Shame Anxiety Research Articles

Imagining a future for psychotherapy in Aotearoa

This paper discusses Donna Orange’s idea that Levinas’s philosophical position of radical ethics, when combined with the psychoanalytic concept of intersubjectivity, could unravel blindness to the climate crisis. Genocidal colonisation by Europeans across the world is a disavowed history that has been ruinous not only for the colonised, but also for the internal worlds of the colonisers. We remain in the grip of a destructive competitive mindset, driven by the forces of shame, shame anxiety, and envy. Psychotherapists could play a part in a better future by articulating the emotional defences at play in ecocide and strengthening our own workforce and those who are fighting against the climate crisis, with group work.

Shame anxiety, stigma and clinical encounters.

Stigma has been associated with delays in seeking treatment, avoiding clinical encounters, prolonged risk of transmission, poor adherence to treatment, mental distress, mental ill health and an increased risk of the recurrence of health problems, among many other factors that negatively impact on health outcomes. While the burdens and consequences of stigma have long been recognized in the health literature, there remains some ambiguity about how stigma is experienced by individuals who live with it. The aim of this paper is to elucidate the phenomenology of stigma, or to describe how it is that stigma shows up in the first-person experience of individuals who live with stigma and its burdens. Exploring the relationship between shame and stigma, I argue that shame anxiety, or the chronic anticipation of shame, best characterises the experience of living with a health-related, or healthrelevant, stigma. Understanding the experiential features, or phenomenology, of shame anxiety will give healthcare professionals a greater sensitivity to stigma and its impacts in clinical settings and encounters. I will conclude by suggesting that ‘shame-sensitive’ practice would be beneficial in healthcare.

Shame, Stigma and HIV: Considering Affective Climates and the Phenomenology of Shame Anxiety.

The affective climate often associated with HIV prevention and care practices is often dominated by negative emotions such as shame, fear and suspicion which arise because of HIV’s historical stigma. This article explores the experiential consequences of this affective climate and the continued stigma associated with HIV, through a focus on the experience of shame anxiety which can be understood as the chronic anticipation of shame or shameful exposure. Exploring first-person narratives of gay men living with HIV, the article gives an account of how shame anxiety is central to understanding how stigma causes harm, especially in experiences of chronic illnesses such as HIV. Using a philosophical framework, through phenomenology, it will be demonstrated how shame anxiety manifests in bodily lived experience through the structure of the “horizon”. The article will finish with reflections on how shame anxiety can act as a barrier to the effective delivery of health services for those with stigmatised chronic illnesses and, furthermore, why the experience of shame anxiety might be useful to consider when delivering health services.

The Fear of Laughter in Restoration Prose Fiction

This article draws on recent studies on the fear of derisive laughter (or ‘gelotophobia’) in order to relate them to early modern comments on laughter and to the representation of that anxiety in some texts of Restoration prose fiction, and with a particular emphasis on Alexander Oldys’s The Fair Extravagant(1682). Gelotophobia is a variant of shame anxiety and a social phobia defined as the pathological fear of being an object of laughter. Although the fear shown in the texts analysed is not pathological, it certainly reveals the strong pressure of the shame culture and gender politics prevailing in Restoration England.

The Fear of Laughter in Restoration Prose Fiction

This article draws on recent studies on the fear of derisive laughter (or ‘gelotophobia’) in order to relate them to early modern comments on laughter and to the representation of that anxiety in some texts of Restoration prose fiction, and with a particular emphasis on Alexander Oldys’s The Fair Extravagant(1682). Gelotophobia is a variant of shame anxiety and a social phobia defined as the pathological fear of being an object of laughter. Although the fear shown in the texts analysed is not pathological, it certainly reveals the strong pressure of the shame culture and gender politics prevailing in Restoration England.

Identity Management and the Fostering of Network Ignorance: Accounts of Queer Iranian Women in the United States

This qualitative study explores the narratives of 12, first-generation, queer, Iranian-American women in an attempt to better understand the experiences of being both Iranian and queer, and to explore the various ways participants manage their sexual identities within their ethnic communities. Online interviews were analyzed using grounded theory analysis, which revealed that shame anxiety motivates the fostering of network ignorance. Feelings of fear and guilt, which together cultivate shame anxiety, motivate the identity management strategies of queer Iranian women as they attempt to foster ignorance of their sexual orientation within the Iranian community. Strategies include (co)-covering, deceiving and passing, and avoiding.

Barriers in entering treatment among women with urinary incontinence.

The aim of the study was to identify barriers in help seeking behaviors among women with urinary incontinence UI. The study was performed using the method of diagnostic enquiry by means of questionnaire and interview among two groups of patients. The first group of women aged 47-79 years consisted of 80 members of the Association of People with Urinary Incontinence "Uroconti". The second group included 61 females aged 26-81 years admitted to the Urodynamic Laboratory of Gynecology and Oncology Clinic at the University Hospital in Krakow. Patients with stress urinary incontinence (SUI) reported to the doctor on average after 4 years, patients with urgency urinary incontinence (UUI), after 3 years, patients with a mixed form of urinary incontinence (MUI), after 6 years, and with overflow incontinence, after 10 years from the appearance of first symptoms. Anxiety shame, the conviction that symptoms of UI are a normal age related state, as well as the conviction that the symptoms are temporary significantly affected the delay in seeking medical consultation. Most of the surveyed women made the decision to undertake treatment themselves, and their main motive was the escalation of symptoms. The majority (89.4%) of women surveyed alleviated the symptoms of urinary incontinence without the help of a doctor sometimes using methods detrimental to their health. The identification of help seeking barriers and reaching out to risk groups is essential for early diagnose and effective treatment of women with urinary incontinence.

Psychological Characteristics of People with Parkinson's Disease Who Prematurely Drop Out of Professionally Led Internet Chat Support Groups

Researchers of Internet health interventions have begun to address the problems of high attrition rates. Attrition has been a problem for psychosocial interventions for nearly 50 years. It is ubiquitous no matter what the type of intervention or the modality of delivery. Consistent are the repeated findings that demographic characteristics are the most robust variables. We tested the hypothesis that the greater the fear and apprehension experienced in professionally led Internet support groups, the more likely the participants would not complete the 25-week intervention. The sample consisted of 66 people with Parkinson's disease; each participant was assigned to one of six chat groups. To assess psychological states, we used PCAD, a text analysis program analyzing each person's postings during each chat room session. There was a statistically significant difference between those who terminated the group early and those who completed the intervention on the Anxiety-Fear dimension, F=2.35, (6,63), p=0.03. People who dropped out demonstrated higher death and shame anxiety. A number of possible designs for online groups that may reduce premature attrition are discussed.

Sprachinhaltsanalyse in der kulturvergleichenden psychosomatischen Forschung

The Gottschalk-Gleser-analysis, a content-analytical technique, measures anxious and aggressive affects. For decades this technique was primarily and widely implemented in psychosomatic research. Today, this technique is offered in numerous languages. Since this technique is time consuming in application and analysis, computer software has been developed for English (Psychiatric Content Analysis and Diagnosis, PCAD 2000) as well as for German contents (Dresdner Angstwörterbuch, DAW). This study compares the anxiety scale of both versions in order to evaluate their comparability in cross-cultural psychosomatic studies. The English and German version of 96 different abstracts of the German Journal for Psychotherapy, Psychosomatic Medicine and Medicine Psychology from 2003 and 2004 with a total of 31 000 words were compared. The scores of the Gottschalk-Gleser anxiety scales of both computer programs correlates between 0.21 and 0.59 (p < 0.05, only exception: shame anxiety). The means of the scores calculated by the PCAD and DAW significantly differ for all scales. Therefore, these two content analytical methods DAW and PCAD provide only limited use for cross-cultural comparisons in psychosomatic research.

The effects of anticancer chemotherapeutic drugs on cognitive function and other neuropsychiatric dimensions in breast cancer patients

This preliminary study aimed to apply a novel computerized measure derived from the content analysis of 5-min speech samples from patients with breast cancer to measure cognitive impairment and other neuropsychiatric dimensions during the course of anticancer chemotherapeutic treatment. Since such patients are often administered other pharmacological agents to alleviate their symptoms in addition to anticancer chemotherapeutic agents, another aim was to try to distinguish the mental effects of the anticancer drugs from the effects of any other drugs administered. Before and during the course of their anticancer chemotherapy, 12 breast cancer patients gave 5-min verbal samples, elicited by purposely ambiguous instructions, to talk about any personal life experiences. The recorded verbal samples were scored by a computer program (PCAD 2000) to measure the magnitude of cognitive impairment and other relevant neuropsychiatric dimensions. All of the pharmacological agents administered to the patients were recorded. The computer program automatically compared the scores derived from each verbal sample to already established norms to determine whether each score was within normal limits or one to three standard deviations from the norms. Significantly elevated Cognitive Impairment Scale scores were found in the verbal samples of 9 of the 12 patients. All patients had instances of elevated Health/Sickness Content Analysis Scale scores as well as frequent significantly elevated scores in shame anxiety and in death anxiety. In the Quality of Life Content Scale, the scores were uniformly low, ranging from +1.64 to -9.11. Further studies are being carried out to determine which patients are especially susceptible to cognitive impairment under these treatment conditions.

Stuttering: Neuropsychiatric features measured by content analysis of speech and the effect of risperidone on stuttering severity

Positron-emission tomographic (PET) studies and genetic research of stuttering have recently revealed underlying cerebral neurobiologic contributing factors in this disorder. We aimed to assess whether cognitive impairment and other neuropsychiatric dimensions could be detected through computerized content analysis of short samples of speech from stutterers, and whether administration of risperidone in a double-blind placebo-controlled study could decrease the severity of stuttering, as well as any of the neuropsychiatric features of these stutterers. A group of 21 stutterers with the developmental form of stuttering, an onset before age of 6 years, aged 20 to 74 years, and who were otherwise free of major medical or psychiatric problems, initially gave a 5-minute tape-recorded speech sample in response to purposely ambiguous instructions to talk about any interesting or dramatic life experiences. Then, half of these subjects (n = 10) were randomly selected to receive 6 weeks of risperidone treatment up to 2.0 mg/d and the other half (n = 11) were administered a placebo. Both groups of subjects gave a second verbal sample after 6 weeks of treatment. Significantly elevated cognitive impairment and social alienation-personal disorganization scores, derived from the computerized content of the initial 5-minute speech samples, were found. After 6 weeks, the risperidone group improved significantly on a measure of severity of stuttering but did not improve on the percentage of time spent stuttering. The placebo group did not improve on either measure of stuttering. The psychopathological processes of subjects who received risperidone treatment, including those with elevated cognitive impairment and social alienation-personal disorganization, did not change significantly. However, stutterers who had lower scores on verbal content analysis-derived shame anxiety, guilt anxiety, or hostility inward measures improved significantly more with risperidone than stutterers with higher scores on these measures. The findings of elevated cognitive impairment and social alienation-personal disorganization scores of adult stutterers with the early developmental form of stuttering are consistent with the neurobiologic abnormalities found in PET scan and genetic research involving stutterers. Risperidone (≤2.0 mg/d) can reduce the severity of stuttering while not significantly affecting the magnitude of neuropsychiatric dimensions such as cognitive impairment or social alienation-personal disorganization. The less the inward shame, guilt, or hostility of the stutterers, the better the beneficial effect of risperidone on the severity of stuttering.

The Italian Version of the Affective Gottschalk-Gleser Content Analysis Scales: A Step Toward Concurrent Validation

A first approach to the validation of the Italian version of the Gottschalk-Gleser Content Analysis Scales of Anxiety and Hostility is presented. To assess the validity of the Affective Content Analysis Scales the Gottschalk-Gleser standard procedure for obtaining verbal samples was followed and concurrently self-report measurements of comparable emotional constructs were applied. A short form of the Differential Emotions Scale (DES) was administered three times to 50 university students to measure the emotional state before as well as after speech sampling and the affectivity associated with the narrated life event. To investigate whether the Gottschalk-Gleser Affect Scales measure emotional traits the State-Trait-Anxiety-Inventory, an S-R Inventory of Anxiety, the Shame-Guilt Scale ( Battacchi, Codispoti, &amp; Marano, 1994 ) and the Irritability Scale ( Caprara, Borgogni, Cinanni, di Giandomenico, &amp; Passerini, 1985 ) were applied. Though the correlations between the measures were generally low, evidence of convergent validity emerged for the Gottschalk-Gleser Total Anxiety Scale, the anxiety subscales Guilt Anxiety and Shame Anxiety (that seem to measure an anxiety pattern consisting of several basic emotions) and for the hostility subscale Overt Outward Hostility. The correlational data indicate that the Gottschalk-Gleser Affect Scales assess emotional traits as well as emotional states.

The Unconscious Life of Organizations: Interpreting Organizational Identity

Introduction Theory Psychoanalytic Organization Theory Ritualistic Organizational Defenses and the Self-System The Psychodynamics of Organizational Culture Organizational Identity Individual and Group Regression in the Workplace The Psychodynamics of Language and Communication in Organizational Consultations Practice Shame Anxiety and Intimidation at Work A Public Agency Copes with Transition and Expansion The Impact of Conflict Avoidance on Organizational Identity Examples of Leadership Transition and Object Loss Conclusions: The Psychodynamics of Organizational Change Bibliography Index

Separation anxiety in panic disorder

A number of researchers have provided evidence that separation anxiety is an important antecedent or current affect in panic disorder. The objective of this pilot study was to test this hypothesis by comparing dreams, screen memories, and life situations of panic disorder patients with those of comparison patients. A recent dream with associations, screen memories with associations, and life situations at onset of symptoms were recorded verbatim during semistructured interviews with 20 patients with DSM-III-R panic disorder and 20 comparison subjects upon referral to a private outpatient practice. A judge blind to the diagnoses rated each of the dreams, screen memories, and life situations separately on each of the 10 Gottschalk-Gleser Content Analysis Scales, thereby measuring manifest and latent death, mutilation, separation, guilt, and shame anxiety and overt and covert hostility in each group. mean separation anxiety scores were significantly higher in both the dreams and screen memories of the panic disorder patients than in the comparison patients. Mean scores for covert hostility directed outward were significantly higher in the dreams of the panic disorder patients than in the comparison patients. The hypothesis that separation anxiety is a prevalent affective undercurrent in the dreams and screen memories of panic disorder patients was supported. Significantly higher covert hostility in the panic disorder patients' dreams may support Bowlby's observation that people with high separation anxiety tend to disavow their anger.

Platelet monoamine oxidase activity and evoked response as predictors of anxiety and depression derived from the content analysis of speech

Platelet MAO activity has been reported by several investigators to differentiate schizophrenia, schizophrenia related depressive disorders, alcoholism, unipolar and bipolar depression from normal controls. Evoked potentials likewise have differentiated schizophrenic and affective patients. However, the precise relationship between MAO activity, evoked potentials (EP), and psychiatric illness has not been clarified. A possible association between psychopathology and high MAO activity/EP reducing and low MAO activity/EP augmenting has been reported. Such a bidirectionality further confounds results. This study was undertaken to determine the association of psychopathological dimensions found in a group of subjects whose platelet MAO activity and evoked responses were obtained two years earlier. Utilizing the Gottschalk-Gleser verbal behavior scales of Anxiety, Depression, Social Alienation-Personal Disorganization and Cognitive Impairmment a significant correlation was revealed between low platelet MAO activity and high Total Anxiety scale and Shame Anxiety subscale scores. Additionally, a significant correlation was demonstrated between reducing evoked potentials and elevated Death Anxiety, Somatic Concerns, and Total Death and Mutilation Depression subscales scores, combined and separately. Furthermore, a significant positive correlation was found between augmenting evoked potentials and Overt Hostility Outward scores. No significant correlations were demonstrated between platelet MAO activity or evoked potentials and Social Alienation-Personal Disorganization or Cognitive Impairment scores. These findings lend support to the position that biological markers may predict predispositions to anxiety and depression.

The Oedipal Organization of Shame

The affect of shame in its development and transformations plays an important role in the oedipal period, alongside guilt, as a source of unpleasure and a signal affect. Earlier experiences of shame, associated with loss of control, are now incorporated into the new meanings derived from oedipal conflicts. The analysis of a phobic woman shows how the shame of exposure, experienced by the patient in terms of body concerns, involved complex compromises representing impulses, defenses, and fantasies. Signals of shame anxiety helped to ward off guilty fantasies of love and hostility by motivating character traits in which even ordinary caring was renounced. In the analysis these traits were represented in a transference of defense.

The emotional impact of mastectomy

To learn about the effects of unilateral mastectomy, the emotional responses of four groups of women were compared 1–3 and 10–12 months after surgery: (1) mastectomy group ( n=125)—women who had a unilateral mastectomy for stage I or II breast cancer; (2) biopsy group ( n=65)—women who had a biopsy revealing benign breast disease; (3) cholecystectomy group ( n=75)—women who had a cholecystectomy; (4) healthy group ( n=84)—women who had not had a major surgical intervention. Measures of emotions were: (1) the SCL-90 Analogue; (2) the Global Assessment Scale (GAS); and (3) the Gottschalk-Gleser Content Analysis Scale. The mastectomy group had significantly higher mean Gottschalk- Gleser scores for total anxiety, death and mutilation anxiety, ambivalent hostility, total denial and anxiety denial, and hopefulness. Significant reductions were found in mean total anxiety, mutilation, and shame anxiety in the mastectomy group and in total, death, and mutilation anxiety in the cholecystectomy group between the two postsurgical assessments. The mastectomy group had a significantly higher mean anxiety and depression score than the healthy group on the SCL-90 at both time points. The mastectomy and cholecystectomy groups had lower emotional well-being scores on the GAS than the healthy group over both testing periods. The groups also differed in their amount of change on the GAS over time. All measures, especially the Gottschalk-Gleser scales, showed significantly more psychopathological emotional responses in the mastectomy group, somewhat less in the cholecystectomy group, and the least in the biopsy group.

Predicaments of Bureaucratic Subordinacy: Dramatic Escape and Compensation

Bureaucracy presents workers with predicaments which frustrate efforts to act competently. Simultaneous ambiguity in responsibility and authority both defeats interests in recognition and creates risks of being scapegoated for problems. At the same time, the structure of bureaucratic authority engenders shame anxiety which discourages assertion and further hinders effective work. Workers defend themselves against this anxiety by producing dramas which offer escape and compensation. These dramas may be daydreams, plans for the future, or actual plays performed alongside formal organizational activities. This paper examines two workers' dramas. The dramas offer security, with the result that the workers regard them as more real than other activities and withdraw from their formal assignments.

The association between family atmosphere and hospital career of schizophrenic patients.

The content analysis was made of special thirty minute discussions between each of 30 acute male schizophrenics and their parents to determine features of parental personality. All patients were discharged, but after 2 years 13 of them had been readmitted. Compared with those not readmitted their fathers expressed more outward-directed hostility and hostility projected on to others, and their mothers expressed more inward-directed hostility as well as guilt anxiety and shame anxiety. Both parents were emotionally more unstable during the course of the discussion. The emotional interaction between mothers and sons was of symmetrical type (whereas it was complementary between mothers and sons who had not been readmitted).

Analyzing affective responses to past events: women's reactions to a childbearing year.

Applied content analysis scales on the work of Gottschalk and Gleser (1969) to 200 women's recollections of four stages of a recently completed child-bearing year. On 11 of 13 affective indices, significant differences were found. Pregnancy was characterized by diffuse and cognitive anxiety and hostility directed inward, and labor by mutilation anxiety. During both pregnancy and labor, general anxiety, death anxiety, ambivalent hostility, and affective costs were comparatively high. Mothers revealed least affective arousal during hospitalization. Considerable guilt and shame anxiety were experienced in the months after the birth.