Post-traumatic stress symptoms and burnout in healthcare professionals working in neonatal intensive care units: Results from the STRONG study

BACKGROUND

Newborns' deaths and life-threatening conditions represent extremely stressful events for parents and professionals working in NICUs, facilitating the onset of secondary traumatic stress symptoms. The STRONG study aims to better understand the psychological impact on Italian NICUs staff of bereavement care.

METHODS

The STRONG (STress afteR lOss in NeonatoloGy) study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic, CommuniCARE-Newborn questionnaire, the Maslach Burnout Inventory and the Impact of Event Scale-Revised.

RESULTS

227 NICU workers (42.7% nurses, 23.3% midwives, 22.2% physicians, 11.8% other HCPs) answered the survey. The hardest tasks were "communicating baby's death" and "informing on autopsy results"; 44.7% of HCPs did not receive formal training in communicating bad news, 44.2% 'learned from the field' by watching other colleagues; 41.2% declared that they do not have any communication strategy. More than 90% of professionals thought that training on bereavement care is necessary. The majority of HCPs showed some degree of post-traumatic stress symptoms: 34% medium and 35.3% severe. Professionals with training in bereavement care and/or in communication had less probability to develop stress symptoms. A multivariate analysis showed that higher levels of burnout were associated with 4 or more monthly losses and medium or severe stress symptoms. Having a well-defined communication strategy for breaking bad news was independently associated with a better personal accomplishment.

CONCLUSION

Dealing with newborns' deaths is a highly stressful task; professionals should receive proper support such as debriefing, psychological support and training in order to prevent post-traumatic stress symptoms and reduce professional burnout.

Construct validity and generalizability of the Carver–White behavioural inhibition system/behavioural activation system scales

The factorial structure and invariance of the BIS/BAS scales of Carver and White were assessed across three samples from the USA, UK, and Italy. Previous validation studies of the BIS/BAS scales relied on individual samples drawn from English‐speaking populations only and failed to formally assess generalizability. The current study shows that the four‐factor structure proposed by Carver and White—i.e. one BIS and three BAS facets—achieved satisfactory psychometric properties in all three samples and that measurement invariance was obtained across countries. Latent mean differences due to gender and country were also investigated. Theoretical issues concerning the validity of the BIS/BAS scales are addressed. Copyright © 2001 John Wiley & Sons, Ltd.

Effects of need for closure on creativity in small group interactions

Three experiments investigated the consequences of the epistemic motivation toward closure on the emergence of creative interactions in small groups. In the first study, need for closure was manipulated via time pressure. Results showed that in groups under high need for closure (i.e. under time pressure) the percentage of creative acts during group discussion was reduced. The second study replicated this result using an individual differences operationalization of the need for closure. In the third study, groups composed of individuals high (versus low) in need for closure performed less creatively, and exhibited less ideational fluidity during group interaction. Moreover, it was demonstrated that conformity pressure mediates the negative relationship between dispositional need for closure and group creativity. Copyright © 2004 John Wiley & Sons, Ltd.

Malleability of the self: electrophysiological correlates of the enfacement illusion

Self-face representation is fundamentally important for self-identity and self-consciousness. Given its role in preserving identity over time, self-face processing is considered as a robust and stable process. Yet, recent studies indicate that simple psychophysics manipulations may change how we process our own face. Specifically, experiencing tactile facial stimulation while seeing similar synchronous stimuli delivered to the face of another individual seen as in a mirror, induces ‘enfacement’ illusion, i.e. the subjective experience of ownership of the other’s face and a bias in attributing to the self, facial features of the other person. Here we recorded visual Event-Related Potentials elicited by the presentation of self, other and morphed faces during a self-other discrimination task performed immediately after participants received synchronous and control asynchronous Interpersonal Multisensory Stimulation (IMS). We found that self-face presentation after synchronous as compared to asynchronous stimulation significantly reduced the late positive potential (LPP; 450–750 ms), a reliable electrophysiological marker of self-identification processes. Additionally, enfacement cancelled out the differences in LPP amplitudes produced by self- and other-face during the control condition. These findings represent the first direct neurophysiological evidence that enfacement may affect self-face processing and pave the way to novel paradigms for exploring defective self-representation and self-other interactions.

Need for Cognitive Closure and Political Ideology

Abstract. Little is known about epistemic motivations affecting political ideology when people make environmental decisions. In two studies, we examined the key role that political ideology played in the relationship between need for cognitive closure (NCC) and self-reported eco-friendly behavior. Study 1: 279 participants completed the NCC, pro-environmental, and political ideology measures. Mediation analyses showed that NCC was related to less pro-environmental behavior through more right-wing political ideology. Study 2: We replicated these results with a nonstudent sample (n = 240) and both social and economic conservatism as mediators. The results of Study 2 showed that social conservatism mediated the relationship between NCC and pro-environmental behavior. Finally, NCC was associated with pro-environmental attitude through both social and economic conservatism.

Motivated Closed-Mindedness and Creativity in Small Groups

An experiment was conducted to investigate whether the need for cognitive closure affects the degree of creativity in small groups. Participants in groups of four performed a task in which they had to create advertising slogans for a given product. Some of the groups were composed of individuals with high dispositional need for closure, whereas other groups were composed of individuals with low need for closure. Results showed that ideational fluency, degree of elaboration, and creativity, as rated by independent judges, was lower in high (vs. low) need-for-closure groups. These results suggest that the tendencies to restrict the number of hypotheses generated and to produce conventional ideas, consequences of the need for closure, lower the degree of creativity in interacting groups.

Autocracy Bias in Informal Groups Under Need for Closure

Two experiments investigated the tendency of groups with members under high (vs. low) need for cognitive closure to develop an autocratic leadership structure in which some members dominate the discussion, constitute the “hubs” of communication, and influence the group more than other members. The first experiment found that high (vs. low) need for closure groups, as assessed via dispositional measure of the need for closure, manifested greater asymmetry of conversational floor control, such that members with autocratic interactional style were more conversationally dominant and influential than less autocratic members. The second experiment manipulated the need for closure via time pressure and utilized a social network analysis. Consistent with expectation, groups under time pressure (vs. no pressure) showed a greater asymmetry of participation, of centrality, and of prestige among the group members, such that the more focal members were perceived to exert the greater influence over the groups’ decisions.

Need for Cognitive Closure Modulates How Perceptual Decisions Are Affected by Task Difficulty and Outcome Relevance

The aim of this study was to assess the extent to which Need for Cognitive Closure (NCC), an individual-level epistemic motivation, can explain inter-individual variability in the cognitive effort invested on a perceptual decision making task (the random motion task). High levels of NCC are manifested in a preference for clarity, order and structure and a desire for firm and stable knowledge. The study evaluated how NCC moderates the impact of two variables known to increase the amount of cognitive effort invested on a task, namely task ambiguity (i.e., the difficulty of the perceptual discrimination) and outcome relevance (i.e., the monetary gain associated with a correct discrimination). Based on previous work and current design, we assumed that reaction times (RTs) on our motion discrimination task represent a valid index of effort investment. Task ambiguity was associated with increased cognitive effort in participants with low or medium NCC but, interestingly, it did not affect the RTs of participants with high NCC. A different pattern of association was observed for outcome relevance; high outcome relevance increased cognitive effort in participants with moderate or high NCC, but did not affect the performance of low NCC participants. In summary, the performance of individuals with low NCC was affected by task difficulty but not by outcome relevance, whereas individuals with high NCC were influenced by outcome relevance but not by task difficulty; only participants with medium NCC were affected by both task difficulty and outcome relevance. These results suggest that perceptual decision making is influenced by the interaction between context and NCC.

Motivating Citizens to Participate in Public Policymaking: Identification, Trust and Cost-Benefit Analyses

Under what conditions do citizens of nations and states comply with governmental requests to participate in public policymaking? Drawing on the dual pathway model of collective action (Stürmer & Simon, 2004) but with a focus on compliance with the status quo, rather than participation in collective protest, two studies examined citizens’ motivation to participate in public policymaking. Study 1 (N = 169) was an MTurk hosted survey that recruited participants from California, while Study 2 (N = 198) was a field experiment that recruited participants in Sardinia, Italy. Study 1 measured cost-benefit analyses, societal identification, and willingness to participate in public policymaking. Study 2 repeated the same procedures, with the exception that we manipulated costs of participation, and also measured participants’ trust in government. Study 1 confirmed our initial hypotheses – fewer costs predicted more willingness to participate, as did stronger state identification. However, Study 2 found an interactive effect of costs, identification, and trust on willingness to participate in public policymaking. Results confirm our hypotheses by showing that both costs and identification independently influence willingness to participate in public policymaking. Results also add to the literature by showing that these additive pathways can be influenced by trust in the source of governance.

The closing of open minds: Need for closure moderates the impact of uncertainty salience on outgroup discrimination

In three studies, we examined how dispositional need for cognitive closure (NCC) moderates the impact of various types of uncertainty salience (personal and supraliminal in studies 1 and 2; economic and subliminal in Study 3) on implicit attitudes (studies 1 and 3) and explicit discriminatory intentions (Study 2) towards outgroup members. Across all three studies, we found that uncertainty increased discrimination against outgroups among low-NCC individuals but not among high-NCC individuals. High-NCC individuals tended to be more discriminatory irrespective of uncertainty salience. These results suggest that uncertainty salience leads individuals with a low dispositional need for closure to act like those with high need for closure. The implications of the findings for theories about how uncertainty influences social attitudes and intergroup behaviour are discussed.

'Beauty is no quality in things themselves': epistemic motivation affects implicit preferences for art

Art preferences are affected by a number of subjective factors. This paper reports two studies which investigated whether need for closure shapes implicit art preferences. It was predicted that higher need for closure would negatively affect implicit preferences for abstract art. In study one, 60 participants were tested for dispositional need for closure and then completed an Implicit Association Test (IAT) task to measure their implicit preference for abstract (vs. figurative) paintings. In study two, 54 participants completed the same IAT task. In this experiment need for closure was both manipulated by cognitive load and tapped as a dispositional trait. Results of the studies converged in showing that after controlling for other important individual factors such as participants'expertise and cognitive ability, need for closure, both as a dispositional trait and as a situationally induced motivational state, was negatively associated with implicit preference for abstract art.

Routes of motivation: stable psychological dispositions are associated with dynamic changes in cortico-cortical functional connectivity

The present study provides a neurobiological framework to the theory of epistemic motivation that has been extensively studied for the last three decades in the domain of social cognition. Epistemic motivations affect the way people generate and validate hypotheses, and ultimately form and modify knowledge. Strong dispositional measures such as need for cognitive closure (NCC), the desire for a quick firm answer (any answer) to a question, show gross and stable inter-individual differences. The cognitive mechanisms and neural underpinnings of such differences, however, remain largely unexplored. Here we show that high (compared to low) levels of NCC, measured with need for cognitive closure scale, are associated with reduced online adjustment in cognitive control, as indexed by behavioral conflict adaptation. This behavioral effect is mediated by dynamic changes in cortico-cortical functional connectivity between prefrontal regions involved in conflict monitoring and implementation of cognitive control. In particular, these regions show increased functional connectivity after exposure to conflict in low but not high NCC individuals. These results demonstrate that the level of flexibility of functional cortico-cortical connections can mediate stable psychological dispositions.

Framing political messages to fit the audience's regulatory orientation: how to improve the efficacy of the same message content

This research investigates how the impact of persuasive messages in the political domain can be improved when fit is created by subliminally priming recipients’ regulatory focus (either promotion or prevention) and by linguistic framing of the message (either strategic approach framing or strategic avoidance framing). Results of two studies show that regulatory fit: a) increases the impact of a political message favoring nuclear energy on implicit attitudes of the target audience (Study 1); and b) induces a more positive evaluation of, and intentions to vote for, the political candidate who is delivering a message concerning immigration policies (Study 2).

Cultural Differences in Attitudes Toward Action and Inaction: The Role of Dialecticism

The current research examined whether nations differ in their attitudes toward action and inaction. It was anticipated that members of dialectical East Asian societies would show a positive association in their attitudes toward action/inaction. However, members of non-dialectical European-American societies were expected to show a negative association in their attitudes toward action/inaction. Young adults in 19 nations completed measures of dialectical thinking and attitudes toward action/inaction. Results from multi-level modeling showed, as predicted, that people from high dialecticism nations reported a more positive association in their attitudes toward action and inaction than people from low dialecticism nations. Furthermore, these findings remained after controlling for cultural differences in individualism-collectivism, neuroticism, gross-domestic product, and response style. Discussion highlights the implications of these findings for action/inaction goals, dialecticism, and culture.

The propensity toward reconciliation among young people in Northern Ireland and Croatia

Two studies, conducted in Northern Ireland ( N = 266) and Croatia ( N = 261), examined the role of constructive adolescents-parents conflict management style (CAPCMS) in predicting inter-group reconciliation attitudes. We hypothesized that CAPCMS would be a unique and positive predictor of reconciliation attitudes over and above other common predictors of reconciliation attitudes, such as inter-group contact quantity and quality, and the experience of inter-group conflict. Findings from Study 1 supported this hypothesis. Study 2 replicated these findings in a different cultural context and extended them by examining the robustness of the relationship between CAPCMS and reconciliation attitudes in the presence of an individual difference measure (self-confidence in social interactions). Furthermore, both studies revealed that for adolescents with high CAPCMS the relationships between intergroup contact (quantity and quality) and reconciliation attitudes were more accentuated, and their reconciliation attitudes were less affected by their experience of conflict, relative to those with low CAPCMS.

Regulatory fit effects on perceived fiscal exchange and tax compliance

Paying taxes can be considered a contribution to the welfare of a society. But even though tax payments are redistributed to citizens in the form of public goods and services, taxpayers often do not perceive many benefits from paying taxes. Information campaigns about the use of taxes for financing public goods and services could increase taxpayers' understanding of the importance of taxes, strengthen their perception of fiscal exchange and consequently also increase tax compliance. Two studies examined how fit between framing of information and taxpayers' regulatory focus affects perceived fiscal exchange and tax compliance. Taxpayers should perceive the exchange between tax payments and provision of public goods and services as higher if information framing suits their regulatory focus. Study 1 supported this hypothesis for induced regulatory focus. Study 2 replicated the findings for chronic regulatory focus and further demonstrated that regulatory fit also affects tax compliance. The results provide further evidence for findings from previous studies concerning regulatory fit effects on tax attitudes and extend these findings to a context with low tax morale.

The perfect mix: regulatory complementarity and the speed-accuracy balance in group performance

In this research, we varied the composition of 4-member groups. One third of the groups consisted exclusively of "locomotors," individuals predominantly oriented toward action. Another third of the groups consisted exclusively of "assessors," individuals predominantly oriented toward evaluation. The final third of the groups consisted of a mix of locomotors and assessors. We found that the groups containing only locomotors were faster than the groups containing only assessors, and the groups containing only assessors were more accurate than the groups containing only locomotors. The groups containing a mix of assessors and locomotors were as fast as the groups containing only locomotors and as accurate as the groups containing only assessors. These results echo findings at the individual level of analysis, and suggest that the testing and action components of operating systems independently contribute to performance both intra- and interpersonally.

Framing of information on the use of public finances, regulatory fit of recipients and tax compliance

Information campaigns to increase tax compliance could be framed in different ways. They can either highlight the potential gains when tax compliance is high, or the potential losses when compliance is low. According to regulatory focus theory, such framing should be most effective when it is congruent with the promotion or prevention focus of its recipients. Two studies confirmed the hypothesized interaction effects between recipients' regulatory focus and framing of information campaigns, with tax compliance being highest under conditions of regulatory fit. To address taxpayers effectively, information campaigns by tax authorities should consider the positive and negative framing of information, and the moderating effect of recipients' regulatory focus.

Groups as epistemic providers: need for closure and the unfolding of group-centrism

Theory and research are presented relating the need for cognitive closure to major facets of group behavior. It is suggested that a high need for closure, whether it is based on members' disposition or the situation, contributes to the emergence of a behavioral syndrome describable as group-centrism--a pattern that includes pressures to opinion uniformity, encouragement of autocratic leadership, in-group favoritism, rejection of deviates, resistance to change, conservatism, and the perpetuation of group norms. These theoretical predictions are borne out by laboratory and field research in diverse settings.

Groups as epistemic providers: need for closure and the unfolding of group-centrism

Theory and research are presented relating the need for cognitive closure to major facets of group behavior. It is suggested that a high need for closure, whether it is based on members' disposition or the situation, contributes to the emergence of a behavioral syndrome describable as group-centrism--a pattern that includes pressures to opinion uniformity, encouragement of autocratic leadership, in-group favoritism, rejection of deviates, resistance to change, conservatism, and the perpetuation of group norms. These theoretical predictions are borne out by laboratory and field research in diverse settings.

Relevance override: on the reduced impact of "cues" under high-motivation conditions of persuasion studies

This research addressed the reduced impact of cues under high processing motivation of persuasion experiments. The results of 3 studies suggested that such reduced impact is due to a relevance override whereby any more subjectively relevant information swamps the effects of any less subjectively relevant information, given the recipient's sufficient motivation to process both. Because, in much persuasion research, cues may have been perceived as less relevant to the attitudinal judgments than message arguments, the relevance override hypothesis provides a general explanation of the reduced cue effect.

The Social Cognition of Immigrants' Acculturation: Effects of the Need for Closure and the Reference Group at Entry

Three studies found support for the notion that immigrants' acculturation to the host culture is interactively determined by their need for cognitive closure (A. W. Kruglanski & D. M. Webster, 1996) and the reference group they forge on their arrival. If such reference group is fashioned by close social relations with coethnics, the higher the immigrants' need for closure, the weaker their tendency to assimilate to the new culture and the stronger their tendency to adhere to the culture of origin. By contrast, if the reference entry group is fashioned by close relations with members of the host country, the higher their need for closure, the stronger their tendency to adapt to the new culture and the weaker their tendency to maintain the culture of origin. These findings obtained consistently across 3 immigrant samples in Italy, 1 Croatian and 2 Polish, and across multiple different measures of acculturation.

When similarity breeds content: need for closure and the allure of homogeneous and self-resembling groups

Four studies explored the relation between members' need for cognitive closure and their feelings toward groups. It was found that high (vs. low) need for closure individuals liked in-groups and out-groups more as function of the degree to which their membership was perceived as homogeneous (Studies 1-4), provided it was also self-similar (Studies 3 and 4). These results are discussed in terms of the relation between need for closure and homogeneous (vs. heterogeneous) groups' apparent potential as "closure providers."

When similarity breeds content: need for closure and the allure of homogeneous and self-resembling groups

Four studies explored the relation between members' need for cognitive closure and their feelings toward groups. It was found that high (vs. low) need for closure individuals liked in-groups and out-groups more as function of the degree to which their membership was perceived as homogeneous (Studies 1-4), provided it was also self-similar (Studies 3 and 4). These results are discussed in terms of the relation between need for closure and homogeneous (vs. heterogeneous) groups' apparent potential as "closure providers."

The statistical analysis of data from small groups

The authors elaborate the complications and the opportunities inherent in the statistical analysis of small-group data. They begin by discussing nonindependence of group members' scores and then consider standard methods for the analysis of small-group data and determine that these methods do not take into account this nonindependence. A new method is proposed that uses multilevel modeling and allows for negative nonindependence and mutual influence. Finally, the complications of interactions, different group sizes, and differential effects are considered. The authors strongly urge that the analysis model of data from small-group studies should mirror the psychological processes that generate those data.

A cross-cultural study of the Need for Cognitive Closure Scale: comparing its structure in Croatia, Italy, USA and The Netherlands

This study was designed to compare the factor structure of Need for Closure Scale (NFCS) as it emerges from three European samples (Croatia, Italy and The Netherlands) to the structure emerging from a USA sample, and to test the invariance of the structure of the scale both across three European contexts and across European and US samples. This comparison was conducted to examine the generalizability of results obtained with the NFCS across cultures. The sample sizes employed in this study range from 201 (Croatia) to 418 (Italy) participants. First- and second-order confirmatory factor analysis and multiple-group measurement invariance tests were performed using the LISREL-8 program (Jöreskog and Sörbom, 1993). The analyses revealed that the factor structure of the scale was invariant across all samples, and that the best fitting model was one with two latent second-order factors, thus confirming results of previous studies (Kruglanski et al., 1997; Neuberg, Judice, & West, 1997).

Psychological theory testing versus psychometric nay-saying: comment on Neuberg et al.'s (1997) critique of the need for closure scale

S. L. Neuberg, T. N. Judice, and S. G. West (1997) faulted our work with the Need for Closure Scale (NFCS) on grounds that the NFCS lacks discriminant validity relative to S. L. Neuberg's and J. T. Newsom's (1993) Personal Need for Structure (PNS) Scale and is multidimensional, which, so they claim, renders the use of its total score inadmissible. By contrast, the present authors show that neither of the above assertions is incompatible with the underlying need for closure theory. Relations between NFCS and the PNS are to be expected, as these were designed to operationalize the very same construct (of need for closure). Furthermore, no unidimensionality of the NFCS has been claimed, and none is required to use its total score for testing various theoretically derived predictions. An instrument's ultimate utility hinges on theoretical considerations and empirical evidence rather than on questionable psychometric dogma unrelated to the substantive matters at hand.