Maladaptive Shame Research Articles

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Emotion-Focused Therapy (EFT) is rooted in the humanistic psychotherapy tradition. A core assumption in EFT is that our life experiences are organised in emotion schemes. For instance, problematic childhood experiences that are not processed can form what are typically referred to as maladaptive emotion schemes, continuing to influence us later in in life. The goal in EFT is to activate, process and change maladaptive emotion schemes. Such a change process typically occurs through an emotional sequence, moving from secondary emotions (e.g., depressive hopelessness) through primary maladaptive emotions (e.g., maladaptive shame) to adaptive emotions (e.g., assertive anger). This sequence is termed changing emotion with emotion, and builds on substantial process research. In this article, we will describe from an EFT perspective how psychological illness arises and which conditions are necessary for it to change. We will give an account of the empirical foundation for the model and illustrate some specific interventions using the case of ‘Nadine’. Keywords: Emotion-Focused Therapy, transdiagnostic therapy, humanistic therapy, experiential therapy

From childhood trauma to hyperarousal in adults: The mediating effect of maladaptive shame coping and insomnia.

A new line of insomnia research focuses on the developmental trajectories from early live stress to insomnia in adulthood. Adverse childhood experiences (ACE's) might create a vulnerability for later maladaptive coping with distress, as seen in chronic hyperarousal or insomnia. In an functional magnetic resonance imaging (fMRI) study, failure to dissociate the neurobiological components of shame from autobiographical shameful memories in insomnia was reflected by continued activation of the dorsal anterior cingulate cortex (dACC), which may be a result of maladaptive coping in the wake of ACE's. Following up on that study, the current pilot study explores the relation between ACE's, shame coping-styles, adult insomnia, hyperarousal, and neurobiology of autobiographical memory. We used existing data (N = 57) from individuals with insomnia (N = 27) and controls (N = 30), and asked these participants to complete the childhood trauma questionnaire (CTQ). Two structural equation models were used to test the hypotheses that shame-coping styles and insomnia symptom severity mediate the association between ACE's and (1) self-rated hyperarousal symptoms and (2) dACC activation to recall of autobiographical memories. For the association between ACE's and hyperarousal, there was a significant mediation of shame-coping style (p < 0.05). This model also indicated worse shame coping with more ACE's (p < 0.05) and worse insomnia symptoms with more ACES's (p < 0.05), but no association between shame coping and insomnia symptoms (p = 0.154). In contrast, dACC activation to recall of autobiographical memories could only be explained by its direct association with ACE's (p < 0.05), albeit that in this model more ACE's were also associated with worse insomnia symptoms. These findings could have an implication for the approach of treatment for insomnia. It could be focused more on trauma and emotional processing instead of conventional sleep interventions. Future studies are recommended to investigate the relationship mechanism between childhood trauma and insomnia, with additional factors of attachment styles, personality, and temperament.

Shame in Response to Affective Expression and Its Relation to Social Anhedonia and Schizotypy Traits.

Schizotypy is marked by negative symptoms including blunted affect, social isolation, and social anhedonia. Contemporary personality theory suggests that maladaptive shame regulation may disrupt interpersonal function across personality disorders. We hypothesized that "affect shame"-a conditioned response of shame evoked by openly expressing emotions would co-occur with interpersonal deficits in schizotypy. As hypothesized, affect shame was associated with interpersonal deficits (r = 0.17, p < 0.001), physical anhedonia (r = 0.13, p = 0.001), and social anhedonia (r = 0.17, p = 0.001). The observed findings were upheld in analyses controlling for demographic characteristics, depression symptom severity, and neuroticism and were maintained consistently across sensitivity analyses. Findings suggest that shame related to emotional expression is related to interpersonal deficits in schizotypy and have implications for our understanding of the etiology and treatment of this disorder.

Emotional processing in attachment-based family therapy for suicidal adolescents

Objective: This study examined proposed sequential pathways through which suicidal adolescents are thought to shift from secondary global distress and rejecting anger to primary adaptive hurt, grief and assertive anger in the context of attachment-based family therapy (ABFT). Method: Participants were 39 suicidal adolescents who had received 16 weeks of ABFT as part of a randomized clinical trial, and who had been assigned to one of three outcome groups (i.e., good responders, slow responders and non-responders). Adolescents’ in-session emotions were observationally coded using the Classification of Affective-Meaning States. Results: Across outcome groups, adolescents evidenced shifts from global distress to maladaptive shame, from maladaptive rejecting anger to adaptive assertive anger, and from adaptive assertive anger to adaptive grief/hurt. Adolescents who did not respond to treatment evidenced higher rates of maladaptive global distress. Conclusions: Findings are discussed in the context of ABFT and sequential emotional processing theories.

A clinical interpretation of shame regulation in maladaptive perfectionism

Maladaptive perfectionism, a transdiagnostic personality trait, is associated with depression. Shame has been associated with depressive disorders and to negatively impact its treatment. Interestingly, maladaptive perfectionism and maladaptive shame regulation strategies might be both expressions of an internalizing personality style. We applied forward and backward stepwise linear regression modeling to explain maladaptive perfectionism by association of shame coping styles in a highly powered cross-sectional study of 1436 participants. Maladaptive perfectionism was shown to have significant positive associations with the two internalizing coping styles attacking the self, and withdrawing, and negative associations with adaptive coping. Furthermore, a significant positive interaction effect was shown for the two internalizing coping styles.Our research shows that participants who adopt maladaptive perfectionism, internalize the pain of shame. Clinically, this is especially relevant during treatment: the patterns of maladaptive perfectionism must come into the open, the client feels exposed and, consistent with his shame regulation style, shame grows. Our research might account for the negative responsiveness of perfectionism to brief therapies for depression: there may not be enough focus on and time for working through the evoked shame.

Shame Proneness, Shame Coping, and Functions of Nonsuicidal Self-Injury (NSSI) Among Emerging Adults

Shame proneness (i.e., experiencing shame in a trait-like manner) and internalizing shame coping styles (e.g., withdrawing/attacking one’s self when feeling shame) predict distress, psychopathology, and nonsuicidal self-injury (NSSI) among emerging adults. Parental invalidation is instrumental in the development of both maladaptive shame and NSSI. In this study, we proposed that shame proneness and internalized shame coping would link perceived parental invalidation and psychological distress to NSSI functions among emerging adults. A sample of 384 Australian emerging adults with a history of NSSI (M age = 20.7 years, SD = 2.25; 81.3% female, 61.2% Caucasian) completed online self-reports assessing the relevant constructs. Hypothesized indirect effects through shame proneness and internalized shame coping were supported when participants reported using NSSI for intrapersonal (e.g., self-punishment), but not interpersonal (e.g., signaling autonomy), functions. Findings advance theories on why some young pe...

Emotion-focused therapy for social anxiety (EFT-SA)

ABSTRACTSocial anxiety (SA) is a common, disabling difficulty characterized by persistent fear of other people. After a brief clinical description, we present an emotion-focused therapy (EFT) theory of SA: We describe its developmental origins in experiences of social degradation, which result in primary emotional processes organized around a core sense of shame-ridden defective self. These give rise to secondary reactive anxiety that others will see the person’s defectiveness, organized around a coach/critic/guarding aspect of self that, in the process of trying to keep the person safe from exposure, inadvertently generates the emotional dysregulation characteristic of SA. Following this, we present a model and case example for working with SA via an emotional deepening process that begins with accessing secondary reactive anxiety of others in particular situations and then works backwards to accessing and activating primary maladaptive shame so that this emotion scheme can be restructured within a secure, accepting therapy relationship. We conclude with a brief summary of evidence for EFT-SA and some final thoughts about how working with this client population has changed our EFT practice.

Dealing with shame – the ‘Psychopathic Way’: Preliminary investigation for a new developmental framework of psychopathic traits

Although individuals with psychopathic traits are deemed as immune to emotional experiences, in recent year, some authors have advanced the hypothesis that a pervasive pattern of emotion dysregulation may characterize the developmental trajectories leading to a psychopathic personality structure. Shame has been proposed as crucial emotions to understand psychopathy. It has been argued that people, who often experience shame feelings during their childhood, may develop adaptive strategies to cope with them, which lead to maladaptive strategies to regulate shame feelings in adulthood. These maladaptive strategies may explain the increased likelihood for these individuals to violence when feeling ashamed. Whether these mechanisms may also explain the presence of high psychopathic traits remains a clinically valid theoretical hypothesis, which lacks empirical support.ObjectiveTo investigate whether maladaptive strategies to cope with shame feelings were associated with psychopathic traits.AimsTo examine the association between four maladaptive shame coping were positively related with psychopathic traits.MethodsA sample of male offenders incarcerated in Italian jails completed the Self-Report Psychopathy Scale (Paulhus et al., 2015) and the Compass of Shame Scale (Elison et al., 2006).ResultsAs hypothesized, maladaptive shame regulation strategies did predict psychopathic traits in the offender sample examined. Specifically, significant and meaningful associations occurred between avoidance and attack other coping styles and psychopathic traits.ConclusionsThe present study is among the first in providing evidence of a possible relationship between maladaptive strategies to cope with shame feelings and psychopathic traits, and such link can be informative to tailor treatment programs for these hard-to-treat patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Development of the Military Compass of Shame Scale

ABSTRACTThe Military Compass of Shame Scale (M-CoSS) was designed to evaluate a service member's response to four maladaptive shame regulation strategies. The M-CoSS is composed of two externalizing subscales (attack other, AO; avoidance, AV) and two internalizing subscales (withdrawal, WD; attack self, AS). The final version of the scale was administered to a sample of U.S. Navy sailors preparing to deploy to Iraq and Afghanistan (n = 379). The final sample consisted of active duty patients clinically diagnosed with post-traumatic stress disorder (PTSD) and undergoing residential treatment (n = 27). Internal consistency reliability was acceptable to good within both the large predeployment sample (α = .70 to .89) and the PTSD sample (α = .79 to .89). Exploratory factor analysis provided evidence of construct validity in the predeployment sample. Last, compared to the predeployment sample, the PTSD sample was significantly more likely to utilize three of the four maladaptive shame regulation strategies, with the exception of the AV scale. The M-CoSS is recommended for research purposes in the study of shame regulation in service members diagnosed with PTSD and experiencing moral injury.

Intimate partner aggression-related shame and posttraumatic stress disorder symptoms: The moderating role of substance use problems.

A dearth of literature has examined the consequences of women's use of aggression in intimate relationships. Women's use of aggression against their intimate partners, regardless of their motivation (e.g., self-defense, retaliation), may elicit shame. Shame, in turn, may contribute to the maintenance and/or exacerbation of posttraumatic stress disorder (PTSD) symptoms, which are commonly experienced in this population. Further, emerging research suggests that emotionally avoidant coping strategies, such as substance use, may strengthen the relation between shame and PTSD symptoms. The goal of the present study was to examine whether women's shame concerning their use of intimate partner aggression is associated with their PTSD symptoms, and whether drug and alcohol use problems moderate this association. Participants were 369 community women who had used and been victimized by physical aggression in an intimate relationship with a male partner in the past six months. The intimate partner aggression-related shame × drug (but not alcohol) use problems interaction on PTSD symptom severity was significant. Analysis of simple slopes revealed that women's intimate partner aggression-related shame was positively associated with their PTSD symptoms when drug use problems were high, but not when drug use problems were low. Findings have implications for the potential utility of PTSD treatments targeting a reduction in shame and maladaptive shame regulation strategies (i.e., drug use) in this population. Aggr. Behav. 42:427-440, 2016. © 2015 Wiley Periodicals, Inc.

The influence of shame on posttrauma disorders: have we failed to see the obvious?

BackgroundWhile fear is known to be the dominant affect associated with posttraumatic stress disorder (PTSD), the presence and possible influence of other emotions is less well explored. Recent changes to diagnostic criteria have added anger, guilt and shame alongside fear as significant emotional states associated with the disorder. This article suggests that shame is a frequent, often poorly recognised sequel to trauma, occurring as a result of the meaning the individual places on the traumatic experience and on subsequent interpersonal and environmental events.MethodsThe article reviews the literature on the socio-interpersonal aspects of the posttraumatic experience with particular emphasis on the emotion of shame as both primary and secondary emotion, in its intrapersonal and interpersonal contexts, and in adaptive and maladaptive forms.ResultsThe review suggests that posttrauma shame, and maladaptive shame regulation strategies, often manifesting as anger, substance abuse, social withdrawal or depression, may play an important role in the maintenance or exacerbation of the symptoms of PTSD and the development of co-morbidities.ConclusionThe recognition of shame and maladaptive shame regulation strategies in PTSD treatment and management is critical. However, because shame is frequently considered a painful and discomforting emotion, it may fail to be addressed in the therapeutic setting by both client and therapist. Examination of potential shame-related changes in self-concept, close interpersonal relationships and social inclusion are recommended for individuals who have experienced a range of traumas to identify and address any underlying unacknowledged shame.

Self-Forgiveness and Hypersexual Behavior

Although initial research on treatment for hypersexual behavior has had promising results, there has been little work that explicates the theoretical rationale for various treatment strategies. Self-forgiveness may be one strategy to help individuals with hypersexual behavior work through maladaptive shame and guilt. The present study explored the role of self-forgiveness in hypersexual behavior. Participants (N = 187) reported a time in which they had violated their sexual values and completed measures of self-forgiveness, shame/guilt, and hypersexual behavior. Self-forgiveness was negatively related to hypersexual behavior. Self-forgiveness was also negatively related to shame/guilt. The association between self-forgiveness and hypersexual behavior was mediated by shame/guilt.

Shame, Rumination, and Self-Compassion in Men Assessed for Hypersexual Disorder

A number of studies have linked maladaptive shame to higher levels of hypersexual behavior and tendencies to ruminate. However, little research has examined factors that may attenuate the negative impact that shame and rumination may have on hypersexuality. Drawing on data collected from male patients (N=172) assessed for hypersexual disorder in a DSM-5 field trial, path analysis was used to explore relationships among shame, rumination, self-compassion, and hypersexual behavior. The findings from this study showed that self-compassion partially mediated the relationship between shame and rumination and hypersexual behavior. The implications of these results are discussed and directions for future research are offered.

Shame regulation in personality pathology.

Drawing on extant work on shame and emotion regulation, this article proposes that three broad forms of maladaptive shame regulation strategies are fundamental in much of personality pathology: Prevention (e.g., dependence, fantasy), used preemptively, lessens potential for shame; Escape (e.g., social withdrawal, misdirection) reduces current or imminent shame; Aggression, used after shame begins, refocuses shame into anger directed at the self (e.g., physical self-harm) or others (e.g., verbal aggression). This article focuses on the contributions of shame regulation to the development and maintenance of personality pathology, highlighting how various maladaptive shame regulation strategies may lead to personality pathology symptoms, associated features, and dimensions. Consideration is also given to the possible shame-related constructs necessitating emotion regulation (e.g., shame aversion and proneness) and the points in the emotion process when regulation can occur.

Emotion-Focused Therapy: A Clinical Synthesis

A summary of an emotion-focused approach to therapy (EFT) and its research base is presented. In this view, emotion is seen as foundational in the construction of the self and is a key determinant of self-organization. People, as well as simply having emotion, also live in a constant process of making sense of their emotions. In EFT, distinctions between different types of emotion provide therapists with a map for differential intervention. Six major empirically supported principles of emotion processing guide therapist interventions and serve as the goals of treatment. A case example illustrates how the principles of EFT helped a patient overcome her core maladaptive shame and basic insecurity in a relatively brief treatment of depression.

The treatment of maladaptive shame in borderline personality disorder: A pilot study of “opposite action”

This study sought to pilot test a short-term intervention for maladaptive shame in borderline personality disorder (BPD) based on the skill of “opposite action” from dialectical behavior therapy. Five women with BPD were treated with the intervention using a single-subject, multiple-baseline design. Results indicate that, although state ratings of shame are highly variable, it is possible to reduce shame about a specific event over a short period of time. This was verified by a new shame measure that was created for this study. Results from this study have several implications for the treatment of shame in BPD and other clinical populations. A detailed case example is provided.

Shame Coping Styles and Psychopathic Personality Traits

The convergent validity of the primary and secondary psychopathy scales of the Levenson, Kiehl, and Fitzpatrick (1995) Self-Report Psychopathy Scale (SRPS) were investigated by contrasting correlations between the two SRPS scales and self-report adaptive and maladaptive shame coping scales. The results, from a sample of 305 undergraduates, supported the convergent validity of the SRPS primary (selfish, uncaring, manipulative interpersonal style) and secondary (impulsivity and self-defeating behavior) scales; both possessed small but significant negative relationships with adaptive shame coping and small but significant positive relationships with externalizing shame coping. An opposing pattern of convergent validity was evidenced by partial correlations (controlling for SPRS scale covariance) that indicated the SRPS primary scale had a negative relationship and the secondary scale had a positive relationship to internalizing shame coping.