Study Guide with article summaries for Clinical Child and Adolescent Psychology at Leiden University

Introduction

A moral and constructive life is the weighted sum of many individual, morally relevant behaviors that are performed daily. However, this behavior is not always in line with moral standards. There can be several explanations for this:

• Social psychological theory: there is no perfect link between intentions and behavior.

• Field theory: individual behavior varies per situation, interpersonal negotiations can undermine the link between intention and behavior, and the spread of responsibility can undermine the ability to act according to one's own (deep-rooted) beliefs.

• Ajzen's theory of planned behavior: attitudes, norms and perceived (emotional) control have an influence on behavioral intentions and subsequent behavior.

The link between moral standards and moral decisions and behavior is influenced by moral emotions. Moral standards are the knowledge and internalization of moral norms and conventions. These are determined by universal moral laws, but also by cultural regulations. Important in moral choices and behavior are the individual differences in anticipation and experience of moral emotions.

Moral emotions are used to understand why people follow moral standards in terms of behavior. Moral emotions are linked to the interests and well-being of society or other people. It provides motivation for doing good and avoiding evil.

Self-conscious emotions

Shame, guilt, embarrassment, and pride are called self-conscious emotions that arise through self-reflection and evaluation. Self-evaluation can be implicit or explicit and conscious or unconscious. In any case, the self (the person) is always the subject of self-conscious emotions. The emotions therefore provide direct reward or punishment as feedback on social and moral acceptability. Because of this, they have a strong influence on our moral choices and behavior. Emotion disposition is the tendency to experience a certain emotion. Shame susceptible individuals, for example, are more vulnerable to anticipatory and actual experiences of shame.

Shame and guilt

An attempt has been made to distinguish between shame and guilt in three ways:

• Type of provocative events

• Public versus private violations

• Failure of yourself or of behavior

Research shows that the type of event cannot properly distinguish between shame and guilt. Some researchers state that shame arises after moral and non-moral offenses, while guilt is primarily associated with moral offenses. There is a "Big Three" ethics of morality, namely autonomy, community and divinity. Shame is mainly linked to violations of ethics of community and divinity, although this does not translate one-on-one to certain situations.

In addition, shame is often seen as a more public emotion, caused by public exposure and disapproval. Guilt is more a private emotion, arising from self-generated thoughts. However, empirical research does not support this distinction. Then why do we think this distinction exists? It appears that people in shame-inducing situations are more concerned about other's evaluations about themselves. In guilt situations people are more worried about the effect of their actions on others. Shame would therefore lead to a focus on itself (egocentric) and guilt on a specific behavior (others-oriented). Empirical research does support this distinction.

Both shame and guilt can lead to feeling intrapsychic pain. However, shame is more painful because one's core of self is affected. It can lead to the feeling of being 'small' and feelings of worthlessness and powerlessness. Guilt brings about a less painful experience, because it is about a specific behavior and not about core characteristics of the self. People who feel guilty think about their behavior and the consequences of it and this thinking leads to regret about the 'bad' action. Research shows that internal, stable and uncontrollable attributions for failure are positively related to shame, and internal, unstable and controllable attributions for failure are positively related to guilt.

Adaptive versus non-adaptive

Guilt is an adaptive emotion that benefits the individual and his or her relationships. However, shame is not adaptive. Shame leads to attempts to deny or escape the shame-inducing situation. This leads to increased levels of pro-inflammatory cytokine and cortisol. Guilt leads to remedial actions, such as confessions, apologies and undoing consequences. Although guilt therefore leads to constructive and proactive behavior, shame leads to defensive behavior, interpersonal separation and distance.

Guilt is also related to other-oriented empathy, because an action has led to negative consequences for another, while shame disrupts emphatic connections with others. Because of shame, people actually focus on themselves, so that they cannot address themselves to the other. Shame is positively correlated with anger, hostility and the tendency to look for factors outside of themselves in case of setbacks. Designating others as the cause of the guilt helps to feel in control, but it has negative long-term consequences for relationships with others. Guilt-prone people are less likely to end up in aggression and take responsibility faster, resulting in positive long-term consequences.

Vulnerability to shame is related to low self-confidence, depression, anxiety, eating disorders, PTSD and suicidal thoughts. Guilt is only related to psychological symptoms if it occurs along with shame. Problems can arise if you have an exaggerated or disturbed sense of responsibility for events beyond control or where you have no personal involvement. Guilt can lead to psychological problems. In addition, there is a positive relationship between internalizing symptoms and vulnerability to guilt in situations where responsibility is ambiguous.

Vulnerability to experience guilt is negatively related to antisocial and risky behavior. The chance of arrests and the use of drugs and alcohol is lower and the chance of safe sex is higher. Guilt vulnerability therefore has a protective function. In addition, shame-vulnerability is positively correlated with externalizing symptoms and can lead to illegal behavior, early drug and alcohol use and higher chances of unsafe sex. However, this link does not apply to all populations and all behaviors.

New study

Shame vulnerability is described in three ways:

• The tendency to experience shame in different situations

• Frequent or continuous experience of global shame, not necessarily related to specific events

• Chronic feeling of shame about certain behaviors or traits

Little research has been conducted into how people deal with shame and guilt. However, various instruments have been developed to measure individual differences in coping with shame: Compass of Shame Scale (COSS-4), TOSCA and Self-Report Psychopathy Scale (SRPS).

People who have elevated levels of shame also appear to have elevated pro-inflammatory cytokine activity. Shame, but not guilt, is a predictor of immune-related response. In addition, it appears that there is more shame in situations of negative social evaluations and rejection, which increases activity in the cortisol and pro-inflammatory systems. Increased cardiovascular reactivity may also be associated with shame.

Victims of abuse or trauma often experience feelings of shame. This is especially present in child abuse, because this is often kept secret and hidden. Severe punitive parenting is also associated with helplessness and self-blame. Physical and sexual abuse in childhood is related to physical shame and shame about the traumatic event. Internalizing shame is related to unwanted sexual experiences. Vulnerability to shame is associated with a history of emotional abuse and shameful practices of parents. In addition, shame after sexual abuse can lead to depression and PTSD. Abuse-specific shame appears to be stable over time. People who have told about their abuse express their shame more verbally, while people who have not told about their abuse express their shame more non-verbally.

In addition to the self-aware emotions of guilt and shame, there is also 'substitute' or 'group-based' guilt and shame. These are feelings that are experienced in response to violations or failures of other people. Personal causality is therefore not a requirement for the experience of guilt or shame. Personal guilt and shame has many similarities with group-based guilt and shame. Group-based shame mainly occurs when there are concerns about maintaining the positive group identity. Substitute guilt is more common when someone has an interpersonal relationship with the perpetrator and when relationship-based concerns are increased by damage to another group or individual.

With ambiguous information about the violations of group members, people who identify with the group take advantage of this and report less substitute shame or group-based debt compared to people who identify less with the group because they themselves are less threatened. Just like personal guilt experiences, group-based guilt is also associated with empathy and motivation to restore relationships. In substitute group-based shame, there is a desire to remove oneself from the shame-inducing event. The link between anger and substitute shame also remains. 

Embarrassment

Embarrassment is less relevant to morality. It is an aversive state of mortification and sorrow after public social difficult situations. Possible causes are:

• Normative public deficiencies. These are situations in which a person behaves in an awkward, absent or unhappy way

• Uncomfortable social interaction

Situations that evoke embarrassment often indicate that something is wrong. This means that an aspect of yourself or your behavior must be carefully monitored, hidden or changed. Shy people behave in conciliatory ways to earn approval and inclusion. It can lead to the adoption of widely accepted moral standards or locally endorsed deviant acts. Embarrassment is associated with neuroticism, high levels of negative feelings, self-awareness and fear of negative evaluation from others. People who are susceptible to shyness are also more sensitive to peer pressure.

Moral pride

Pride is generated by the assessment that someone is responsible for a socially valued outcome or that someone is a socially valued person. It improves self-confidence and leads to more behavior in line with social standards. It has a motivating function and rewards engagement with the ethics of autonomy, community and divinity. There are two types of pride: alpha pride (pride in yourself) and beta pride (pride in your behavior). Being proud of yourself can be maladaptive, because it can lead to bending situations to your own advantage, which can lead to interpersonal problems.

Moral emotions focused on others

Examples of moral emotions directed at others are elevation and gratitude. Those emotions are experienced after observing admirable actions of others, which is a motivation to start exhibiting admirable actions themselves.

Anger, contempt and disgust

Anger is a negative emotion which is often aimed at others, but it is not necessarily a moral emotion. It occurs in many situations, but especially when an event is seen as personally relevant, an obstacle to achieving personal goals and when an event is caused by someone else. Justice anger arises when the behavior of a perpetrator is a violation of a moral standard. The damage does not have to be personally experienced. Justice anger occurs primarily in violations of the ethics of autonomy. It can motivate bystanders to take action to correct the injustice.

Disregard and disgust arise with negative evaluations of others, whereby disregard is primarily linked to violations of the ethics of community and disgust to violations of the ethics of divinity.

Elevation

Elevation is a positive emotion that is evoked when others behave in a virtuous and praiseworthy way. It can lead to a warm, pleasant and tingling sensation in the chest, where one is open to others and feels motivated to help others and become a better person.

Gratitude

Gratitude is a positive moral emotion. It is a reaction to the benevolence of others, which benefits one, especially if this is unexpected or detrimental to the person who gives it. It can lead to moral motivation in the recipient and stimulates helping behavior in the future. The people who get the most benefit from the experience and expression of gratitude are the grateful people themselves. People who feel gratitude have improved psychological resistance, physical health, quality of life and adaptive behavior.

Empathy

Empathy is an emotional process with implications for moral behavior. It is a shared emotional response between one person with another. It requires three skills:

• The cognitive capacity to take a different perspective (so, you need to be able for Theory of Mind)

• Cognitive ability to recognize and distinguish the feelings of others

• Affective ability to feel many emotions

Empathy can lead to the desire to help others. It is different from sympathy, which is about the emotional state of the other, but not the substitute or shared experience of other people's emotions. There is a distinction between others-oriented empathy and self-oriented personal needs. During other-oriented empathy, you take on the perspective of someone else and you feel the same emotions. So, people focus on the experiences and needs of the other person and not on their own empathetic response. This leads to altruistic behavior, such as helping others without expecting anything in return. With self-oriented personal need one focuses on one's own feelings, needs and experiences. This leads to interference with prosocial behavior.

Introduction

Rumination is the term for a pattern of repetitive, self-focused thoughts in response to an emotional state. Rumination has a big effect on someone's well-being. The more someone engages in rumination, the more likely it is that he or she will experience sadness, anger and have a poor sleep quality. Rumination is also linked to psychopathology. For example, people who ruminate often are more likely to develop major depression later in life, experience more anxiety symptoms and have more problems with alcohol abuse. 

Rumination is correlated to different forms of psychopathology. However, most studies have focused on depressive rumination. There is less known about other forms of rumination, such as anger rumination. There have been a few studies conducted and those show that as well anger as depression rumination are related to psychopathology. Ciesla, Dickson, Anderson and Neal found that anger rumination is linked to higher alcohol consumption in a week, but depressive rumination is not. Another study conducted by Baer and Sauer found that borderline personality disorder is linked more to anger rumination than to depressive rumination. 

Two other studies found that only anger rumination was associated with anger, overt aggression and relational aggression. Depressive rumination was linked to depressive symptoms and had a negative association with overt aggression. So, these studies suggest that different kinds of rumination (depressive or anger) may be differentially linked with psychopathology. However, the studies that have been conducted have only focused on individual outcomes or discrete disorders (depression) instead on looking at the transdiagnostic relations between the different subtypes of rumination. A transdiagnostic approach means that common features are examined (so, shared genes or temperament) which divide general psychopathology from normality and contribute to internalizing psychopathology (major depressive disorder, generalized anxiety disorder) and externalizing psychopathology (antiosocial personality disorder, substance use disorder). 

Because the correlations within internalizing and externalizing psychopathology are higher than the correlations between them, this shows that there is indeed a distinction between these kinds of psychopathology. By examining broad-band specific features (features that differentiate between internalizing and externalizing psychopathology), this can help to understand why some individuals are at a higher risk for internalizing disorders than externalizing disorders and vice versa.

The current study

In this study, it is predicted that anger and depressive rumination are best described by two correlated factors, instead of being just one factor (so, it are two separate things). The researchers then looked at whether focusing on the process versus on the content has implications for understanding internalizing and externalizing psychopathology. 

Based on previous transdiagnostic research on depressive rumination, the authors of the article hypothesized that depressive and anger rumination would be associated with both internalizing and externalizing psychopathology.  They also thought that the degree to which an individual ruminates, was associated with more psychopathology. In addition, they expected that the emotional focus of the rumination (sadness versus anger) would be differentially associated with psychopathology. They also expected that depressive rumination would lead to internalizing psychopathology and that anger rumination would lead to externalizing psychopathology such as aggression and hostility. 

During their analyses, they allowed for gender differences in the relationship between depressive rumination, anger rumination and psychopathology. This was done because in previous research, higher levels of depressive rumination had been found in woman compared to in men. However, the literature suggests that there would be no gender differences in anger rumination. There have also been gender differences reported in psychopathology: internalizing disorders are more prevalent in women and externalizing disorders are more prevalent in men. Other studies have shown that gender moderates the relation between rumination and alcohol problems: rumination predicts alcohol problems later in life, only in women! Based on these findings, the authors of this article have decided to include gender as a potential moderator.

Method

Participants

The participants in this study were 764 young adults, from 382 same-sex twin pairs. These twin pairs participated in the Colorado Longitudinal Twin Study (LTS).

Measures

Depressive rumination

The participants in the study completed two measures of depressive rumination: the Rumination-Reflection Questionnaire (RRQ) and the 10-item revised version of the Ruminative Response Scale (RRS). The RRS is a 24-item scale which measures rumination (RRQ-Ru) and reflection (RRQ-Re) on a scale from 1 (strongly disagree) to 5 (strongly agree). The RRQ-Ru measures negative self-focused thoughts and the RRQ-Re measures self-reflection.

Anger rumination

The Anger Rumination Scale (ARS) is a 19-item scale which is designed to measure the cognitions (thoughts) that emerge during and after an anger episode. The items in the ARS are rated on a scale from 1 (almost never) to 4 (almost always). These items are also divided into four subscales: angry afterthoughts ("I re-enact the anger episode in my mind after it has happened), thoughts of revenge ("I have long living fantasies of revenge after the conflict is over"), angry memories ("I think about certain events from a long time ago) and understanding causes ("I think about the reasons people treat me badly"). 

Psychopathology

Participants completed the major depressive disorder (MDD), generalized anxiety disorder (GAD) and antisocial personality disorder (ASPD) from the Diagnostic Interview Schedule-IV. This interview was designed to diagnose the major psychiatric disorders which are in the DSM-IV.

Relations of rumination with psychopathology

Are depressive and anger rumination both associated with internalizing and externalizing psychopathology?

Yes. All the correlations between rumination and psychopathology were significant, which means that both forms of rumination are associated with more psychopathology.

Are depressive and anger rumination differentially associated with internalizing and externalizing psychopathology?

Yes. The correlation between depressive rumination was higher with internalizing psychopathology than with externalizing psychopathology.  Aggressive rumination is associated equally with both forms of psychopathology.

Are internalizing or externalizing psychopathology equally associated with anger and depressive rumination?

Yes. Anger rumination and depressive rumination were associated equally with externalizing psychopathology in both men and women.

Discussion

So, the results of this study suggest that both anger and depressive rumination are associated with internalizing and externalizing psychopathology. Depressive rumination is more strongly associated with internalizing psychopathology compared to anger rumination. 

Anger and depressive rumination are two common characteristics of psychopathology, but it is still important to look at their independent associations with internalizing and externalizing psychopathology. The results of this study also support a two-factor model of anger and depressive rumination. Addressing both the process and emotional content of rumination is important in clinical practice and research. And, because ruminative thought processes are a common feature of psychopathology, this should be a key target in clinical treatments.