Trauma and negative underlying assumptions in feelings of shame: An exploratory study (original) (raw)
Related papers
2015
The dominant theory of PTSD and, subsequently, current gold standard PTSD treatments are based on a model of dysregulated fear. However, a growing body of research suggests that other emotional responses, like shame, are important contributors to PTSD symptom maintenance. The current study sought to forward the trauma literature by using an experimental paradigm to test if trauma survivors, especially those distressed by an interpersonal (vs. non-interpersonal) trauma, experience shame in response to day-today experiences of fear. This experimental study used a pre-post between group design in which participants (N = 178) were randomized to receive either a fear or neutral emotion prime with postmanipulation state shame serving as the outcome measure. As predicted, the fear emotion prime interacted with PTSD symptom level to significantly predict postmanipulation state shame. Among participants who reported an interpersonal index trauma and received the fear emotion prime, those with high PTSD symptom levels reported significantly more postmanipulation shame than those with low symptom levels. Interestingly, among participants who reported a non-interpersonal index and received the fear emotion prime, those with high PTSD symptom levels reported significantly less postmanipulation shame than those with low symptom levels. Exploratory analyses did not implicate emotion regulation skill deficits in this relationship. This study contributes to the literature by demonstrating the relationship of shame to daily experiences of fear in the maintenance of PTSD symptoms, but further exploration into the dynamics of fear, shame, and PTSD represents a priority for the field of traumatology. This is, in part, because shame may impede the treatment and emotional processing of traumas in current gold standard exposure-based treatments. ii Dedication I dedicate this project to the female and male veterans I have had the privilege to work with, particularly in the Women's Trauma and STARR Programs at the Albuquerque VA. They are the reason I transitioned into psychology and remain passionate as I stand at the crest of my journey into life as a psychologist. iii Acknowledgments and Gratitude Goodbye 30's, Hello PhD! If education were a sport, a PhD would be an ultramarathon. In my case, one that took the bulk of my 30's. Obtaining a PhD is a test of endurance and tenacity. The challenge is to keep moving forward when your body and brain ache and are screaming for rest, until you get the endorphin rush at the finish line. Like any successful überathlete (or über-nerd, in this case), I could not have reached the finish line without the help and support of many others along the way. First and foremost, my advisor Tony Papa was essential in challenging me and keeping me on course. Like many who complete a PhD, I am a different person now than when I began the program. I credit much of this to my experiences with Tony, and I am proud of the growth and change that has occurred under his guidance. He played a vital role in shaping me into a clinical scientist. Thank you, Tony! I also appreciate the mentorship and support of other faculty. In particular, I appreciate Bill Follette, who was consistent with his support and sound advice during some of the harder moments. Additionally, I appreciate that he was always available for a quick question, particularly when we night owls worked at MSS. I remember fondly the early grad school years when we shared a wall and had dueling stereos. I also appreciate fellow night owl Markus Kemmelmeier, who let me share my excitement and professional successes, ask stats questions, and just generally pick his brain. Victoria Follette also served as a mentor, particularly as I first began my journey in iv Reno. The mentorship and support of the following individuals was also important to me during my journey: Amy Street, Jillian Shipherd, Dan and Lynda King, and Dawne Vogt. Thank you to each of you! Fundamental to my professional growth was the clinical training I received not only from Tony, but also from Steven Hayes, as a member of the ACT treatment team, and Victoria Follette, as a member of the trauma treatment team. I also appreciate the clinical supervision I received from Cindy Marczynski at the UNR Counseling Center, Do Trauma Survivors Experience Shame after Fear? An Experimental Examination of a Basic Assumption in the Trauma Literature While the experience of overwhelming fear is linked to the maintenance of posttraumatic stress disorder (PTSD), recent research suggests that other emotions, particularly shame, may also play a role in the maintenance of PTSD (Hathaway, Boals, & Banks, 2009; Leskela, Dieperink, & Thuras, 2002). This research is consistent with a basic assumption in the trauma literature that trauma survivors can experience shame around a number of trauma-related factors, including feeling ashamed of their dysregulated fear responses, which perpetuates PTSD avoidance and hyperarousal symptoms (e.g., Frankl, 1962; Herman, 1992). The primary goal of the current study is to experimentally test the assumption that trauma survivors are ashamed of their dysregulated fear responses by assessing if trauma survivors with high levels of PTSD symptoms experience shame after experiencing experimentally induced fear. Emotional Responses to Trauma The dominant theory of PTSD hypothesizes that PTSD is a result of dysregulated fear responding in reaction to exposure to events involving death, the threat of death, or physical harm. In this theory, the experience of the trauma is hypothesized to cause hypersensitivity to trauma-related cues and hyperactivation of fear-related memories (Foa & Kozak, 1986; Keane, Fairbank, Caddell, Zimering, & Bender, 1985). Over time these responses generalize to other stimuli, leading to hypersensitivity to a broad range of threat cues, physiological hyperarousal, and avoidance of stimuli associated with the trauma, which negates the opportunity for new learning (Foa & Riggs, 1993). Thus, fear responding is hypothesized to both cause and maintain PTSD (Foa & Rothbaum, 1998). A growing body of research, however, suggests that other emotional responses to trauma exposure, like shame, are important contributors to PTSD symptom profiles (Friedman, Resick,
The Trauma Related Shame Inventory: Measuring Trauma-Related Shame Among Patients with PTSD
Journal of Psychopathology and Behavioral Assessment, 2014
This article proposes a new measurement instrument of trauma-related shame. The purpose of this study is to investigate the psychometric properties of the scores derived from the Trauma Related Shame Inventory (TRSI) by means of generalizability theory (G-theory). The psychometric analyses are based on a sample of 50 patients in treatment for Posttraumatic Stress Disorder (PTSD). The results provided supporting construct validity evidence for the interpretation of TRSI as a homogeneous construct. The 24-item version of internal and external referenced shame yielded generalizability and dependability coefficients of .874 and .868, respectively. The distinction between shame and guilt was supported by a high generalizability coefficient of .812 for the difference scores between TRSI and guilt cognition scale. Further validity evidence was provided by a positive relationship between TRSI and a) self-judgment subscale in Self-Compassion Scale (SCS; Neff Self and Identity 2:(3), 223-250, 2003) and b) Beck Depression Inventory (Beck Steer and Brown 1996a) when controlled for guilt. The results of the present study provided promising support for using the 24-item version of TRSI in both clinical research and practice.
Comparing Shame in Clinical and Nonclinical Populations: Preliminary Findings
Psychological Trauma: Theory, Research, Practice, and Policy, 2016
To conduct a preliminary study comparing different trauma and clinical populations on types of shame coping style and levels of state shame and guilt. Methods: A mixed independent groups/correlational design was employed. Participants were recruited by convenience sampling of three clinical populations, namely Complex Trauma (n = 65), DID (n = 20), General Mental Health (n = 41), and a control group of Healthy Volunteers (n = 125). All participants were given 1) the Compass of Shame Scale, which measures the four common shame coping behaviours/styles of "withdrawal", "attack self", "attack other" and "avoidance"; and 2) the State Shame and Guilt Scale, which assesses state shame, guilt and pride. Results: The DID group exhibited significantly higher levels "attack self", "withdrawal", and "avoidance" relative to the other groups. The Complex Trauma and General Mental Health groups did not differ on any shame variable. All three clinical groups had significantly greater levels of the "withdrawal" coping style and significantly impaired shame/guilt/pride relative to the healthy volunteers. "Attack self" emerged as a significant predictor of increased state shame in the Complex Trauma, General Mental Health, and Healthy Volunteer groups, whereas "withdrawal" was the sole predictor of state shame in the DID group. Conclusions: DID emerged as having a different profile of shame processes compared to the other clinical groups, whereas the Complex Trauma and General Mental Health groups had comparable shame levels and variable relationships. These differential profiles of shame coping and state shame are discussed with reference to assessment and treatment.
More or less than human : the influence of shame on psychological distress
2011
Background Shame is a powerful emotion involved in a wide variety of phenomena including psychopathology. The propensity to react with shame to situations of transgression is formed early in life, but the processes by which elevated shame-proneness causes higher levels of psychological distress and functional impairment in some people rather than in others is as yet poorly understood. Objectives The main objective of this thesis was to further elucidate these processes by investigating the implications for shame states, guilt, general coping strategies, attachment styles, and shame-related coping in this context, as well as to evaluate an assessment method for shameproneness. Methods The self-report questionnaires Test of Self-Conscious Affect (TOSCA), Compass of Shame Scale (CoSS-5), Harvard Trauma Questionnaire (HTQ), Ways of Coping Questionnaire (WCQ), Attachment Style Questionnaire (ASQ), Symptom Checklist 90 (SCL-90), and an interview measure for event-related shame and guilt were used for assessment in adult normative, healthy-only, crime victim, and patient samples (n=25-361). A combination of uni-and bivariate approaches and multivariate soft and hard modeling approaches were used for statistical analysis. Results Paper I showed that the TOSCA could be used as a reliable measure for shame-proneness. Paper II showed that guilt was unrelated to post-victimization distress. Elevated shame-proneness was related to higher levels of post-victimization distress. This effect was partially mediated by event-related shame. Paper III showed that in CFS patients, higher levels of shame-proneness, escape-avoidance, and accepting responsibility coping contributed to elevated levels of psychological distress. Seeking support, positive reappraisal coping, and proneness to detachment contributed in the opposite direction. These relationships were weaker in the comparison groups. Paper IV showed that shameproneness was associated with secure attachment style in a negative direction. Higher levels of secure attachment style contributed to lower levels of psychological distress, whereas shame-proneness, insecure attachment styles and withdrawal, attack self, and attack other shame coping strategies contributed in the opposite direction. There were mean differences between women and men regarding most of the variables, but the relationships between variables did not differ between men and women. Conclusions The association between shame-proneness and psychological distress seem to involve a complex balancing act between motives toward preserving close relationships and protecting a relatively positive sense of self. If others are perceived as trustworthy and compassionate and are utilized for support in times of need, the effects of shameproneness may be less debilitating, whereas if others are perceived as distancing or disapproving, and life stress and social transgressions are managed by escape strategies, social withdrawal, self-blame or by transferring blame onto others, the distress effects become more severe. The inner psychodynamics of these functional patterns seem to be rather similar in women and men.
Evaluating Shame; A Comparative Look at Sexual and Physical Abuse
2018
Shame is a potential adverse effect which can occur following a traumatic experience, such as being a survivor of sexual and physical abuse. Demonstrating the prevalence and levels of shame resulting from sexual and physical abuse can be of interest to those professionals working with survivors of trauma. The purpose of this study was to separately evaluate the prevalence of shame within sexual and physical abuse. This study tested the following hypotheses: hypothesis 1, shame will be more prevalent and demonstrate higher levels in sexual abuse survivors than in physical abuse survivors and hypothesis 2, survivors of both sexual and physical abuse will demonstrate higher prevalence and higher levels of shame than those who only experienced sexual or physical abuse. Participants completed a questionnaire that assessed any history of sexual and physical abuse and a questionnaire that assessed prevalence and levels of shame. Data was analyzed by running a Univariate ANOVA through SPSS....
Although current theories emphasize the role of fear in the etiology of posttraumatic stress disorder (PTSD), recent research suggests that shame may also play a role in the development of PTSD symptoms. This study tested if the experience of peritraumatic shame mediates the relationship between 2 conceptually linked PTSD risk factors (i.e., experiencing an interpersonal vs. impersonal reference trauma and number of previous potentially traumatic events [PTEs]) and current levels of PTSD symptoms. Path analysis was used to test a series of nested models assessing the indirect effects of these risk factors on PTSD via peritraumatic shame, while controlling for the potential indirect effect of these risk factors via peritraumatic fear. The final structural model found that the number of previous PTEs had a direct effect on current levels of PTSD, no association with fear, and a marginally significant indirect effect on PTSD symptoms via shame. The effects of reference trauma type on PTSD symptom levels was mediated by levels of both peritraumatic shame and fear, suggesting that shame, in addition to fear, may contribute to the development of PTSD symptoms in survivors of interpersonal traumas. The results underscore the need for further, more fine-grained research in this area and contribute to the nascent literature suggesting that other emotions, beyond fear, are important to our theoretical understanding of PTSD.
Expectancy-value relationships of shame reactions and shame resiliency
Journal of Educational Psychology, 2001
This study investigated expectancy-value predictors for experiencing shame from test feedback and the possible consequences of these shame reactions. Those who experienced shame included a broader range of students than previously thought, including some high achievers who had high self-perceptions of competence. Main expectancy-value predictors of shame were lower self-efficacy ratings and higher intrinsic as well as extrinsic goal orientations. Also, although having important future goals for which the course had instrumental value was not predictive of inducing shame, such goals appeared to exert influence on whether a person would be resilient from a shame reaction with increased motivation, motivated behavior, and higher academic exam scores. If students believe they have the capabilities and are committed to a clear future goal for which the course grade or course information is relevant, then a shame reaction may be a warning signal that current actions are not in line with future goal attainment. For these students, a personal evaluation of goal commitment may result in increased motivated behavior.
Shame as a social phenomenon: A critical analysis of the concept of dispositional shame
Psychology and Psychotherapy: Theory, Research and Practice, 2004
An increased clinical interest in shame has been reflected in the growing number of research studies in this area. However, clinically-orientated empirical investigation has mostly been restricted to the investigation of individual differences in dispositional shame. This paper reviews recent work on dispositional shame but then argues that the primacy of this construct has been problematic in a number of ways. Most importantly, the notion of shame as a context-free intrapsychic variable has distracted clinical researchers from investigating the management and repair of experiences of shame and shameful identities, and has made the social constitution of shame less visible. Several suggestions are made for alternative ways in which susceptibility to shame could be conceptualised, which consider how shame might arise in certain contexts and as a product of particular social encounters. For example, persistent difficulties with shame may relate to the salience of stigmatising discourses within a particular social context, the roles or subject positions available to an individual, the establishment of a repertoire of context-relevant shame avoidance strategies and the personal meaning of shamefulness. 3 Dispositional shame The concepts of internalised shame and shame-proneness Andrews (1998) suggests that 'high-shame' people have been conceptualised in three different ways i) shame-prone or more likely than other people to feel shame in commonly shame-eliciting situations, ii) frequently or continuously experiencing generalised or global shame, sometimes described as internalised shame or iii) particularly ashamed of some aspect of their behaviour or personal characteristics. Most studies have focused on the first two of these, conceptualising shame as a trait or disposition. Therefore less attention has been paid to specific shame about something, for example related to some kind of stigma. Instead, chronic shame is approached as if it is a property of the individual, existing independently of the contexts in which it might be manifest. Kaufman (1989) has been instrumental in developing the idea of internalised shame. Drawing on Tomkins' (1963) affect theory, Kaufman describes internalised shame as a 'shamebound' personality or 'shame-based identity'. He argues that internal representations of the expression of affects, interpersonal needs, drives and competencies become linked with representations of shame, through repeated experiences of shaming, particularly in childhood. When this happens it becomes impossible to experience these affects, needs, drives and competencies without experiencing shame and the child develops a generalised sense of being unworthy and inferior which persists into adulthood. Therefore, according to Kaufman, someone who experiences a significant degree of internalised shame not only experiences shame frequently in relation to specific situations, but tends to engage in generalised negative self evaluations and carries a sense of personal inadequacy. Shame-proneness appears to be a concept which is less clearly defined than internalised shame. The former term is often employed more loosely and has been used to mean both the readiness with which someone might experience shame and hence the frequency of the emotion, and also the intensity with which the emotion is usually experienced (Gilbert, 1998b). It has also