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Depressive symptoms in patients with coronary heart disease (CHD) predict adverse outcomes regarding e.g. cardiovascular complications. We trained women with CHD to support female peers through telephone-based counseling and tested whether depressive symptoms can be reduced, and perceived social support can be improved by the intervention over six months. 108 women with CHD and self-reported depressive or anxiety symptoms were included in a randomized controlled trial. The intervention group was offered immediate telephone-based peer support for six months, while the waiting list control group received the intervention with a 6-months delay. Primary outcomes were depressive symptoms and perceived social support immediately after the intervention period and at 6-months-follow-up. 40% of the women made use of the peer support. During the first six months, both groups showed a reduction in depressive symptoms (IIG: t(169) = -1.79

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with impaired health-related quality of life (HRQoL), high symptom severity, and poor cardiovascular outcomes. Both clinical and psychological factors may contribute to symptom severity and HRQoL in AF. Methods: Using data from the observational Atrial Fibrillation Rhine-Neckar Region (ARENA) trial, we identified medical and psychosocial factors associated with AF-related symptom severity using European Heart Rhythm Association symptom classification and HRQoL using 5-level EuroQoL- 5D. Results: In 1218 AF patients (mean age 71.1 ± 10.5 years, 34.5% female), female sex (OR 3.7, p < 0.001), preexisting coronary artery disease (CAD) (OR 1.7, p = 0.020), a history of cardioversion (OR 1.4, p = 0.041), cardiac anxiety (OR 1.2; p < 0.001), stress from noise (OR 1.4, p = 0.005), work-related stress (OR 1.3, p = 0.026), and sleep disturbance (OR 1.2, p = 0.016) were associated with higher AF-related symptom severity. CAD (β = −0.23, p = 0.001), diabetes mellitus (β = −0.25, p < 0.001), generalized anxiety (β = −0.30, p < 0.001), cardiac anxiety (β = −0.16, p < 0.001), financial stress (β = −0.11, p < 0.001), and sleep disturbance (β = 0.11, p < 0.001) were associated with impaired HRQoL. Conclusions: Psychological characteristics, preexisting CAD, and diabetes may play an important role in the identification of individuals at highest risk for impaired HRQoL and high symptom severity in patients with AF.

OBJECTIVES Patients undergoing coronary artery bypass graft (CABG) surgery are exposed to multiple treatment-related stressors, which can impact coping and health-related quality of life (HRQoL). The objective of this trial was to analyse the feasibility and preliminary efficacy of a multi-component intervention that combines psychological support and reduction of hospital-specific stressors on HRQoL, length of hospital and intensive care unit stay, self-efficacy, and plasma interleukin (IL)-6 and -8 levels in CABG patients. METHODS This three-arm, randomized controlled, single-centre pilot trial assessed the Intervention for CABG to Optimize Patient Experience in 88 patients undergoing elective CABG. Standard medical care (SMC, n = 29) was compared with 2 intervention groups: (i) psychological interventions to optimize treatment expectations (IA group, n = 30) and (ii) multi-component intervention (IB group, n = 29) with psychological interventions plus an additional treatment package (light therapy, noise reduction, music, and if desired, 360° images delivered via virtual reality). RESULTS The implementation of psychological interventions in routine medical treatment was feasible (91.5% of participants completed all intervention sessions). Both interventions were associated with significantly shorter hospital stay compared to SMC (IA/IB 9.8/9.3 days vs SMC 12.5 days). Self-efficacy expectations at post-surgery were significantly higher compared to SMC both in the IA group (P = 0.011) and marginally in the IB group (P = 0.051). However, there were no treatment effects of the interventions on HRQoL and plasma levels of IL-6 or IL-8 after CABG. CONCLUSIONS A perioperative multi-component intervention may lead to shorter hospital stay and higher self-efficacy after CABG. Further studies are needed to determine its impact on HRQoL and inflammation. CLINICAL TRIAL REGISTRATION NUMBER Ethical approval (# 21/2/18) for the study was obtained from the Research Ethics Committee of the University of Göttingen Medical Center, and the trial was registered in the German Clinical Trials Register (DRKS00015309, https://www.drks.de/drks_web/setLocale_EN.do).

Background: Risk factor control is essential in limiting the progression of coronary heart disease, but the necessary active patient involvement is often difficult to realise, especially in patients suffering psychosocial risk factors (e.g. distress). Blended collaborative care has been shown as an effective treatment addition, in which a (non-physician) care manager supports patients in implementing and sustaining lifestyle changes, follows-up on patients, and integrates care across providers, targeting both, somatic and psychosocial risk factors. Aims: The aim of this study was to test the feasibility, acceptance and effect of a six-month blended collaborative care intervention in Germany. Methods: For our randomised controlled pilot study with a crossover design we recruited coronary heart disease patients with ⩾1 insufficiently controlled cardiac risk factors and randomised them to either immediate blended collaborative care intervention (immediate intervention group, n=20) or waiting control (waiting control group, n=20). Results: Participation rate in the intervention phase was 67% ( n=40), and participants reported high satisfaction ( M=1.63, standard deviation=0.69; scale 1 (very high) to 5 (very low)). The number of risk factors decreased significantly from baseline to six months in the immediate intervention group ( t(60)=3.07, p=0.003), but not in the waiting control group t(60)=−0.29, p=0.77). Similarly, at the end of their intervention following the six-month waiting period, the waiting control group also showed a significant reduction of risk factors ( t(60)=3.88, pConclusion: This study shows that blended collaborative care can be a feasible, accepted and effective addition to standard medical care in the secondary prevention of coronary heart disease in the German healthcare system.

Abstract. Research on moral judgment often employs bipolar rating scales to assess whether the difference between two contrasted options is judged to be morally relevant. We give an account of how different numbers of response options provided on such scales (odd vs. even) change the meaning of the test question by communicating different implicit presuppositions. We demonstrate experimentally that these changes can qualitatively affect the moral relevance judgments that subjects express in response to a given judgment problem. Several alternative explanations in terms of trivial measurement distortion are tested and refuted, and we present suggestive evidence as to what kind of factors might be prone to scale effects. The findings underscore that expressed moral judgments are constructed ad hoc and do not necessarily reflect the content of underlying stable moral commitments. We discuss implications for theories and methodology in moral psychology and in judgment and decision-making research more generally.

Modern technological means allow for meaningful interaction across arbitrary distances, while human morality evolved in environments in which individuals needed to be spatially close in order to interact. We investigate how people integrate knowledge about modern technology with their ancestral moral dispositions to help relieve nearby suffering. Our first study establishes that spatial proximity between an agent's means of helping and the victims increases people's judgement of helping obligations, even if the agent is constantly far personally. We then report and meta-analyse 20 experiments elucidating the cognitive mechanisms behind this effect, which include inferences of increased efficaciousness and personal involvement. Implications of our findings for the scientific understanding of ancestral moral dispositions in modern environments are discussed, as well as suggestions for how these insights might be exploited to increase charitable giving. Our meta-analysis provides a practical example ...

In this article, it is argued that empirical data can undermine normative arguments generated by intuitionist methodologies that involve a step of inducing an abstract principle from a set of case-based moral intuitions. The use of case-based intuitions in normative theory construction is conceptualized here as an inductive inference procedure in which philosophers draw conclusions from introspectively observable data (their intuitions) to the state of a latent variable (what morality actually requires). We argue that such a procedure can only generate valid output if it can be applied objectively in the sense that its outcome is independent of the person who carries it out. This requirement is only met when fundamental case-based intuitions are intersubjectively shared to a relevant degree. At this point, empirical data comes into play. It is needed to assess the degree to which specific intuitions are actually intersubjectively shared. In contexts in which this requirement is not met, principles resulting from this method cannot be argued to be valid representations of what morality actually requires. We illustrate this argument with a concrete example from the literature in which a specific normative principle is called into question on the basis of psychological data on laypeople’s moral intuitions. Furthermore, we defend the argument against potential objections, and we discuss its relationship to other criticisms of moral intuitionism as well as its implications for intuitionist methodologies in general.

In clinical practice and in research, there is an ongoing debate on how to return incidental and secondary findings of genetic tests to patients and research participants. Previous investigations have found that most of the people most of the time are in favor of full disclosure of results. Yet, the option to reject disclosure, based on the so-called right not to know, can be valuable especially for some vulnerable subgroups of recipients. In the present study we investigated variations in informational preferences in the context of genetic testing in a large and diverse German sample. This survey examined health care professionals, patients, participants of genetic counseling sessions and members of the general population (N = 518). Survey participants were assessed regarding their openness to learning about findings under various hypothetical scenarios, as well as their attitudes about the doctor-patient-relationship in a disclosure situation and about informational transfer to third parties. While the majority of participants wanted to learn about their findings, the extent of support of disclosure varied with features of the hypothetical diagnostic scenarios (e.g., controllability of disease; abstract vs. concrete scenario description) and demographic characteristics of the subjects. For example, subjects with higher levels of education were more selective with regards to the kind of information they want to receive than those with lower levels of education. We discuss implications of these findings for the debate about the right not to know and for the clinical practice of informed consent procedures.

A heavily disputed question of moral philosophy is whether spatial distance between agent and victim is normatively relevant for the degree of obligation to help strangers in need. In this research, we focus on the associated descriptive question whether increased distance does in fact reduce individuals' sense of helping obligation. One problem with empirically answering this question is that physical proximity is typically confounded with other factors, such as informational directness, shared group membership, or increased efficaciousness. In a series of 5 experiments, we show that distance per se does not influence people's moral intuitions when it is isolated from such confounds. We support our claims with both frequentist and Bayesian statistics. We relate these findings to philosophical arguments concerning the normative relevance of distance and to psychological theories linking distance cues to higher level social cognition. The effects of joint versus separate evaluation paradigms on moral judgments are also discussed.

Explaining moral intuitions is one of the hot topics of recent cognitive science. In the present article we focus on a factor that attracted surprisingly little attention so far, namely the temporal order in which moral scenarios are presented. We argue that previous research points to a systematic pattern of order effects that has been overlooked until now: only judgments of actions that are normally regarded as morally acceptable are susceptible to be affected by the order of presentation, and this in turn is only the case if the dilemma is immediately preceded by a dilemma in which the proposed action was considered as not morally acceptable. We conducted an experiment that largely confirmed this pattern and allowed us to analyze by what individual level responses it was generated. We argue that investigating order effects is necessary for approaching a complete descriptive moral theory. Furthermore, we discuss the implications of these findings for moral philosophy.