Research question 2

The study aimed to explore what factors relate to moral reasoning in both groups separately. The power equation suggested a sample size of thirty individuals in each group to explore these relationships. Data were available for thirty-four participants in the healthy comparison group and twenty participants in the TBI group. The proposed sample size was therefore not reached in the TBI group. Given the exploratory nature of these research

95 questions and the power issues, these findings should be interpreted with caution and treated as preliminary.

4.2.2.1 Hypothesis 2, 3 and 4 - Moral reasoning and Executive Functions Based on previous studies and taking into account theory, it was hypothesised that moral reasoning would be related to executive function difficulties and that greater executive function difficulties and lower inhibition and cognitive flexibility would be associated with lower moral reasoning scores.

A significant negative correlation was revealed between executive function difficulties and moral reasoning in the healthy comparison group and this was a medium effect size. This suggested executive function difficulties explained some of the variance in moral reasoning and that fewer difficulties in executive function were associated with higher moral reasoning which supported the hypothesis.

It has been suggested that the DEX questionnaire, is better understood by three individual constructs; Executive cognition, Behavioural-emotional self-regulation and Metacognition (Simblett & Bateman, 2011). The study revealed a significant negative correlation in the healthy comparison group between moral reasoning and the Executive cognition domain. This finding may indicate, therefore, that the Executive cognition domain may be the particular aspect of executive functioning important to moral reasoning. The Executive cognition domain captures controlled processes such as planning, monitoring, switching and directing automatic function.

This was consistent with findings from the comparisons between moral reasoning and other measures of executive function. Cognitive flexibility and Inhibitory control are

processes within the Executive cognition domain. Significant positive correlations were revealed between moral reasoning and cognitive flexibility in both groups with medium and

96 medium to large effect sizes reported in the healthy comparison and TBI group respectively. This suggested that cognitive flexibility accounted for some of the variance in moral

reasoning and indicated individuals with higher cognitive flexibility had higher moral reasoning. A significant positive correlation of medium effect size was also revealed

between moral reasoning and inhibition in the healthy comparison group. This indicated that some of the variance in moral reasoning was shared by inhibition. In addition, it supported the hypothesis that individuals with higher levels of inhibitory control would have higher moral reasoning. Significant correlations were not reported in the TBI group, between inhibition and moral reasoning, and this may be because many participants underperformed on this subtest and there was a lack of variability in the dataset.

The findings from the healthy comparison group supported the hypotheses and were supportive of studies which have shown correlations between moral reasoning and cognition (Cottone et al., 2007; Lee, 1971; Tomilinson-Kearsey & Kearsey, 1974) and specific

correlations between moral reasoning and inhibition (Cottone et al., 2007). It was also consistent with the case studies which have demonstrated executive function deficits alongside moral reasoning deficits (Gratton & Eslinger, 1992; Price et al., 1990) and in contrast, no deficits in either domain following adult brain injury (Saver & Damasio, 1991). Furthermore, it was in line with others studies that have shown co-existing cognitive

flexibility deficits and moral reasoning deficits in brain injury samples (Price et al., 1990; Anderson et al., 1999). The current study reported larger correlations between these domains and moral reasoning in the healthy comparison group than previous studies but could not account for all of the variance in moral reasoning.

Significant correlations between executive functioning domains and moral reasoning were not reported in the TBI group, apart from cognitive flexibility. It is likely that given the small sample, the study did not have enough power to detect significant relationships. The

97 study did reveal coexisting differences, however, between the groups on moral reasoning and cognitive flexibility, inhibition and executive-cognitive domain. The healthy comparison group performed significantly better on all of these domains. This may infer that the aspects of executive function captured by this study may contribute to moral reasoning, thereby supporting the link between moral and cognitive development (see theoretical implications section), and encourage future research.

4.2.2.2 Hypothesis 5 - Moral reasoning and Empathy

The study also aimed to explore the relationship between moral reasoning and empathy, as measured by the EQ, and predicted a positive correlation between empathy and moral reasoning.

The hypothesis was supported in the healthy comparison group, where a significant positive correlation of a medium effect size was revealed between empathy and moral reasoning. This suggested that empathy may explain some of the variance in moral reasoning. There was no significant correlation between these variables in the TBI group.

The finding in the healthy comparison group was consistent with previous research. This was in line with the finding of co-existing moral reasoning and empathy deficits in brain injury studies (Graffton & Eslinger, 1992; Price et al., 1990). It was also consistent with a similar finding in individuals with intellectual disabilities (Langdon et al., 2011). The non significant correlation in the TBI group may be explained by the smaller sample size. This study did reveal significantly higher levels of moral reasoning and empathy in the healthy comparison group compared to the TBI group and this may suggest they are related. Indeed a larger study has revealed a significant positive correlation between empathy and moral

98 4.2.2.3 Hypothesis 6 – Moral reasoning and Emotion-based decision making

Based on theoretical background suggestive of the role of intuition and emotion-based decision making in moral reasoning (Damasio, 1994; Haidt, 2001), a final hypothesis was made that there would be a positive correlation between moral reasoning and emotion-based decision making. These did not quite meet significance. In addition, there was not a

significant difference between the groups in their performance on this task across the 100 deck selections or across the five blocks. Furthermore, there was no learning curve over the five blocks for either group.

In addition no significant difference was reported between participants on the Behavioural-emotional self-regulation sub domain of the DEX which may tap into a similar function. This is not consistent with previous research that has indicated individuals who have sustained a brain injury have difficulties with emotional processing. Anderson et al. (1999) demonstrated that individuals with a brain injury did not demonstrate anticipatory skin conductance responses (SCRs) in a similar gambling task and inferred this represented

difficulties in emotion based decision making. Furthermore, Adlam, Turnbull, Yeates and Gracey (submitted; personal communication) found that adults with TBI showed poorer performance on an emotion-based decision-making task (the Bangor Gambling Task; BGT, Bowman & Turnbull, 2004), as reflected by a delay in learning to select the profitable stimuli.