Does asking about trauma history create participant distress? If so, how does it compare with reactions to other personal questions? Do participants consider trauma questions important compared to other personal questions? Using 2 undergraduate samples (Ns = 240 and 277), the authors compared participants' reactions to trauma questions with their reactions to other possibly invasive questions through a self-report survey. Trauma questions caused relatively minimal distress and were perceived as having greater importance and greater cost-benefit ratings compared to other kinds (...) of psychological research in an undergraduate human subjects pool population. These findings suggest that at least some kinds of trauma research appear to pose minimal risk when compared to other minimal risk research topics, and that participants recognize the importance of research about trauma. (shrink)

The purpose of this article is to show that animal rights are not necessarily at odds with the use of animals for research. If animals hold basic moral rights similar to those of humans, then we should consequently extend the ethical requirements guiding research with humans to research with animals. The article spells out how this can be done in practice by applying the seven requirements for ethical research with humans proposed by Ezekiel Emanuel, David Wendler and Christine Grady to (...) animal research. These requirements are i) social value, ii) scientific validity, iii) independent review, iv) fair subject selection, v) favorable risk-benefit ratio, vi) informed consent, and vii) respect for research subjects. In practice, this means that we must reform the practice of animal research to make it more similar to research with humans, rather than completely abolish the former. Indeed, if we banned animal research altogether, then we would also deprive animals of its potential benefits – which would be ethically problematic. (shrink)

Vulnerability has been extensively discussed in medical research, but less so in health care. Thus, who the vulnerable in this domain are still remains an open question. One difficulty in their identification is due to the general criticism that vulnerability is not a property of only some, but rather of everyone. By presenting a philosophical analysis of the conditions of vulnerability ascription, we show that these seemingly irreconcilable understandings of vulnerability are not contradictory. Rather, they are interdependent: they refer to (...) the same concept with different likelihoods of manifestation. We argue that the general vulnerability of living beings relies on their having certain types of interests. In health care, those individuals are particularly vulnerable who are more likely to have these interests unjustly considered. They should be afforded special protection in order to receive what is due to everyone, but which they are likely to fail to receive. (shrink)

There is broad agreement that humans can be wronged independently of their incurring any harm, that is, when their welfare is not affected. Examples include unnoticed infringements of privacy, ridiculing unaware individuals, or disregarding individuals’ autonomous decision-making in their best interest. However, it is less clear whether the same is true of animals—that is, whether moral agents can wrong animals in situations that do not involve any harm to the animals concerned. In order to answer this question, I concentrate on (...) the illustrative case of treating animals in a demeaning yet harmless way that would be disrespectful if humans were concerned. I discuss whether such actions are permissible or unjustifiably discriminatory from a moral point of view. I conclude that moral agents cannot directly wrong animals without harming them and thus do not owe it to a particular animal to refrain from such actions. However, if the actions increase the likelihood that animal abuse will occur, this presents a strong indirect reason against performing them. Thus, the reasons for refraining from such actions are merely indirect rather than direct. (shrink)

While human vulnerability has been discussed for some time in the contemporary philosophy and bioethics literature, animal vulnerability has received less attention. In this article, I investigate whether the concept of vulnerability, as it is currently used in bioethics, can be meaningfully extended to animals. Furthermore, I discuss the ethical implications of ascribing vulnerability to animals and I show what vulnerability discourse can add to debates on animal ethics. In a first step, I analyse the conditions of vulnerability ascription. By (...) taking as my basis the definition of vulnerability presented by Martin, Tavaglione and Hurst, I demonstrate that some animals fulfil the conditions of vulnerability ascription. I explore the ethical implications of vulnerability ascriptions in three domains: livestock farming, animal experimentation, and animals living in the wild. I argue that many groups of animals currently qualify as particularly vulnerable and should be afforded special protection so that they receive what they are due. I conclude by outlining the differences between vulnerability and sentience ascriptions: while sentience is a sufficient reason to ascribe moral status to a being, vulnerability draws our attention to those who are more likely to be denied what they are due. (shrink)

In this chapter, it is argued that some animal shelters fulfill the conditions that make triage protocols necessary, namely, the operation with limited financial budgets, space, medical resources, and staff. It is suggested that requirements presented for triage in humans can be fruitfully applied to the context of animal shelters. The focus lies on the criteria of maximizing benefit, justice, medical criteria, life-span considerations, fair decision-making, patient will, re-evaluation of triage decisions and changes in the therapeutic goal, and burden of (...) triage and staff support. The establishment of triage protocols for shelters will make the decision-making process less arbitrary, fairer, and more transparent. Furthermore, it is argued that, in situations where disagreement persist among shelter staff, an external Ethics Board could be called in to help analyze and potentially resolve some of the remaining ethical issues. (shrink)

This paper offers a critical analysis of the strategic use of biomedical models of mental illness as a means of challenging stigma. Likening mental illnesses to physical illnesses reinforces notions that persons with mental illnesses are of a fundamentally “different kind,” entrenches misperceptions that they are inherently more violent, and promotes overreliance on diagnostic labeling and pharmaceutical treatments. I conclude that too much has been invested in the claim that the body is somehow morally neutral, and that advocates of this (...) approach oversimplify, misrepresent, and underestimate the personal and social costs of physical illness. (shrink)

The word stigma comes from ancient Greece, and was initially used in reference to signs or symbols physically cut into or burned onto the bodies of those deemed to be of an inferior status. It was a marking of one's tarnished and flawed character. Today, stigma is more often attached to one's social standing, personality traits, or psychological makeup. "People are no longer physically branded; instead they are societally labeled—as poor, as criminal, homosexual, mentally ill, and so on. These labels (...) influence public perceptions and behavior and lead to devaluation and denigration of those who are so labeled" (Wahl 1999, 11–12).The modern usage of the term stigma and contemporary focus on the concept as a topic of .. (shrink)

Human and animal interests are often in conflict. In many situations, however, it is unclear how to evaluate and weigh competing human and animal interests, as the satisfaction of the interests of one group often inevitably occurs at the expense of those of the other group. Human-animal conflicts of this kind give rise to ethical questions. If animals count morally for their own sake, then we must ask in which cases the satisfaction or frustration of the interests of humans and (...) animals in conflict situations is justified or unjustified from an ethical perspective. In this article, we argue that limited aggregation accounts represent a promising means for resolving interspecies conflicts. The reason for this is that they can appropriately consider the qualitative relevance of interests, their relative importance to each other, and the number of individuals affected. For our argument, we start from the premise that animals count morally for their own sake, albeit to a lesser extent than humans. That is, we accept the view that animals may be used, for example, as a source of food or in animal research. However, as we will show, many basic interests of animals are sufficiently similar to human interests and can thus be compared to them. Hence, they ought to be aggregated in cases of conflict with human interests. We illustrate our account and its practical implications with the real-world example of a human-animal conflict during the outbreak of a zoonotic disease among farmed animals. We conclude that, in many cases, animal interests ought to be given more importance than they currently receive, which includes distributing the burdens and risks of farming practices more fairly. (shrink)

Over 60% of all epidemics have a zoonotic origin, that is, they result from the transmission of infectious diseases from animals to humans. The spill-over of diseases often happens because humans exploit and use animals. In this article, I outline the four most common interfaces that favour the emergence and spread of zoonotic infectious diseases: wildlife hunting, small-scale farming, industrialised farming practices and live animal markets. I analyse which practices serve human food security – and thus have a non-trivial purpose (...) – and which predominantly have an economic purpose or serve as a symbol of wealth. I conclude that many practices that increase the risk for zoonotic infectious disease outbreaks actually do not contribute to the survival and food security of humans. I make two arguments in turn. First, I argue that in cases where the consumption and use of animal products does not contribute to the food security of a population, then this population has a duty to abstain from them, since they impose a grave and avoidable risk to themselves as well as to innocent third-parties. However, some communities must sometimes rely on practices that increase the risk of emergence and transmission of zoonotic infectious diseases, because they have no healthy alternatives. That is, the food security of the local population depends on the consumption and use of risky animal products. The second argument I advance is that, in such scenarios, the international community has a duty to provide the communities concerned with alternative food options, as well as economic and educational opportunities and technologies, in order to reduce the spill-over risk of infectious diseases. Given that abstention from such practices contributes signifcantly to the public good and benefits the international community, the latter has a corresponding duty to provide local communities which abandon such practices with alternatives. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 55-57, June 2011.

In this open access book, Angela K. Martin thoroughly addresses what animal vulnerability is, how and why it matters from a moral point of view, and how it compares to human vulnerability. Vulnerability has been an important topic in bioethical discourse over the last forty years. Its predominant focus was on human vulnerability but recently, animal vulnerability has become a topic of philosophical investigation as well. She carefully explores both human and animal vulnerability, bringing out both their similarities and (...) their differences, and she shows how vulnerability discourse can be made fruitful for animal ethics. This is an open access book. (shrink)

In this chapter, Angela Martin explores what moral agents owe to insects as a potential food source. Given that no scientific consensus has yet been reached on the question of whether or not insects are sentient, she investigates three assumptions on that head, along with their moral implications: i) the view that insects are definitely not sentient; ii) the view that there is uncertainty about insect sentience; and iii) the view that insects are definitely sentient. Martin argues that under (...) assumptions i) to iii), there are no strong reasons against eating insects. She thus concludes that it is morally permissible (although not morally obligatory) to use insects for human consumption. (shrink)

The American Journal of Bioethics, Volume 12, Issue 4, Page 12-13, April 2012.

Human encroachment on the habitats of wild animals and the dense living conditions of farmed animals increase spill-over risk of emerging infectious diseases from animals to humans (such as COVID-19). In this article, we defend two claims: First, we argue that in order to limit the risk of emerging infectious disease outbreaks in the future, a One Health approach is needed, which focuses on human, animal, and environmental health. Second, we claim that One Health should not solely be grounded in (...) collaborations between veterinary, medical, and environmental scientists, but should also involve more dialogue with animal and environmental ethicists. Such an interdisciplinary approach would result in epidemiology-driven measures that are ethically legitimate. (shrink)

Community-level legal and policy innovations or “experiments” can be important levers to improve health. States and localities are empowered through the 10th Amendment of the United States Constitution to use their police powers to protect the health and welfare of the public. Many legal and policy tools are available, including: the power to tax and spend; regulation; mandated education or disclosure of information, modifying the environment — whether built or natural ; and indirect regulation. These legal and policy interventions can (...) be targeted to specific needs at the community level and are often relatively low-cost, but high impact interventions. As every community is different, effective laws and policies will vary. This freedom allows states and localities to, as Justice Louis Brandeis argued, truly serve as “laboratories of democracy.”. (shrink)

Each decade since 1979, the Healthy People initiative establishes the national prevention agenda and provides the foundation for disease prevention and health promotion policies and programs. Law and policy have been included in Healthy People objectives from the start, but not integrated into the overall initiative as well as possible to potentially leverage change to meet Healthy People targets and goals. This article provides background on the Healthy People initiative and its use among various stakeholder groups, describes the work of (...) a project aiming to better integrate law and policy into this initiative, and discusses the development of Healthy People 2030 — the next iteration of health goals for the nation. Lessons from the preliminary stages of developing Healthy People by the HHS Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 and a Federal Interagency Workgroup will be included. Efforts by the Committee focused on the role of law and policy as determinants of health and valuable resources around health equity are also shared. Finally, the article discusses ways that law and policy can potentially be tools to help meet Healthy People targets and to attain national health goals. (shrink)

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged – that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, (...) care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care – thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to physical integrity, autonomy, freedom, social provision, impartial quality of government, social bases of self-respect or communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice. (shrink)

Human-wildlife interactions frequently lead to conflicts – about the fair use of natural resources, for example. Various principled accounts have been proposed to resolve such interspecies conflicts. However, the existing frameworks are often inadequate to the complexities of real-life scenarios. In particular, they frequently fail because they do not adequately take account of the qualitative importance of individual interests, their relative importance, and the number of individuals affected. This article presents a limited aggregation account designed to overcome these shortcomings and (...) thus to facilitate decision-making in real-world human-wildlife conflicts. (shrink)

Background Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness. -/- Methods We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods. (...) -/- Results 30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions. -/- Conclusions Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified. (shrink)

On behalf of the Robert Wood Johnson Foundation, I want to thank the Public Health Law Association and the American Society of Law, Medicine & Ethics for your leadership and the work that both you and the Centers for Disease Control and Prevention have done to grow this field. RWJF is pleased to co-sponsor this conference.The music that opened this talk is a clip from Warren Zevon, who encouraged us musically to “send lawyers, guns and money.” Zevon was a singer/songwriter (...) and social critic whose songs often took a jaundiced, somewhat cynical point of view. Even so, I know that I am probably stretching his meaning when I think of this song. I see “lawyers, guns and money” as his take on the major drivers of how change happens in a society. (shrink)

On behalf of the Robert Wood Johnson Foundation, I want to thank the Public Health Law Association and the American Society of Law, Medicine & Ethics for your leadership and the work that both you and the Centers for Disease Control and Prevention have done to grow this field. RWJF is pleased to co-sponsor this conference.The music that opened this talk is a clip from Warren Zevon, who encouraged us musically to “send lawyers, guns and money.” Zevon was a singer/songwriter (...) and social critic whose songs often took a jaundiced, somewhat cynical point of view. Even so, I know that I am probably stretching his meaning when I think of this song. I see “lawyers, guns and money” as his take on the major drivers of how change happens in a society. (shrink)

With postmodern societies placing a strong emphasis on making full use of one’s time, it is increasingly common to extol busy individuals as more achieving. In this context, although feeling a social expectation to be busy might imply that individuals are regarded as competent and desirable, its accompanying stressors may also detrimentally impact their mental health. Utilising data from a seven-day diary study, the current research examined the relationship between people’s daily perceived pressure to be busy and their daily emotional (...) wellbeing. Multilevel modelling revealed that daily social pressure to be busy was a significant predictor of daily negative affect, anxiety, and depressive symptoms at the within-person level. Of import, individuals’ trait emotional complexity acceptance moderated these relationships, with those lower on emotional complexity acceptance reporting significantly higher negative affect, anxiety, and depressive symptoms on days they felt greater social pressure to be busy. These effects were not observed among those higher on emotional complexity acceptance. Together, the current findings suggest that social pressure to feel busy is generally related to poorer daily emotional wellbeing, and that those with higher trait emotional complexity acceptance have an advantage of maintaining their emotional wellbeing in the face of such a social pressure. (shrink)

Decision-making is an integral part of business meetings in an organization. Research has suggested that a participant’s engagement in the decision-making process has direct relevance to his or her role in the team or organization. This study extends the investigation of communicative behavior in decision-making to a special meeting setting where all participants assume similar organizational roles and where there is no designated chair. In particular, it draws on conversation analytic methods and a recently developed framework of participant roles to (...) examine discursive strategies and discourse roles on a moment-by-moment basis in the process of consensus negotiation. Findings show that participants’ choices of discursive strategies and the display of discourse roles vary as the discussion proceeds. A limited range of discursive strategies and discourse roles are identified when the discussion fails to lead to consensus. Our analysis also suggests that certain discourse roles appear to have a greater impact on reaching consensus decisions. (shrink)

Individuals of lower socioeconomic status display increased attentiveness to others and greater prosocial behavior compared to individuals of higher SES. We situate these effects within Pepper & Nettle's contextually appropriate response framework of SES. We argue that increased prosocial behavior is a contextually adaptive response for lower-SES individuals that serves to increase control over their more threatening social environments.

What is it to be morally responsible for something? Recent philosophical work reveals considerable disagreement on the question. Indeed, some theorists claim to distinguish several varieties of moral responsibility, with different conditions that must be satisfied if one is to bear responsibility of one or another of these kinds. -/- Debate on this point turns partly on disagreement about the kinds of responses made appropriate when one is blameworthy or praiseworthy. It is generally agreed that these include "reactive attitudes" such (...) as resentment and gratitude, but theorists disagree about the nature of these attitudes. They dispute the connections between moral responsibility, desert, and the justification of punishment as well. -/- Many theorists take it that, whatever the appropriate responses are, they are responses to an agent's "quality of will," but there is no consensus on what this comes to. Are the agent's beliefs about the moral status of her behavior what matter, or is it what she cares about, or what she judges important? -/- This volume presents twelve original essays from participants in these debates. The contributors include prominent established figures as well as influential younger philosophers. A substantive introduction by the editors surveys recent debates and situates the contributions within it. (shrink)

Recent ideological positioning on the world stage has born a startling resemblance to a form of positioning within nursing theory – that of taking complex ideas, reducing them to a simplistic binary form, and uncritically adopting one half of that form. In some cases, this adoption of a binary position has led to a passionately held form of ‘othering’ that prohibits a healthy and critical engagement with ideas. As alluring as settling for the binary form may be – we argue (...) for holding binaries in tension as a catalyst for stimulating dialogue – reasoning and exploration of new ways of wrestling with the social and moral complexity of nursing. (shrink)

Apoptosis is now widely recognized as a common form of cell death and represents a mechanism of cell clearance in many physiological situations where deletion of cells is required. Peptide growth factors, initially characterised as stimulators of cell proliferation, have now been shown to inhibit death in many cell types. Deprivation of growth factors leads to the induction of apoptosis, i.e. condensation of chromatin and degradation in oligonucleosomesized fragments, formation of plasma and nuclear membrane blebs and cell fragmentation into apoptotic (...) bodies which can be taken up by neighbouring cells. Here we discuss the mechanism(;s) by which growth factors may inhibit apoptosis. (shrink)

Stereotypical images of Appalachians abound in entertainment media. When CBS proposed transplanting a poor Appalachian family to California for a reality television show titled The Real Beverly Hillbillies, Appalachians and advocacy groups were outraged. This article explores ethical issues raised by stereotypical portrayals of Appalachians and potential harm from those stereotypes as well as the reality from which they emerged. Using the theories of Levinas, Kant, and Aristotle, we then examine the ethics of stereotyping Appalachians and other subcultures in entertainment (...) media. Finally, we propose a decision tree to aid producers of entertainment media in creating ethical portrayals of fictional characters and real people. (shrink)

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). (...) No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems. (shrink)

BackgroundBiobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people’s (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures.MethodsWe designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated (...) via the Young Person’s Advisory Group North England (YPAGne) and participating CYP’s secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer.ResultsOne hundred two CYP completed the survey. Most were between 16–18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73).Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: ‘altruism’, ‘potential benefits outweigh individual risk’, 'frugality', and ‘(in)convenience’.Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: ‘altruism’, ‘body integrity’ and ‘sample frugality’. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80).ConclusionProspective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Over the past three decades, more and more students are expressing a desire to attend college, yet for many members of disenfranchised groups, this goal is often not attained. While many factors contribute to these disparities, research has shown that students begin adjusting their expectations (what they think they can achieve) for the future in relation to their idealised aspirations (what they would like to achieve). The current study explores this gap among 207 eighth grade students from two urban middle (...) schools. Using the School Attitude Assessment Survey-Revised, three factors were found to predict expectations which matched student aspirations. These factors were academic motivation and self-regulating behaviours, academic self-perception and attitudes towards teachers. Implications for educational interventions and school reform are discussed. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care (...) had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size, in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population. (shrink)