals in the scientific study of consciousness introduces a direct conflict between scientific relevance and ethics – the more scientifically valuable an animal model is for studying consciousness, the more difficult it becomes to ethically justify compromises to its well-being for consciousness research. Lastly, in light of these considerations, we call for a discussion of the immediate ethical corollaries of the body of knowledge that has accumulated, and for a more explicit consideration of the role of ideology and ethics in the scientific study of consciousness.

Here is how the article ends:

Finally, we believe consciousness researchers, including those working only with consenting humans, should take an active role in the ethical discussion about these issues, including the use of animal models for the study of consciousness. Studying consciousness, the field has the responsibility of leading the way on these ethical questions and of making strong statements when such statements are justified by empirical findings. Recent examples include discussions of ethical ramifications of neuronal signs of fetal consciousness (Lagercrantz, 2014) and a consolidation of evidence for consciousness in vertebrate animals, with a focus on livestock species, ordered by the European Food and Safety Authority (Le Neindre et al., 2017). In these cases, the science of consciousness provided empirical evidence to weigh on whether a fetus or a livestock animal is conscious. The question of animal models of consciousness is simpler because the presence of consciousness is a prerequisite for the model to be valid. Here, researchers can skip the difficult question of whether the entity is indeed conscious and directly ask, “Do we believe that consciousness, or some specific form or dimension of consciousness, entails moral status?”

It is useful to remind ourselves that ethical beliefs and practices are dynamic: Things that were considered

acceptable in the past are no longer acceptable today.  A relatively recent change is that to the status of nonhuman great apes (gorillas, bonobos, chimpanzees, and orangutans) such that research on great apes is banned in some countries today, including all European Union member states and New Zealand. In these countries, drilling a hole in chimpanzees’ heads, keeping them in isolation, or restricting their access to drinking water are forbidden by law. It is a fundamental question of the utmost importance which differences between animals make some practices acceptable with respect to some animals and not others. If consciousness is a determinant of moral status, consciousness researchers have a responsibility in taking an active part in this discussion—by providing scientific observations that either justify current ethical standards or induce the scientific and legal communities to revise these standards.

A pdf is here.

Countertransference awareness and treatment outcome

Abargil, M., & Tishby, O. (2022). 

Journal of counseling psychology,

69(5), 667–677.

https://doi.org/10.1037/cou0000620

Abstract

Countertransference (CT) is considered a central component in the therapy process. Research has shown that CT management does not reduce the number of CT manifestations in therapy, but it leads to better therapy outcomes. In this study, we examined therapists' awareness of their CT using a structured interview. Our hypotheses were (a) treatments in which therapists were more aware of their CT would have a better outcome and (b) different definitions of CT would be related to different therapy outcomes. Twenty-nine patients were treated by 19 therapists in 16 sessions of short-term psychodynamic therapy. We used the core conflictual relationship theme to measure CT, a special interview was developed to study CT awareness. Results show that awareness of CT defined as the relationship with the patient moderated 10 outcome measures and awareness of CT defined as the relationship with the patient that repeats therapist conflicts with significant others moderated three outcome measures We present examples from dyads in this study and discuss how awareness can help the therapist talk to and handle patient challenges.

From the Discussion section

Increased therapist awareness of CT facilitate improvement in patient symptoms, emotion regulation and affiliation in relationships. Since awareness is an integral part of CT management, these findings are consistent with Hayes’ results from 2018 regarding the importance of CT management and its contribution to treatment outcome. Moreover, therapist’s self-awareness was found to be important in treating minorities (Baker, 1999). This study expands the ecological validity of therapist awareness and shows that the therapists’ awareness of their own wishes in therapy, as well as his perception of himself and the patient, is relevant to the general population as well. Thus, therapists of all theoretical orientations are encouraged to attend to their personal conflicts and to monitor their reactions to patients as a routine part of effective clinical practice. Moreover, therapist awareness has been found in the past to lead to less therapist self-confidence, but to better treatment outcomes (Williams, 2008). Our clinical examples illustrate these findings (the therapist who had high awareness showed much more self- doubt) and the results of multilevel regression analysis demonstrate better improvement for patients whose therapists were highly aware. Interestingly, the IIP control dimension was not found to be related to the therapist’s awareness of CT. It may be that since this dimension relates to the patient’s control need, the awareness of transference is more important. Another possibility is that the patient’s experience of the therapist as “knowing” may actually increase his control needs. Moreover, regarding patient main TC, we only found a trend and not a significant interaction. One reason may be the sample size. Another explanation is that patients do not necessarily link the changes in their lives to the relationship with the therapist and the insights associated with it. Thus, although awareness of CT helps to improve other outcome measures, it is not related to the way patients feel about the reason they sought out treatment.

A recent study of CT found that negative types of CT were correlated with more ruptures and less repair in the alliance. For positive CT the picture is more complex; Positive patterns predicted resolution when the therapists repeated positive patterns with par- ents but predicted ruptures when they tried to “repair” negative patterns with the parents (Tishby & Wiseman, 2020). The authors suggest that awareness of CT will help the therapist pay more attention to ruptures during treatment so they can address it and initiate resolutions processes. Our findings support the authors’ suggestion. The clinical example demonstrates that when the therapist was aware of negative CT and was able to talk about it in the awareness interview, he was also able to address the difficult feelings that arose during a session with the patient. Moreover, the treatment outcomes in these treatments were better which characterizes treatments with proper repair processes.

The article is paywalled here.

Individual differences in (dis)honesty are represented in the brain's functional connectivity at rest

Speer, S. P., Smidts, A., & Boksem, M. A. (2022).

NeuroImage, 246, 118761.

https://doi.org/10.1016/j.neuroimage.2021.118761

Abstract

Measurement of the determinants of socially undesirable behaviors, such as dishonesty, are complicated and obscured by social desirability biases. To circumvent these biases, we used connectome-based predictive modeling (CPM) on resting state functional connectivity patterns in combination with a novel task which inconspicuously measures voluntary cheating to gain access to the neurocognitive determinants of (dis)honesty. Specifically, we investigated whether task-independent neural patterns within the brain at rest could be used to predict a propensity for (dis)honest behavior. Our analyses revealed that functional connectivity, especially between brain networks linked to self-referential thinking (vmPFC, temporal poles, and PCC) and reward processing (caudate nucleus), reliably correlates, in an independent sample, with participants’ propensity to cheat. Participants who cheated the most also scored highest on several self-report measures of impulsivity which underscores the generalizability of our results. Notably, when comparing neural and self-report measures, the neural measures were found to be more important in predicting cheating propensity.

Significance statement

Dishonesty pervades all aspects of life and causes enormous economic losses. However, because the underlying mechanisms of socially undesirable behaviors are difficult to measure, the neurocognitive determinants of individual differences in dishonesty largely remain unknown. Here, we apply machine-learning methods to stable patterns of neural connectivity to investigate how dispositions toward (dis)honesty, measured by an innovative behavioral task, are encoded in the brain. We found that stronger connectivity between brain regions associated with self-referential thinking and reward are predictive of the propensity to be honest. The high predictive accuracy of our machine-learning models, combined with the reliable nature of resting-state functional connectivity, which is uncontaminated by the social-desirability biases to which self-report measures are susceptible, provides an excellent avenue for the development of useful neuroimaging-based biomarkers of socially undesirable behaviors.

Discussion

Employing connectome-based predictive modeling (CPM) in combination with the innovative Spot-The-Differences task, which allows for inconspicuously measuring cheating, we identified a functional connectome that reliably predicts a disposition toward (dis)honesty in an independent sample. We observed a Pearson correlation between out-of-sample predicted and actual cheatcount (r = 0.40) that resides on the higher side of the typical range of correlations (between r = 0.2 and r = 0.5) reported in previous studies employing CPM (Shen et al., 2017). Thus, functional connectivity within the brain at rest predicts whether someone is more honest or more inclined to cheat in our task.

In light of previous research on moral decisions, the regions we identified in our resting state analysis can be associated with two networks frequently found to be involved in moral decision making. First, the vmPFC, the bilateral temporal poles and the PCC have consistently been associated with self-referential thinking. For example, it has been found that functional connectivity between these areas during rest is associated with higher-level metacognitive operations such as self-reflection, introspection and self-awareness (Gusnard et al., 2001; Meffert et al., 2013; Northoff et al., 2006; Vanhaudenhuyse et al., 2011). Secondly, the caudate nucleus, which has been found to be involved in anticipation and valuation of rewards (Ballard and Knutson, 2009; Knutson et al., 2001) can be considered an important node in the reward network (Bartra et al., 2013). Participants with higher levels of activation in the reward network, in anticipation of rewards, have previously been found to indeed be more dishonest (Abe and Greene, 2014).

The research is here.