Psychological Safety: Bodily and Psychological Determinants in Clinical Settings

Dear Colleagues,

Psychological safety is increasingly recognized as a core condition for effective clinical care, and in clinical psychology and psychotherapy, it is often conceptualized as the experiential foundation that allows patients to approach—rather than avoid—emotionally salient material. A robust clinical literature links perceived safety to key therapeutic processes, including disclosure, mentalization/reflective functioning, emotion regulation, and the development of a stable therapeutic alliance, especially in populations with trauma histories, attachment insecurity, shame, or dissociative tendencies. When safety is compromised, patients may shift toward defensive strategies (withdrawal, compliance without engagement, distrust, or hypervigilance), which can undermine treatment adherence and mislead clinical assessment. At the same time, psychotherapy research increasingly intersects with embodied and neurobiological perspectives, highlighting how autonomic arousal, interoceptive accuracy, pain, sleep disruption, and chronic stress physiology can constrain regulatory capacity and interpersonal openness, thereby shaping the felt sense of safety in-session and across care pathways. Beyond the dyad, clinician variables (burnout, secondary traumatic stress, emotional regulation, and trust) influence containment, decision-making, and rupture–repair dynamics. Yet these determinants are still too often studied independently, limiting integrative, mechanistic models and the translation of findings into scalable, clinically actionable interventions across settings.

This Special Issue invites original research, reviews, and clinically oriented contributions that examine how psychological safety is established, threatened, and restored in medical and mental health contexts. We particularly welcome submissions addressing psychological determinants (e.g., trauma-related processes, attachment, emotion regulation, dissociation, trust, and perceived control) and bodily determinants (e.g., autonomic arousal, interoception, pain, sleep, and stress physiology), as well as their interaction in shaping communication, treatment adherence, decision-making, therapeutic alliance, and clinical outcomes. Contributions focusing on high-impact settings, such as primary care, emergency medicine, oncology, intensive care, rehabilitation, chronic illness management, and psychotherapy, that may be rooted within the polyvagal theory framework are encouraged. We also invite studies on clinician and team factors, including burnout and emotional regulation and their implications for patient safety and quality of care. Methodological papers integrating psychometric, observational, and psychophysiological approaches are considered. This Special Issue aims to foster a translational and multidisciplinary dialogue, generating clinically feasible evidence to improve patient-centered care and promote safer, more responsive clinical systems.

EJIHPE accepts original articles in quantitative or qualitative research, systematic reviews and meta-analyses (following the PRISMA 2020 statement: https://www.prisma-statement.org/prisma-2020).

You may choose our Joint Special Issue in Journal of Clinical Medicine.

Dr. Andrea Poli
Prof. Dr. Stephen W. Porges
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. European Journal of Investigation in Health, Psychology and Education is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• psychological safety
• fear
• psychological trauma
• shame
• dissociation
• neuroception
• trust
• polyvagal theory