Reductions In Shame Research Articles

Internalized Shame Among Justice-Involved Women in Substance Use Disorder Treatment: Measurement Invariance and Changes During Treatment.

Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N=105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to post-treatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.

The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial.

Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.

Shame and stigma in association with the HCV cascade to cure among people who inject drugs

BackgroundPsycho-social experiences including shame and experienced and internalized stigma have been associated with substance use, HCV infection, and reluctance to disclose HCV status and pursue treatment. These psycho-social barriers have been examined independently for many chronic diseases, including HCV, but to our knowledge have not been quantitatively explored in a large multi-site US-based sample of people who inject drugs (PWID) in HCV treatment. MethodsWe examine baseline relationships with HCV-stigma and engagement across the HCV treatment cascade as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment cascade including treatment initiation, adherence, completion, and sustained virologic response (SVR) among a multi-site sample of PWID with HCV, where N=755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and N=623 initiated treatment. ResultsWhile cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment (aOR=5.29; 95%CI: 1.56,18.00) and achieve SVR (aOR=6.32; 95%CI: 1.61, 24.87). ConclusionResults underscore the relationships between lower levels of shame and health-related behavior and treatment outcomes among PWID and suggest SVR achievement may contribute to reductions in shame or that reductions in shame may contribute to continued treatment and thus SVR.

Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry

BackgroundAdolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity. ObjectivesThis study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya. MethodsWe conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose. ResultsWe found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm. ConclusionsThis study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically.This trial was registered at clinicaltrials.gov as NCT03741634.

Shame on Me? Love Me Tender! Inducing and Reducing Shame and Fear in Social Anxiety in an Analogous Sample.

Shame is considered an important factor in the development and maintenance of many psychological disorders, e.g., social anxiety disorder, and an interesting target point for therapeutic intervention. In the present experimental study, we used an online-adopted Autobiographical Emotional Memory Task (AEMT) to induce shame and tested different micro-interventions (self-compassion, cognitive reappraisal, and a control intervention) with respect to their potential to reduce shame intensity. One-hundred-and-fifteen healthy subjects participated in the study and completed a series of self-report questionnaires on self-compassion, shame, and social anxiety. The experimental shame induction was well accepted and successful (with significantly heightened feelings of shame); there were no study drop-outs. There was a significant time*condition interaction, which was due the self-compassion-based intervention resulting in a significantly larger reduction of shame than the control condition (counting fishes). In addition, the main effect of the factor experimental condition was further moderated (enhanced) by trait social anxiety and trait self-compassion. The findings demonstrate the usefulness of online-adopted AEMT for the experimental induction of shame. They suggest that especially self-compassion interventions can be beneficial in alleviating intense shame experiences, which is in accordance with self-compassion theory. Overall, the results are promising in the context of experimental shame research and its potential clinical impacts call for further replication.

“Name Three Good Things About Yourself in Mathematics” – An Intervention to Reduce Pre-Service Teachers’ Shame in Mathematics

Shame is an unpleasant and activating emotion that affects learners’ achievement, including in mathematics, and pre-service teachers’ identity development. It is closely connected with the self. The current study investigated the efficacy of an intervention adapted from positive psychology aiming to reduce pre-service primary teachers’ shame in mathematics. Accordingly, the three good things technique was adapted with respect to the self. The efficacy of the intervention was analyzed in comparison to a qualified control group and a control group receiving no intervention. Participants were allocated at random to the three groups. In total, n = 176 pre-service primary school teachers took part in the experiment for a duration of five weeks with exercises twice a week. Findings suggest small positive effects of the adapted intervention on shame reduction in mathematics and superior effects in comparison to both control groups.

Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: the COMpassion for Psychiatric disorders, Autism and Self-Stigma (COMPASS) study protocol for a randomized controlled study

BackgroundPeople with mental disorders face frequent stigmatizing attitudes and behaviors from others. Importantly, they can internalize such negative attitudes and thus self-stigmatize. Self-stigma is involved in diminished coping skills leading to social avoidance and difficulties in adhering to care. Reducing self-stigma and its emotional corollary, shame, is thus crucial to attenuate the negative outcomes associated with mental illness. Compassion-focused therapy (CFT) is a third-wave cognitive behavioral therapy that targets shame reduction and hostile self-to-self relationship and allows for symptom improvement while increasing self-compassion. Although shame is a prominent part of the concept of self-stigma, the efficacy of CFT has never been evaluated in individuals with high levels of self-stigma. The purpose of this study is to evaluate the efficacy and acceptability of a group-based CFT program on self-stigma, compared to a psychoeducation program for self-stigma (Ending Self-Stigma) and to treatment as usual (TAU). We hypothesize that diminished shame and emotional dysregulation and increased self-compassion will mediate the relationship between self-stigma improvements post-therapy in the experimental group.MethodsThis seven-center trial will involve 336 participants diagnosed with a severe mental illness and/or autism spectrum disorder and reporting high levels of self-stigma. Participants will be randomized into one of three treatment arms: 12 week-treatment of compassion-focused therapy (experimental arm), 12 week-treatment of Psychoeducation (active control arm), and TAU (treatment as usual—passive control arm). The primary outcome is the decrease of self-stigma scores on a self-report scale, i.e., ISMI, at 12 weeks. Secondary endpoints include sustainability of self-stigma scores (ISMI) and self-reported scores regarding target psychological dimensions, e.g., shame and emotional regulation, social functioning, and psychiatric symptoms. Assessments are scheduled at pretreatment, post-treatment (at 12 weeks), and at 6-month follow-up. Acceptability will be evaluated via (i) the Credibility and Expectancy Questionnaire at T0, (ii) the Consumer Satisfaction Questionnaire for Psychotherapeutic Services posttreatment and at 6-month follow-up, (iii) attendance, and (iv) dropout rates.DiscussionThis study will evaluate the potential efficacy and acceptability of a group-based CFT program on the decrease of self-stigma and thereby contribute to the continuing development of evidence-based therapeutic interventions for the internalized stigma of mental and neurodevelopmental disorders.Trial registrationClinicalTrials.gov NCT05698589. Registered on January 26, 2023

Processes and Outcomes of Pornography Addiction Support Groups

This study investigated the processes and outcomes associated with religiously sponsored pornography addiction support group meetings. We identified a variety of themes using a collaborative hermeneutic interpretation method. Results showed that participants experienced shame due to their pornography use and that member-to-member sharing in meetings facilitated self-compassion, cohesion, shame reduction, and spiritual experiences. Participants reported outcomes such as adopting a lifelong recovery approach, viewing pornography use as a symptom, and prioritizing their relationship with God. In some cases, participants reported increased shame and distress from the significant focus in group on their pornography use, in addition to specific shame-inducing experiences in meetings.

Evaluation of a compassionate mind group for self-harming behaviour within a secondary mental health service

ObjectivesThis service evaluation study aimed to evaluate a pilot Compassionate mind (CM) group for self-harming behaviour with participants experiencing mental health difficulties who struggled with shame and self-criticism.MethodsThe study was a within-subjects design using pre and post measures for five participants attending a 20 session CM group in a community mental health setting. Validated self-report questionnaires were administered before and after the group intervention and evaluation feedback questionnaires were given at the end of the group.ResultsThe data were analysed using descriptive statistics and the non-parametric Wilcoxon signed rank test. There was a significant increase in ratings on the Self-compassion scale (SCS) (z=2.023 p&lt;.043), a significant decrease in the depression (z=−2.032 p&lt;.042), anxiety (z= −2.060 p&lt;.039) and stress (z= −2.032 p&lt;.042) subscales within the Depression Anxiety Stress Scales (DASS), a significant decrease in The Other as Shamer Scale (OAS) (z=−2.023 p&lt;.043) and decreases in impairment in functioning as measured by the Work and Social Adjustment Scale (WSAS) (z=−2.023 p&lt;.043). There was also a significant increase in reassured self (z=2.032 p&lt;.042) and significant decreases in the inadequate self (z=2.023 p&lt;.043) and hated self (z=2.070 p&lt; .043) domains on the Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FCSRS) and in the self-persecution (z= −2.023 p&lt;.043) and self-correcting (z=−2.023 p&lt;.042) domains on the Functions of Self-Criticising/Attacking Scale (FSCS). Results should be interpreted with caution given the small sample size.ConclusionsThis study provides preliminary evidence that the pilot CM group for self-harming behaviour has a beneficial impact for participants around reductions in shame and self-criticism and increases in self-compassion, resulting in reductions in self-harm. Limitations, recommendations for improvement and future research are discussed.

Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial

Dysfunctional cognitive processes and maladaptive interpersonal patterns have been postulated to maintain body dysmorphic disorder (BDD). The present trial evaluated CT for BDD (CT-BDD), which includes modules targeting maladaptive cognitive processing in BDD, as well as elements of schema therapy related to interpersonal problems. We investigated whether (a) CT-BDD is effective, as compared with a wait-list (WL) group at Week 12; (b) outcome of CT-BDD is maintained at posttreatment and 3- and 6-months follow-up; and (c) whether changes in shame and insight mediate changes in BDD symptom severity. Forty adults with BDD were randomized to 36 weeks immediate CT-BDD (n = 21), or to 12-week WL (n = 19). At Week 12, immediate CT-BDD was significantly superior to WL in clinician-rated BDD symptom severity, insight, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. Changes in outcomes were associated with moderate to large effect sizes at Week 12. Reductions in shame and increase in insight separately mediated changes in BDD symptom severity during treatment at Week 12. From baseline to posttreatment, significant improvements occurred within CT-BDD in clinician-rated symptom severity, insight, depression, global functioning, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. At posttreatment, improvements were associated with large effect sizes and were maintained at 3- and 6-month follow-up. Preliminary results support the efficacy of CT-BDD. Addressing interpersonal problems in addition to cognitive dysfunctions may increase the benefit of CBT for BDD patients.

A randomized controlled feasibility trial of online compassion-focused self-help for psoriasis.

SummaryBackgroundPeople with psoriasis can experience psychological distress that might be amenable to psychosocial self‐help.ObjectivesThis study tested the feasibility and acceptability of two theoretically developed self‐help interventions designed to reduce feelings of shame and improve quality of life.MethodsA randomized controlled feasibility trial was conducted comprising 130 participants with psoriasis who were randomly allocated to receive either compassion‐based self‐help (n = 65) or mindfulness‐based self‐help (n = 65), over a 4‐week period. Both interventions were provided online.ResultsThe interventions were found to be acceptable, with over 70% of study completers reporting that they found the materials helpful. Of the 130 participants, 92 completed the study, with attrition at 29%. Both interventions showed modest yet statistically significant reductions in shame (Cohen’s d = 0.20) and improvements in quality of life (Cohen’s d = 0.40).ConclusionsSelf‐help based on compassion and mindfulness is acceptable to users, and can reduce feelings of shame and improve quality of life for people living with psoriasis. What is already known about this topic? Psoriasis can be associated with psychological distress.Various forms of psychological intervention have been tested; however, few compassion based interventions have been developed or trialled. What does this study add? This study demonstrates that compassion‐based self‐help is acceptable to people with psoriasis.This study provides provisional evidence of effectiveness of compassion based self‐help in reducing feelings of shame and improving quality of life for people living with psoriasis.

“Someone Who Has Been in My Shoes”: The Effectiveness of a Peer Support Model for Providing Support to Partners, Family and Friends of Child Sexual Abuse Material Offenders

ABSTRACT Reports of child sexual abuse material (CSAM) on the internet are rapidly increasing and the number of people accessing it is substantial. Many of these men have partners or families who are impacted by their CSAM use. These families experience negative mental health and social outcomes as a result. Despite this, there are limited services that provide support to this population. In this article, we examine the findings of an evaluation of PartnerSPEAK, a service in Victoria, Australia, that supports the non-offending partners and families of CSAM offenders. The evaluation included a survey of 53 clients as well as seven in-depth interviews. The findings showed that the peer support model utilized by PartnerSPEAK offered effective support for this underserved client group including the reduction of shame and isolation.

Acceptance and Commitment Coaching for Music Performance Anxiety: Piloting a 6-Week Group Course With Undergraduate Dance and Musical Theatre Students.

Treatments for students with problematic levels of music performance anxiety (MPA) commonly rely on approaches in which students are referred to psychotherapists or other clinical professionals for individual care that falls outside of their music training experience. However, a more transdisciplinary approach in which MPA treatment is effectively integrated into students’ training in music/performing arts colleges by teachers who work in consultation with clinical psychologists may prove more beneficial, given the resistance students often experience toward psychotherapy. Training singing teachers, and perhaps music teachers at large, to use an evidence-based coaching strategy like Acceptance and Commitment Coaching (ACC) to directly manage students’ MPA is one such approach. Building on the work of a previous study in which ACC was administered by a singing teacher to a musical theatre student with problematic MPA, we piloted the effectiveness of a six-session, group ACC course for a sample of performing arts students (N = 6) with MPA related to vocal performances, using a mixed-methods design. The coach here was also a singing teacher without a clinical background, and her training in ACC by a clinical psychologist was of a similar duration (8 h) as the previous teacher’s (7 h). Similar to the musical theatre student, the students reported being significantly less fused with their MPA-related cognitions, more accepting of their MPA-related physiological symptoms, and more psychologically flexible while performing in general, and these improvements were maintained after 3 months. Furthermore, they appeared to lower their shame over having MPA and change how they thought in relation to one another. Of note, these improvements were similar to those shown by seven vocal students with MPA after they received Acceptance and Commitment Therapy from a clinical psychologist, but with larger reductions in shame and better acceptance of MPA, which suggests a non-clinical, group ACC intervention that includes supportive discussions to normalize MPA and challenges attempts to control it may be more helpful than individual psychotherapy. These results are promising and indicate a brief training in ACC (<10 h) may be sufficient for singing teachers to provide significant benefit for students with problematic MPA.

“I Thought It Was My Fault Just for Being Born”. A Review of an SEL Programme for Teenage Victims of Domestic Violence

Research has established the life-altering effects of living with domestic violence on young people. Traumatic experiences negatively impact their education, leisure activities, and social-emotional learning (SEL). The secrecy concerning domestic violence means young people suffer self-blame, shame, fear of disclosure and family separation. The researcher designed a 12-week multimedia programme, ‘up2talk’, to enhance the communications skills and emotional literacy of the participants. Parents and teenagers were fully informed of the aims and previously attended the family service hosting the programme. Domestic violence was identified as a core issue, without the expectation of personal disclosure. This approach enabled young people to voice and explore the effects of domestic violence on their lives. Participants developed the elements of the programme and a family worker co-facilitated the groups. The third-party approaches: ‘how would a teenager feel?’, artistic expression, assertiveness, debates and videoing drama increased SEL and generated discussion, while protecting privacy. Parents provided two interviews concerning their children, and teenagers provided three individual interviews and ongoing group reviews. A thematic analysis showed a reduction in shame and self-blame, enhanced self-esteem and self-efficacy, increased engagement in education and recreation and improved family relationships. Themes were triangulated by facilitators’ observations, interview data, artefacts, group reviews and parental feedback. All families were offered follow-up support. The effectiveness of the interactive group indicates opportunities for its development in educational and youth settings.

MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder.

Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.

Shame as a Mediator in the Association Between Emotion Dysregulation and Posttraumatic Stress Disorder Symptom Reductions Among Combat Veterans in a Residential Treatment Program.

Emotion dysregulation (ED) can be defined as one's inability to effectively respond to and manage internal experiences and the expression of emotion. ED has been linked to the development and maintenance of posttraumatic stress disorder (PTSD), with recent research suggesting that reductions in ED may predict improved treatment outcomes among both civilian and veteran populations. However, few studies have examined how changes in ED may predict treatment outcomes among veterans with PTSD and whether certain core features of PTSD, such as shame, may act as potential mediators in the association between ED and PTSD symptom reductions. The present study sought to explore facets of ED, feelings of shame, and PTSD symptoms among 43 combat veterans upon their admission and discharge to a residential PTSD program. The results demonstrated that all variables of interest significantly decreased from admission to discharge, ds = 0.75-1.84. Correlations indicated that reductions in ED, R2 = .184, and shame, R2 = .228, were associated with reductions in PTSD symptoms. However, the association between reductions in ED and PTSD was significantly mediated by reductions in shame. Overall, these results suggest that higher levels of emotion regulation may partially affect PTSD symptoms through reductions in shame. This may explain the efficacy of frontline PTSD treatments, as they explicitly focus on the processing of one's traumatic experience by reducing PTSD symptoms through regulation techniques that target emotional-behavioral cycles, which may include the shame-withdraw cycle.

Is there adequate evidence to support the use of compassion focused therapy group interventions with forensic mental health service users? A rapid evidence assessment

Compassion focused therapy (CFT) is a model of psychotherapy based on cultivating the capacity for compassion to others and self. The evidence base has grown considerably in the last decade regarding CFT’s effectiveness for a range of mental health problems. However, the literature supporting CFT as a treatment provision for forensic service users with mental health needs is lacking despite the observed overlap in needs between this population and their non-offending clinical counterparts. This rapid evidence assessment (REA) sought to evaluate the current evidence of CFT’s effectiveness as a group therapeutic intervention with clinical populations to allow consideration of the use of CFT with individuals with both mental health and criminogenic needs. A search of electronic databases was undertaken and after a process of review and extraction 10 papers were included. These studies showed promising effects of group-level CFT for those with complex mental health needs. Some evidence emerged of CFT generating significant improvements compared to no treatment and treatment as usual (TAU), but insufficient evidence has been produced in respect of whether CFT can supersede traditional ‘gold-standard’ approaches such as Cognitive Behavioural Therapy (CBT). Tentative conclusions are made regarding the applicability of CFT interventions but the observed reductions in shame and self-criticism and a move towards more guilt-based motivational drives suggest that this approach shows some promise in being able to assist forensic service users in taking more responsibility for their harmful actions and foster social and affiliative processes with others. Further high quality RCTs are needed in order to make firm conclusions about the clinical utility of this therapy for forensic populations with mental health needs.

Usage and Acceptability of the iBobbly App: Pilot Trial for Suicide Prevention in Aboriginal and Torres Strait Islander Youth.

BackgroundThe proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing and also concerning: Few apps have been rigorously evaluated, and, indeed, the safety of the vast majority of them has not been determined. Over 10,000 self-help apps exist but most are not used much after being downloaded. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers.ObjectiveThis paper presents pilot usage and acceptability data from the iBobbly suicide prevention app, an app distributed through a randomized controlled trial.MethodsAboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13), and data on their experiences with and views of the iBobbly app were also collected in semistructured interviews (n=13) and thematically analyzed. Finally, engagement with the app, such as the number of sessions completed and time spent on various acceptance-based therapeutic activities, was analyzed (n=18). Both groups were participants in the iBobbly app pilot randomized controlled trial (n=61) completed in 2015.ResultsRegression analysis indicated that app use improved psychological outcomes, although only minimally, and effects were not significant. However, results of the thematic analysis indicated that the iBobbly app was deemed effective, acceptable, and culturally appropriate by those interviewed.ConclusionsThere is a scarcity of randomized controlled trials and eHealth interventions in Indigenous communities, while extremely high rates of psychological distress and suicide persist. In this environment, studies that can add evidence from mixed-methods approaches are important. While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use. The results on engagement with the iBobbly app were however positive. This study showed that Indigenous youth are early and frequent users of technology in general, and they regarded the iBobbly app to be culturally safe and of therapeutic value. Qualitative analyses demonstrated that iBobbly app use was associated with self-reported improvements in psychological wellbeing, mental health literacy, and reductions in shame. Importantly, participants reported that they would recommend other similar apps if available to their peers.

Through Benevolent Eyes: the Differential Efficacy of Perspective Taking and Cognitive Reappraisal on the Regulation of Shame.

Difficulties in regulating feelings of shame is a risk factor for the onset and recurrence of mental health disorders. The present research investigated the impact of the individual differences in propensity to experience shame (or shame-proneness) on two emotion regulation strategies—perspective taking and positive reappraisal. A total of 228 participants, undergraduate students, were allocated randomly to one of the eight experimental conditions. The results revealed that for high shame-prone participants, the use of perspective taking, without positive reappraisal, led to a heightened experience of shame. In contrast, the combination of perspective taking and positive reappraisal led to reductions in shame among high shame-prone participants. The findings highlight the relationship between individual differences, and the separate and combined effects of affect regulation strategies on the experience of shame.

A participatory study of patient views on psychotherapy for complex post-traumatic stress disorder, CPTSD

Background A new diagnosis of Complex Post-traumatic Stress Disorder, CPTSD, is included in ICD-11 which was adopted in May 2019 by the World Health Organisation, WHO. In addition to the symptoms of PTSD, CPTSD includes emotional dysregulation, negative self-concept, and disturbances in relationships. It may be a helpful diagnosis for trauma survivors with experiences of human mistreatment such as torture and abuse. Aims This study explores the views of patients in the community on psychotherapy for the diagnosis of CPTSD, taking a qualitative, participatory approach. Method Twenty-four former patients from an NHS secondary mental health service in London interviewed each other about their treatment. Participants also collaborated in data analysis. All had a diagnosis of PTSD, with additional symptoms of CPTSD identified at assessment. Results The key factor in recovery was rebuilding relationships, beginning with the therapist. Groupwork was helpful in promoting relationships with others, as it may result in shame reduction. Involvement in the wider community through peer support groups was also valuable. Conclusions The rebuilding of relationships based on trust was an active mechanism of change and recovery from CPTSD. Participants felt that sufficient time, at least one year of psychotherapy with weekly sessions, was needed.