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Caspi E. Residents' Fear of Retaliation in America's Nursing Homes: An Exploratory Study. J Appl Gerontol 2024; 43:497-514. [PMID: 37991342 DOI: 10.1177/07334648231214413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
The phenomenon of residents' fear of staff retaliation when voicing care concern and making mistreatment complaints in nursing homes has been shown in research to be common. Despite longstanding concerns by care advocacy organizations about this phenomenon and its impact on residents (including emotional suffering, inadequate care, and mistreatment due to fear-driven lack of reporting, investigation, and resolution), little research examined it to date. Using 100 standard survey and complaint investigation reports from state survey agencies in nursing homes in 30 states, the researcher of this qualitative study aimed to improve understanding of residents' lived experience of four aspects of this phenomenon-fear of retaliation, allegations of threats of retaliation, perceived retaliation, and actual (confirmed) retaliation-and their emotional consequences. The findings could inform practice and policy changes necessary to realize residents' federal right to speak up without fear of retaliation when advocating for dignified and safe care.
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Loh MY, Dollard MF. Acting out when psychosocial safety climate is low: understanding why middle-level managers experience upward mistreatment. Front Psychol 2024; 15:1336130. [PMID: 38694437 PMCID: PMC11061357 DOI: 10.3389/fpsyg.2024.1336130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/29/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Upward mistreatment, despite being under studied, is an influential phenomenon affecting middle managers' well-being and performance. The work environment hypothesis of bullying proposes that an undesirable work context is the main cause of workplace bullying, suggesting the importance of creating an anti-mistreatment climate, that is, psychosocial safety climate (PSC). In this study, we argue that upward bullying and aggression are unsafe behaviors, a "retaliation" by employees resulting from their unsafe work context. Methods Using a large-scale multisource sample collected from 123 organizations, 6,658 middle managers and 34,953 employees, we examined the relationship between collective PSC, individual-perceived PSC and middle managers' experience of upward mistreatment. Results Single-level and multi-level modeling results suggested that PSC is an important element in reducing the likelihood of upward bullying and aggression, in turn, protecting managers' well-being. More importantly, upward bullying is a way that employees act out when there is an undesirable working context. Discussion Future research on workplace mistreatment should examine PSC and upward mistreatment. Interventions provided should focus on improving PSC which could in turn preventing upward mistreatment, thereby improving psychosocial safety for both employees and middle managers to prevent negative actions.
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Affiliation(s)
- May Young Loh
- Psychosocial Safety Climate Global Observatory, Centre for Workplace Excellence, University of South Australia, Adelaide, SA, Australia
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Abraham J, Mangapul CJ, Amaniputri DN, Manurung RH, Ispurwanto W. Intention to whistleblow: Perception of reporting skill mediates the predicting role of class consciousness and perceived probability of revenge. F1000Res 2023; 12:1566. [PMID: 38434655 PMCID: PMC10904998 DOI: 10.12688/f1000research.142265.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 03/05/2024] Open
Abstract
Background A number of corruption cases would never have been revealed without the role of the whistleblower. Whistleblowers - as people who know about corruption incidents in their environment - are social capital in preventing and eradicating corruption. For this reason, it is urgent to know the configuration of psychological predictors of a person's intention to carry out whistleblowing. Methods Predictive correlational design with a mediation analysis was used in this study. The participants of this study were 374 Indonesians (187 males, 187 females; M age = 25.61 years old; SD age = 6.78 years). Results The results showed that perception of reporting skill can mediate the predicting relationship between class consciousness, perceived probability of revenge, and intention to blow the whistle. Conclusions Class consciousness and perceived probability of retaliation might encourage someone to feel competent to blow the whistle - or improve their reporting skill - to carry out whistleblowing.
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Affiliation(s)
- Juneman Abraham
- Psychology Department, Faculty of Humanities, Bina Nusantara University, Jakarta, DKI Jakarta, 11480, Indonesia
| | - Christian Jeremia Mangapul
- Psychology Department, Faculty of Humanities, Bina Nusantara University, Jakarta, DKI Jakarta, 11480, Indonesia
| | | | - Rudi Hartono Manurung
- Japanese Department, Faculty of Humanities, Bina Nusantara University, Jakarta, DKI Jakarta, 11480, Indonesia
| | - Wing Ispurwanto
- Psychology Department, Faculty of Humanities, Bina Nusantara University, Jakarta, DKI Jakarta, 11480, Indonesia
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Carrier A, Bolduc F, Delli-Colli N, Makela F, Hudon A, Caty ME, Duhoux A, Beaudoin M. Fear of Reprisal and Change Agency in the Public Health and Social Service System: Protocol for a Sequential Mixed Methods Study. JMIR Res Protoc 2023; 12:e48400. [PMID: 37733408 PMCID: PMC10556997 DOI: 10.2196/48400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Since they are key witnesses to the systemic difficulties and social inequities experienced by vulnerable patients, health and social service (HSS) professionals and clinical managers must act as change agents. Using their expertise to achieve greater social justice, change agents employ a wide range of actions that span a continuum from the clinical (microsystem) to the societal (macrosystem) sphere and involve actors inside and outside the HSS system. Typically, however, clinical professionals and managers act in a circumscribed manner, that is, within the clinical sphere and with patients and colleagues. Among the hypotheses explaining this reduced scope of action is the fear of reprisal. Little is known about the prevalence of this fear and its complex dynamics. OBJECTIVE The overall aim is to gain a better understanding of the complex dynamic process leading to clinical professionals' and managers' fear of reprisal in their change agent actions and senior administrators' and managers' determination of wrongdoing. The objectives are (1) to estimate the prevalence of fear of reprisal among clinical professionals and managers; (2) to identify the factors involved in (a) the emergence of this fear among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; (3) to describe the process of emergence of (a) the fear of reprisal among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; and (4) to document the legal and ethical issues associated with the factors identified (objective 2) and the processes described (objective 3). METHODS Based on the Exit, Voice, Loyalty, Neglect model, a 3-part sequential mixed methods design will include (1) a web-based survey (objective 1), (2) a qualitative grounded theory design (objectives 2 and 3), and (3) legal and ethical analysis (objective 4). Survey: 77,794 clinical professionals or clinical managers working in the Québec public HSS system will be contacted via email. Data will be analyzed using descriptive statistics. Grounded theory design: for each of the 3 types of participants (clinical professionals, clinical managers, and senior administrators and managers), a theoretical sample of 15 to 30 people will be selected via various strategies. Data will be independently analyzed using constant comparison process. Legal and ethical analysis: situations described by participants will be analyzed using, respectively, applicable legislation and jurisprudence and 2 ethical models. RESULTS This ongoing study began in June 2022 and is scheduled for completion by March 2027. CONCLUSIONS Instead of acting, fear of reprisal could induce clinical professionals to tolerate situations that run counter to their social justice values. To ensure they use their capacities for serving a population that is or could become vulnerable, it is important to know the prevalence of the fear of reprisal and gain a better understanding of its complex dynamics. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48400.
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Affiliation(s)
- Annie Carrier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, University Integrated Health and Social Services Centre of the Eastern Townships - Sherbrooke University Hospital, Sherbrooke, QC, Canada
| | - François Bolduc
- Department of Industrial Relations, Faculty of Social Sciences, Université Laval, Quebec, QC, Canada
- Interuniversity Research Centre on Globalization and Work, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Delli-Colli
- Research Center on Aging, University Integrated Health and Social Services Centre of the Eastern Townships - Sherbrooke University Hospital, Sherbrooke, QC, Canada
- School of Social Work, Faculty of Arts and Humanities, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Finn Makela
- Faculty of Law, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, University Integrated Health and Social Services of the South-Center-of-Montreal-Island, Montreal, QC, Canada
- Research Center for Ethics, Université de Montréal, Montreal, QC, Canada
| | - Marie-Eve Caty
- Department of Speech-Language Pathology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Research Centre of the Integrated Health and Social Services Centre of Laval, Laval, QC, Canada
| | - Michaël Beaudoin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, University Integrated Health and Social Services Centre of the Eastern Townships - Sherbrooke University Hospital, Sherbrooke, QC, Canada
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Mathur A, Bashford-Largo J, Elowsky J, Zhang R, Dobbertin M, Tyler PM, Bajaj S, Blair KS, Blair RJR. Association Between Aggression and Differential Functional Activity of Neural Regions Implicated in Retaliation. J Am Acad Child Adolesc Psychiatry 2023; 62:805-815. [PMID: 36889505 PMCID: PMC10330338 DOI: 10.1016/j.jaac.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The goal of the current study was to determine the extent to which atypical neural responsiveness during retaliation is associated with observed aggression in youth in residential care. METHOD This functional magnetic resonance imaging study involved 83 adolescents (56 male and 27 female; mean age, 16.18 years) in residential care performing a retaliation task. Of the 83 adolescents, 42 displayed aggressive behavior within the first 3 months of residential care, whereas 41 did not. During the retaliation task, participants were offered either fair or unfair divisions of $20 pots (allocation phase) and could either accept the offer or reject it, and, by spending $1, $2, or $3, punish the partner (retaliation phase). RESULTS The study's main findings were that aggressive adolescent showed the following: reduced down-regulation of activity within regions involved in representing the expected value of choice options (left ventromedial prefrontal cortex and left posterior cingulate cortex) as a function of offer unfairness and retaliation level; and reduced recruitment of regions implicated in response control (right inferior frontal gyrus and bilateral anterior insular cortex) and associated fronto-parietal regions as a function of retaliation level. The aggressive adolescents were also significantly more likely to have been aggressive prior to residential care and showed a strong trend for increased retaliation on the task. CONCLUSION We suggest that individuals with a greater propensity for aggression show reduced representation of the negative consequences of retaliation and associated reduced recruitment of regions potentially involved in over-ruling these negative consequences to engage in retaliation. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
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Affiliation(s)
- Avantika Mathur
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | | | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - R James R Blair
- Child and Adolescent Mental Health Center Research Center, Genthofte Hospital, Hellerup, Denmark.
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Fahlgren MK, Cheung JC, Ciesinski NK, McCloskey MS, Coccaro EF. Gender Differences in the Relationship between Anger and Aggressive Behavior. J Interpers Violence 2022; 37:NP12661-NP12670. [PMID: 33546562 DOI: 10.1177/0886260521991870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Evidence is mixed regarding differences in prevalence of aggressive behavior, with many (though not all) studies suggesting that men are more aggressive than women. Furthermore, while aggression often occurs in response to provocation-induced anger, this relationship may be stronger for men; women may be more likely to engage in non-aggressive (e.g., affiliative) behaviors in response to provocation, particularly at low-level provocation. This study examined gender differences in aggression as well as differences in the relationship between anger and aggression for men and women. Adults (N = 424) participated in a behavioral aggression task, and a subset of participants (n = 304) completed a questionnaire assessing trait levels of anger as part of a larger study at a large midwestern university. Results indicated that while men and women aggressed at similar levels, aggression was significantly associated with trait anger for men only, at low levels of provocation, with only a trending relationship for high provocation. This suggests that while men and women may be equally aggressive in certain situations, this behavior may be differentially associated with anger.
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Affiliation(s)
| | | | | | | | - Emil F Coccaro
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Flores-Camacho AL, Castillo-Verdejo DL, Penagos-Corzo JC. Development and Validation of a Brief Scale of Vengeful Tendencies (BSVT-11) in a Mexican Sample. Behav Sci (Basel) 2022; 12:bs12070215. [PMID: 35877285 PMCID: PMC9312149 DOI: 10.3390/bs12070215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
The development and analysis of psychometric properties of a brief scale that assesses vengeful tendencies (BSVT-11) is presented. A three-dimensional model is proposed: (1) resentment, (2) planning of revenge, and (3) justification of revenge. Two studies were conducted for this purpose: one was carried out with a sample of 478 participants, to evaluate the content validity, factorial structure, reliability, and invariance of the instrument; the other was conducted with a sample of 308 participants, to determine the concurrent validity of the BSVT-11. The data indicated adequate reliability (ω = 0.877), optimal fit (CFI = 1.0, TLI = 1.0) according to the dimensions proposed, and invariance between genders (p = 0.893). Concurrent validity data yield significant correlation values (p < 0.001) ranging from 0.522 to 0.804 in the analyses between the BSVT and other scales. The results allow us to present a brief instrument with good psychometric properties with possibilities for use in basic and translational science.
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8
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Anderson NJ, Smith CK, Foley MP. Work-related injury burden, workers' compensation claim filing, and barriers: Results from a statewide survey of janitors. Am J Ind Med 2022; 65:173-195. [PMID: 34897753 PMCID: PMC9300089 DOI: 10.1002/ajim.23319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness. METHODS Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages. RESULTS There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims. CONCLUSIONS Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.
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Affiliation(s)
- Naomi J. Anderson
- Washington State Department of Labor & Industries Olympia Washington USA
| | - Caroline K. Smith
- Washington State Department of Labor & Industries Olympia Washington USA
| | - Michael P. Foley
- Washington State Department of Labor & Industries Olympia Washington USA
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Abstract
Victims commonly respond to experienced wrongdoing by punishing or forgiving the transgressor. While much research has looked at predictors and immediate consequences of these post-transgression responses, comparably less research has addressed the conditions under which punishment or forgiveness have positive or negative downstream consequences on the victim-transgressor relationship. Drawing from research on Social Value Orientation (SVO), we argue that both forgiveness and punishment can be rooted in either prosocial (i.e., relationship- or other-oriented), individualistic (i.e., self-oriented), or competitive (i.e., harm-oriented) motives pursued by the victim. Furthermore, we posit that downstream consequences of forgiveness and punishment crucially depend on how the transgressor interprets the victim's response. The novel motive-attribution framework presented here highlights the importance of alignment between a victim's motives and a transgressor's motive attributions underlying post-transgression responses. This framework thus contributes to a better understanding of positive and negative dynamics following post-transgression interactions.
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10
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Rotenberg KJ, Manley E, Walker KM. The relation between young adults' trust beliefs in others and interpersonal hostility. Aggress Behav 2021; 47:544-556. [PMID: 34114206 DOI: 10.1002/ab.21969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022]
Abstract
The research examined whether, and if so how, young adults' trust beliefs in others were associated with interpersonal hostility. The participants in Study 1 were 139 young adults from the UK (76 women; Mage = 20.8). In Study 2, 88 young adult women from the UK (Mage = 21.5) served as participants. The participants completed a standardized measure of trust beliefs in others (total with reliability, honesty, and emotional subscales). In Study 1, participants imagined they were victims of peer provocation. They were required to judge the intention for the provocation and their retaliation to it. In Study 2, the participants were engaged in a lab-based acquaintanceship interaction that involved the exchange of disclosures. They completed an adjective checklist that assessed anger and evaluated the quality of the conversation. Trust beliefs were linearly and negatively associated with the attribution of hostile intentions, retaliation, anger toward others, and critical evaluation of a developing peer relationship. As expected though, quadratic relations were found. Young adults with very low and those with very high trust beliefs (primarily emotionally based) showed greater attribution of hostile intentions, retaliation, anger toward others, and critical evaluation of a developing peer relationship than did young adults with the middle range of trust beliefs. The linear relations supported the hypothesis that trust promotes psychosocial adjustment. The quadratic relations supported the deviation from the normative trust (centralist) approach primarily for emotional trust beliefs in others.
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Affiliation(s)
| | - Emma Manley
- School of Psychology Keele Uniiversity Keele United Kingdom
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11
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Rahrig H, Bjork JM, Tirado C, Chester DS, Creswell JD, Lindsay EK, Penberthy JK, Brown KW. Punishment on Pause: Preliminary Evidence That Mindfulness Training Modifies Neural Responses in a Reactive Aggression Task. Front Behav Neurosci 2021; 15:689373. [PMID: 34366804 PMCID: PMC8342928 DOI: 10.3389/fnbeh.2021.689373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Reactive aggression, a hostile retaliatory response to perceived threat, has been attributed to failures in emotion regulation. Interventions for reactive aggression have largely focused on cognitive control training, which target top-down emotion regulation mechanisms to inhibit aggressive impulses. Recent theory suggests that mindfulness training (MT) improves emotion regulation via both top-down and bottom-up neural mechanisms and has thus been proposed as an alternative treatment for aggression. Using this framework, the current pilot study examined how MT impacts functional brain physiology in the regulation of reactive aggression. Participants were randomly assigned to 2 weeks of MT (n = 11) or structurally equivalent active coping training (CT) that emphasizes cognitive control (n = 12). Following training, participants underwent functional magnetic resonance imaging (fMRI) during a retaliatory aggression task, a 16-trial game in which participants could respond to provocation by choosing whether or not to retaliate in the next round. Training groups did not differ in levels of aggression displayed. However, participants assigned to MT exhibited enhanced ventromedial prefrontal cortex (vmPFC) recruitment during punishment events (i.e., the aversive consequence of losing) relative to those receiving active CT. Conversely, the active coping group demonstrated greater dorsomedial prefrontal cortex (dmPFC) activation when deciding how much to retaliate, in line with a bolstered top-down behavior monitoring function. The findings suggest that mindfulness and cognitive control training may regulate aggression via different neural circuits and at different temporal stages of the provocation-aggression cycle. Trial Registration: identification no. NCT03485807.
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Affiliation(s)
- Hadley Rahrig
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - James M. Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Camila Tirado
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - David S. Chester
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - J. David Creswell
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Emily K. Lindsay
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer Kim Penberthy
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kirk Warren Brown
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
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12
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Clemente M, Espinosa P. Revenge in Couple Relationships and Their Relation to the Dark Triad. Int J Environ Res Public Health 2021; 18:7653. [PMID: 34300105 DOI: 10.3390/ijerph18147653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Abstract
Background: This research examines how, when a romantic partner commits a perceived transgression that leads to couple break up, vengeful reactions are predicted by the type of transgression and the Dark Triad of personality. Methods: An incidental sample of 2142 participants, half male and half female aged 18 to 70, completed a questionnaire developed by the authors to assess how they had reacted after being the perceived victims of a transgression committed by their partner and a measure of the Dark Triad. Results: Results show half of the people who feel as though they are victims of a partner transgression show revenge reactions. These reactions are more emotional than rational and do not usually anticipate their consequences or success. Moreover, revenge is related primarily to psychopathy and to a lesser extent to Machiavellianism. Psychopathy is the best predictor for revenge thoughts and actions, whereas narcissism does not predict revenge when controlling for other dark traits. Conclusions: This study contributes to the explanation of revenge reactions in couple relationships in relation to the type of transgression perceived and the Dark Triad. Conflicts that arise out of revenge may have long-lasting consequences for both the perceived aggressor and victim, and our results may be useful for assessing risks, monitoring, and preventing negative consequences for partners or ex-partners.
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Gönültaş S, Mulvey KL. Bystander responses to bias-based bullying and retaliation: Is retaliation perceived as more acceptable than bias-based bullying? Br J Dev Psychol 2021; 39:442-461. [PMID: 33629758 DOI: 10.1111/bjdp.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/30/2020] [Indexed: 11/30/2022]
Abstract
The current study examined intergroup-related and social-cognitive correlates of bystanders' acceptability judgements and their responses to bias-based bullying of immigrant peers and to possible retaliation for the bullying. Participants included 179 immigrant-origin and non-immigrant-origin youth (Mage = 13.23; SD = 1.55; 79 immigrant-origin youth). Participants' bystander judgements and responses to bullying and retaliation were examined via a hypothetical scenario. Further, participants' intergroup attitudes towards immigrants and their social-cognitive skills were evaluated. ANOVA results showed that immigrant-origin youth judged bullying as less acceptable and retaliation as more acceptable compared to non-immigrant-origin youth, documenting that group membership is related to adolescents' judgements. A similar pattern was observed in active bystander responses. Hierarchical regression analyses revealed that immigration background, intergroup process in the context of immigration, and social-cognitive skills predict bystander responses to bullying and retaliation. This study provides important implications for anti-bullying intervention programmes to overcome the negative consequences of retaliation in the escalation of aggressive behaviours.
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Affiliation(s)
- Seçil Gönültaş
- North Carolina State University, Raleigh, North Carolina, USA
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14
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Eder AB, Mitschke V, Gollwitzer M. What stops revenge taking? Effects of observed emotional reactions on revenge seeking. Aggress Behav 2020; 46:305-316. [PMID: 32232867 DOI: 10.1002/ab.21890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/20/2020] [Accepted: 03/17/2020] [Indexed: 12/28/2022]
Abstract
What reaction stops revenge taking? Four experiments (total N = 191) examined this question where the victim of an interpersonal transgression could observe the offender's reaction (anger, sadness, pain, or calm) to a retributive noise punishment. We compared the punishment intensity selected by the participant before and after seeing the offender's reaction. Seeing the opponent in pain reduced subsequent punishment most strongly, while displays of sadness and verbal indications of suffering had no appeasing effect. Expression of anger about a retributive punishment did not increase revenge seeking relative to a calm reaction, even when the anger response was disambiguated as being angry with the punisher. It is concluded that the expression of pain is the most effective emotional display for the reduction of retaliatory aggression. The findings are discussed in light of recent research on reactive aggression and retributive justice.
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Affiliation(s)
- Andreas B. Eder
- Department of Psychology Julius‐Maximilians‐University of Würzburg Würzburg Germany
| | - Vanessa Mitschke
- Department of Psychology Julius‐Maximilians‐University of Würzburg Würzburg Germany
| | - Mario Gollwitzer
- Department of Psychology Ludwig‐Maximilians‐University of Munich Munich Germany
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15
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Abstract
The current article examined the characteristics of real-life revenge acts. A demographically diverse sample of avengers described autobiographical revenge acts and the preceding offense. They rated the severity of both acts, the time before taking revenge, and motives for the timing. Independent raters also rated the severity of both acts and coded the domains. Results revealed that real-life revenge is (1) by and large equally common as revealed by lab-based studies on revenge, but (2) is usually a delayed response, and (3) although similar to offenses in severity (according to independent parties), it is dissimilar in the domain. These characteristics contradict manifestations of revenge as studied in lab research (e.g., as a response that must take place immediately and in the same domain). These discrepancies suggest that not all real-life instances of revenge are optimally suited to serve a deterrence function and that other motives may underlie more destructive revenge acts.
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16
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Chester DS. Beyond the aggregate score: Using multilevel modeling to examine trajectories of laboratory-measured aggression. Aggress Behav 2019; 45:498-506. [PMID: 30957879 DOI: 10.1002/ab.21837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 11/11/2022]
Abstract
Aggression is often measured in the laboratory as an iterative "tit-for-tat" sequence, in which two aggressors repeatedly inflict retaliatory harm upon each other. Aggression researchers typically quantify aggression by aggregating across participants' aggressive behavior on such iterative encounters. However, this "aggregate approach" cannot capture trajectories of aggression across the iterative encounters and needlessly eliminates rich information in the form of within-participant variability. As an alternative approach, I used multilevel modeling (MLM) to examine the slope of aggression across the 25-trial Taylor Aggression Paradigm as a function of trait physical aggression and experimental provocation. Across two preregistered studies (combined N = 392), participants exhibited a modest decline in aggression. This decline reflected a reciprocal strategy, in which participants responded to an initially-provocative opponent with greater aggression that then decreased over time to match their opponent's declining levels of aggression. Against predictions, trait physical aggression and experimental provocation did not affect participants' overall trajectories of aggression. Yet, exploratory analyses suggested that the participants' tendency to reciprocate their opponent's aggression with more aggression was greater at higher levels of trait physical aggression and attenuated among participants who had already been experimentally provoked by their opponent. These findings (a) illustrate several advantages of an MLM approach as compared with an aggregate approach to iterative laboratory aggression paradigms; (b) demonstrate that the magnifying effects of trait aggression and experimental provocation on laboratory aggression are stable over brief time-frames; and (c) suggest that modeling the opponent's behavior on such tasks reveals important information.
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Affiliation(s)
- David S. Chester
- Department of Psychology Virginia Commonwealth University Richmond Virginia
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17
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Brooks BA, Hoff K, Pandey P. Cultural impediments to learning to cooperate: An experimental study of high- and low-caste men in rural India. Proc Natl Acad Sci U S A 2018; 115:11385-92. [PMID: 30397115 DOI: 10.1073/pnas.1804639115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report experimental findings on how individuals from different cultures solve a repeated coordination game of common interest. The results overturn earlier findings that fixed pairs are almost assured to coordinate on an efficient and cooperative equilibrium. Subjects in the prior experiments were US university students, whereas the subjects in our study are men drawn from high and low castes in rural India. Most low-caste pairs quickly established an efficient and cooperative convention, but most high-caste pairs did not. The largest difference in behavior occurred when a player suffered a loss because he had tried to cooperate but his partner did not: In this situation, high-caste men were far less likely than low-caste men to continue trying to cooperate in the next period. Our interpretation is that for many high-caste men, the loss resulting from coordination failure triggered retaliation. Our results are robust to controls for education and wealth, and they hold by subcaste as well as by caste status. A survey we conducted supports the ethnographic evidence that more high-caste than low-caste men prefer to retaliate against a slight. We find no evidence that caste differences in trust or self-efficacy explain the caste gap in cooperation in our experiment. Our findings are of general interest because many societies throughout the world have cultures that lead individuals to (mis)perceive some actions as insults and to respond aggressively and dysfunctionally.
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18
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Lysova A. A Violent Event Perspective on Women's Involvement in Incidents of Severe Partner Violence. Violence Vict 2018; 33:813-829. [PMID: 30567867 DOI: 10.1891/0886-6708.vv-d-17-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a shortage of research that examines experiences of partner violence (PV) among high-risk, incarcerated women using a situational perspective. This study uses a "violent event perspective" and data from the Canadian-Based Women's Experiences of Violence study to examine the sequential actions of intimate partners in a violent event. It also identifies the types of violent events based on women's involvement in the incidents of severe PV. A total of 135 incarcerated women reported 295 incidents of severe violence with a partner. Findings suggest that PV experiences of women in this clinical sample are highly heterogeneous but mostly represent extreme forms of both victimization and perpetration. This study also identifies the heterogeneity of the types of PV events by providing insight into novel forms of violent dynamics.
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19
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Beyer F, Buades-Rotger M, Claes M, Krämer UM. Hit or Run: Exploring Aggressive and Avoidant Reactions to Interpersonal Provocation Using a Novel Fight-or-Escape Paradigm (FOE). Front Behav Neurosci 2017; 11:190. [PMID: 29089875 PMCID: PMC5650963 DOI: 10.3389/fnbeh.2017.00190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/28/2017] [Indexed: 11/13/2022] Open
Abstract
Interpersonal provocation presents an approach-avoidance conflict to the provoked person: responding aggressively might yield the joy of retribution, whereas withdrawal can provide safety. Experimental aggression studies typically measure only retaliation intensity, neglecting whether individuals want to confront the provocateur at all. To overcome this shortcoming of previous measures, we developed and validated the Fight-or-Escape paradigm (FOE). The FOE is a competitive reaction time (RT) task in which the winner can choose the volume of a sound blast to be directed at his/her opponent. Participants face two ostensible opponents who consistently select either high or low punishments. At the beginning of each trial, subjects are given the chance to avoid the encounter for a limited number of times. In a first experiment (n = 27, all women), we found that fear potentiation (FP) of the startle response was related to lower scores in a composite measure of aggression and avoidance against the provoking opponent. In a second experiment (n = 34, 13 men), we altered the paradigm such that participants faced the opponents in alternating rather than in random order. Participants completed the FOE as well as the Dot-Probe Task (DPT) and the Approach-Avoidance Task (AAT). Subjects with higher approach bias scores in the AAT avoided the provoking opponent less frequently. Hence, individuals with high threat reactivity and low approach motivation displayed more avoidant responses to provocation, whereas participants high in approach motivation were more likely to engage in aggressive interactions when provoked. The FOE is thus a promising laboratory measure of avoidance and aggression.
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Affiliation(s)
- Frederike Beyer
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Macià Buades-Rotger
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Marie Claes
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
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20
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Elshout M, Nelissen RMA, van Beest I. Your act is worse than mine: Perception bias in revenge situations. Aggress Behav 2017; 43:553-557. [PMID: 28547777 DOI: 10.1002/ab.21713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/06/2017] [Accepted: 04/02/2017] [Indexed: 11/08/2022]
Abstract
Theoretical reflections suggest that avengers and targets of revenge have self-serving perception biases when judging the severity of revenge acts and preceding offenses. Empirical research investigating such biases has so far focused on either the offense or the revenge act and may have confounded a perception bias with a situational selection bias (i.e., avengers and targets selecting different events in self-serving ways, so that there may be actual, as opposed to perceptual, differences in severity). The current research circumvents this shortcoming by empirically investigating this perception bias by assessing avengers' and targets' severity scores of both the offense and the revenge act, and comparing these scores with severity scores of independent raters. Results show that although there is a situational selection bias, there is also a perception bias for both avengers and targets: Both avengers and targets believe that the other person's act is worse than their own act. This perception bias may explain the existence of perpetuating revenge cycles.
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Affiliation(s)
- Maartje Elshout
- Department of Social Psychology; Tilburg University; Tilburg The Netherlands
- CentERdata; Tilburg University; Tilburg The Netherlands
| | - Rob M. A. Nelissen
- Department of Social Psychology; Tilburg University; Tilburg The Netherlands
| | - Ilja van Beest
- Department of Social Psychology; Tilburg University; Tilburg The Netherlands
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21
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Grzyb T, Doliński D. Perpetrator as a Potential Victim. Does Threatened Retaliation from the Victim Reduce Obedience towards Authority? Psychol Belg 2017; 57:123-132. [PMID: 30479787 PMCID: PMC6194532 DOI: 10.5334/pb.397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/06/2017] [Indexed: 11/20/2022] Open
Abstract
In an experiment conducted within the Milgram paradigm, it was examined whether obedience towards an authority would be reduced in conditions in which the teacher had grounds to fear revenge from the learner. A comparison was made of the behaviour of participants in classic conditions and in conditions in which they were told that following the first part of the experiment, there would be an alteration of roles: the teacher would become the learner. It turned out that the level of compliance was the same in both groups. The dominant behaviour, regardless of whether the participant expects a change of roles or not, is total obedience.
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Affiliation(s)
- Tomasz Grzyb
- SWPS University of Social Sciences and Humanities, Faculty of Psychology in Wroclaw, PL
| | - Dariusz Doliński
- SWPS University of Social Sciences and Humanities, Faculty of Psychology in Wroclaw, PL
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22
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Abstract
In two experiments (n = 35, n = 34), we used a modified fear-conditioning paradigm to investigate the role of aversive learning in retaliatory behavior in social context. Participants first completed an initial aversive learning phase in which the pairing of a neutral conditioned stimulus (CS; i.e., neutral face) with a naturally aversive unconditioned stimulus (US; electric shock) was learned. Then they were given an opportunity to interact (i.e., administer 0–2 shocks) with the same faces again, during a Test phase. In Experiment 2, we used the same paradigm with the addition of online trial-by-trial ratings (e.g., US expectancy and anger) to examine the role of aversive learning, anger, and the learned expectancy of receiving punishment more closely. Our results indicate that learned aversions influenced future retaliation in a social context. In both experiments, participants showed largest skin conductance responses (SCRs) to the faces paired with one or two shocks, demonstrating successful aversive learning. Importantly, participants administered more shocks to the faces paired with the most number of shocks when the opportunity was given during test. Also, our results revealed that aggressive traits (Buss and Perry Aggression scale) were associated with retaliation only toward CSs associated with aversive experiences. These two experiments show that aggressive traits, when paired with aversive learning experiences enhance the likelihood to act anti-socially toward others.
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Affiliation(s)
- Tanaz Molapour
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Björn Lindström
- Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden; Department of Economics, University of ZurichZürich, Switzerland
| | - Andreas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
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23
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Abou Chakra M, Hilbe C, Traulsen A. Coevolutionary interactions between farmers and mafia induce host acceptance of avian brood parasites. R Soc Open Sci 2016; 3:160036. [PMID: 27293783 PMCID: PMC4892445 DOI: 10.1098/rsos.160036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/05/2016] [Indexed: 06/06/2023]
Abstract
Brood parasites exploit their host in order to increase their own fitness. Typically, this results in an arms race between parasite trickery and host defence. Thus, it is puzzling to observe hosts that accept parasitism without any resistance. The 'mafia' hypothesis suggests that these hosts accept parasitism to avoid retaliation. Retaliation has been shown to evolve when the hosts condition their response to mafia parasites, who use depredation as a targeted response to rejection. However, it is unclear if acceptance would also emerge when 'farming' parasites are present in the population. Farming parasites use depredation to synchronize the timing with the host, destroying mature clutches to force the host to re-nest. Herein, we develop an evolutionary model to analyse the interaction between depredatory parasites and their hosts. We show that coevolutionary cycles between farmers and mafia can still induce host acceptance of brood parasites. However, this equilibrium is unstable and in the long-run the dynamics of this host-parasite interaction exhibits strong oscillations: when farmers are the majority, accepters conditional to mafia (the host will reject first and only accept after retaliation by the parasite) have a higher fitness than unconditional accepters (the host always accepts parasitism). This leads to an increase in mafia parasites' fitness and in turn induce an optimal environment for accepter hosts.
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Affiliation(s)
- Maria Abou Chakra
- Department of Evolutionary Theory, Max Planck Institute for Evolutionary Biology, August-Thienemann-Straße 2, 24306 Plön, Germany
| | - Christian Hilbe
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA 02138, USA
- IST Austria, Am Campus 1, 3400 Klosterneuburg, Austria
| | - Arne Traulsen
- Department of Evolutionary Theory, Max Planck Institute for Evolutionary Biology, August-Thienemann-Straße 2, 24306 Plön, Germany
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24
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Shutters ST. Collective action and the detrimental side of punishment. Evol Psychol 2013; 11:327-46. [PMID: 23579191 PMCID: PMC10481089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 02/28/2013] [Indexed: 06/02/2023] Open
Abstract
Cooperative behavior is the subject of intense study in a wide range of scientific fields, yet its evolutionary origins remain largely unexplained. A leading explanation of cooperation is the mechanism of altruistic punishment, where individuals pay to punish others but receive no material benefit in return. Experiments have shown such punishment can induce cooperative outcomes in social dilemmas, though sometimes at the cost of reduced social welfare. However, experiments typically examine the effects of punishing low contributors without allowing others in the environment to respond. Thus, the full ramifications of punishment may not be well understood. Here, I use evolutionary simulations of agents playing a continuous prisoners dilemma to study behavior subsequent to an act of punishment, and how that subsequent behavior affects the efficiency of payoffs. Different network configurations are used to better understand the relative effects of social structure and individual strategies. Results show that when agents can either retaliate against their punisher, or punish those who ignore cheaters, the cooperative effects of punishment are reduced or eliminated. The magnitude of this effect is dependent on the density of the network in which the population is embedded. Overall, results suggest that a better understanding of the aftereffects of punishment is needed to assess the relationship between punishment and cooperative outcomes.
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Affiliation(s)
- Shade T Shutters
- School of Sustainability and Center for Social Dynamics and Complexity, Arizona State University, Tempe, Arizona, USA.
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25
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Leary E, Diers D. The silence of the unblown whistle: the Nevada hepatitis C public health crisis. Yale J Biol Med 2013; 86:79-87. [PMID: 23483090 PMCID: PMC3592579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2008, one of the worst public health crises occurred in the state of Nevada, where authorities discovered up to 63,000 patients were potentially exposed to hepatitis C infection, largely due to substandard infection control and other negligent practices at two endoscopy clinics in Las Vegas. In the subsequent grand jury proceedings that followed, it was discovered that several clinic employees not only participated in these egregious practices, but doctors, nurses, and other health care professionals witnessed yet failed to report these incidents, largely due to fears of whistleblower retaliation. In response, the Nevada state legislature attempted to strengthen whistleblower protection laws, but it remains unclear if such laws actually protect employees who attempt to report patient safety concerns. As the push for quality patient outcomes becomes more prominent with health care reform, whistleblower concerns must be effectively addressed to ensure that health care professionals can report patient safety concerns without fear of retaliation.
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Affiliation(s)
- Elizabeth Leary
- Master’s Candidate, Nursing, Management, Policy and
Leadership,To whom all correspondence should be
addressed: Elizabeth Leary, BSN, RN, PHN, Master’s Candidate, Nursing,
Management, Policy and Leadership, Yale School of Nursing, 100 Church St., New
Haven, CT 06536;
| | - Donna Diers
- Annie W. Goodrich Professor Emerita, Yale School of
Nursing, New Haven, Connecticut
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