State Shame Research Articles

High trait shame undermines the protective effects of prevalence knowledge on state shame following HPV/CIN diagnosis in women.

Human papillomavirus (HPV), and the related, cervical intraepithelial neoplasia (CIN), are common yet poorly understood physical conditions. The diagnosis of HPV often elicits shame and guilt, which in turn may undermine psychological and physical health. The current study compared shame and guilt responses to diagnosis among two groups: women diagnosed with HPV/CIN and women diagnosed with Epstein-Barr Virus (EBV/IM). Eighty women recently diagnosed with HPV/CIN or EBV/IM completed measures of shame- and guilt-proneness, shame and guilt following diagnosis, and disease knowledge including prevalence estimates (HPV and EBV, respectively). HPV/CIN (vs. EBV/IM) predicted more diagnosis-related shame and guilt. Estimates of high prevalence interacted with diagnosis and shame-proneness to predict diagnosis-related shame. Simple slope analyses indicated that in women with HPV/CIN reporting low-to-average shame-proneness, high prevalence estimates reduced diagnosis-related shame; however, women high in shame-proneness experienced high diagnosis-related shame regardless of more accurate prevalence estimates. Women high in shame-proneness appear to be particularly vulnerable to HPV-related shame even when they are aware that it is very common.

Shame in Medical Education: A Randomized Study of the Acquisition of Intimate Examination Skills and Its Effect on Subsequent Performance

ABSTRACTTheory: Although medical students are exposed to a variety of emotions, the impact of emotions on learning has received little attention so far. Shame-provoking intimate examinations are among the most memorable events for students. Their emotions, however, are rarely addressed during training, potentially leading to withdrawal and avoidance and, consequently, performance deficits. However, emotions of negative valance such as shame may be particularly valuable for learning, as they might prompt mental rehearsal. We investigated the effect of shame on learning from the perspective of cognitive load theory. Hypotheses: We hypothesized that (a) training modality determines state shame, (b) state shame directly affects the quality of a clinical breast examination as one example of a shame-provoking exam, and (c) students who experience shame during training outperform those who just discuss the emotion during subsequent performance assessments. Method: Forty-nine advanced medical students participated in a randomized controlled, single-blinded study. After a basic, low-fidelity breast examination training, students were randomized to further practice either on a high-fidelity mannequin including a discussion of their emotions or by examining a standardized patient's real breasts. Last, all students conducted a breast examination in a simulated doctor's office. Dependent variables were measures of outcome and process quality and of situational shame. Results: Students training with a standardized patient experienced more shame during training (p < .001, d = 2.19), spent more time with the patient (p = .005, d = 0.89), and documented more breast lumps (p = .026, d = 0.65) than those training on a mannequin. Shame interacted with training modality, F(1, 45) = 21.484, p < .001, η2 = 0.323, and differences in performance positively correlated to decline in state shame (r = .335, p = .022). Conclusions: Students experiencing state shame during training do reenact their training and process germane load—in other words, learn. Furthermore, altering simulation modality offers a possibility for educators to adjust the affective component of training to their objectives.

High trait shame undermines the protective effects of prevalence knowledge on state shame following HPV/CIN diagnosis in women

High trait shame undermines the protective effects of prevalence knowledge on state shame following HPV/CIN diagnosis in women

A New Measure of the Expression of Shame: The Shame Code

While shame is essential for adaptive functioning, experiencing shame more often or intensely than others is strongly associated with psychopathology. To date, no measure of the behavioral expression of shame exists, despite the great potential for use in research and clinical settings. The present study aimed to assess the Shame Code, a new behavioral coding system of the expression of shame. Participants included 149 youth between the ages of 12 and 17 (50 % female, M = 14.5). Shame was elicited with a spontaneous speech task. Participants’ overall Shame Code scores were correlated only with a state measure of shame, however, structural equation modeling results showed that Shame Code variables combined differentially to assess state and trait shame scores. A two-factor model was the best fit to the data. The first factor, Fidget, consisted of Hiding, Fidget (positively loaded), Nervous Positive, and Stillness (negatively loaded). The second factor, Freeze, was comprised of Stillness, Facial Tension, and Silence (positively loaded). The Fidget factor was associated with higher Trait Shame and the Freeze factor was associated with higher State Shame but lower Trait Shame. Therefore, the Shame Code not only effectively captured the behavioral manifestations of shame, but Shame Code variables also differentially predicted state and trait shame.

Shame and guilt as shared vulnerability factors: Shame, but not guilt, prospectively predicts both social anxiety and bulimic symptoms

Social anxiety disorder (SAD) and bulimia nervosa (BN) are highly comorbid. However, little is known about the shared vulnerability factors that prospectively predict both SA and BN symptoms. Two potential factors that have not yet been tested are shame and guilt. In the current study we tested if shame and guilt were shared vulnerability factors for SA and BN symptoms. Women (N=300) completed measures of SA symptoms, BN symptoms, state shame and guilt, and trait negative affect at two time points, two months apart. Utilizing structural equation modeling we tested a cross-sectional and prospective model of SA and BN vulnerability. We found that shame prospectively predicted both SA and BN symptoms. We did not find that guilt prospectively predicted SA or BN symptoms. However, higher levels of both BN and SA symptoms predicted increased guilt over time. We found support for shame as a shared prospective vulnerability factor between BN and SA symptoms. Interventions that focus on decreasing shame could potentially alleviate symptoms of BN and SA in one protocol.

Encounters on the Yellow Brick Road: Navigating Mutual Experiences of Fear, Shame, and Destructuralization Along the Therapeutic Path

This article offers a narrative description of a challenging psychotherapeutic process from the vantage point of the author’s subjective experience. The treatment process, which evoked extreme states of fear and shame, ultimately culminating in a physical collapse, is considered from a self psychological perspective as well as a neo-Kleinian perspective. Projective identification, viewed herein as a bidirectional phenomenon, is considered in terms of its potential to expand and enrich our understanding of certain forms of selfobject transferences. Various iterations of coalescence and disjunction between the therapist and the patient are described, which reveal the dismantling and uniting influences of fear, shame, and destructuralization during the therapeutic process.

The Interplay Between Empathy and Authenticity in Moments of Clinical Disjunction

Responding to patients in the midst of intense disjunctions and impending shame states is challenging and worthy of struggle. When we are confronted with dramatically discrepant perspectives about relatedness and emotional meaning, our desire to understand our patients can seem at odds with our desire to express our own subjectivity. We strive to be empathic and authentic. The concepts of empathy and authenticity have been well-covered in the psychoanalytic literature, to the extent that theoretically they are no longer considered dichotomous. And yet, in the consulting room, it often feels that there remains a tension between these two responses. What has not been addressed sufficiently in the literature, and what remains an essential and ubiquitous clinical struggle, is how to understand these concepts in the context of clinical disjunction. This article examines what emerges when seemingly facile theory is challenged by the exigencies and immediacy of clinical practice. This is addressed by providing an in-depth exploration of a disjunction in which the therapist is caught by surprise, there is little time for reflection, and both an empathic and authentic response is indicated and hoped for.

Primary shame, mortal wound and tragic circularity: Some new reflections on shame and shame conflicts

Invited to contribute some thoughts on recent developments in psychoanalytic thinking about shame, the author starts off with Aristotle's prescient analysis of shame and then focuses on accumulating experiences in the psychoanalytic treatment of patients with severe neuroses, in particular the close relationship of severe traumatization and chronic states of shame, and how this is reflected in shelfdestructive repetitions. Reminiscent of what we know from tragedy and the tragic dimension of human existence, this repetition compulsion shows a built‐in circularity. These circular dynamics have at their core struggles with deep woundedness that can variably be conceived of as primary pain, primary shame and primary anxiety.Consequently, throughout the experiences with these patients goes the absoluteness both of their conscience and of their ideal, what we know as the “archaic superego:”

Role of shame and body esteem in cortisol stress responses.

Studies assessing the role of shame in HPA axis reactivity report mixed findings. Discrepancies may be due to methodological difficulties and inter-individual differences in the propensity to experience shame in a stressful situation. Hence, the current study combined self-report of shame and facial coding of shame expressions and assessed the role of body esteem as a moderator of the shame-stress link. For this, 44 healthy students (24F, age 20.5 ± 2.1 years) were exposed to an acute psychosocial stress paradigm (Trier Social Stress Test: TSST). Salivary cortisol levels were measured throughout the protocol. Trait shame was measured before the stress test, and state shame immediately afterwards. Video recordings of the TSST were coded to determine emotion expressions. State shame was neither associated with cortisol stress responses nor with body esteem (self-report: all ps ≥ .24; expression: all ps ≥ .31). In contrast, higher trait shame was associated with both negative body esteem (p = .049) and stronger cortisol stress responses (p = .013). Lastly, having lower body esteem predicted stronger cortisol stress responses (p = .022); however, it did not significantly moderate the association between shame indices and cortisol stress responses (all ps ≥ .94). These findings suggest that body esteem and trait shame independently contribute to strength of cortisol stress responses. Thus, in addition to trait shame, body esteem emerged as an important predictor of cortisol stress responses and as such, a potential contributor to stress-related negative health outcomes.

Comment on the Paper “Impasse-able”

In this discussion, certain aspects of the treatment of a severely disturbed patient are considered: (a) the temptation on the part of the analyst to “take sides” against the perverse influence of a pathological organization; (b) the necessity for the analyst to experience, not just understand, the crisis of the patient; and (c) the need for shameless openness in addressing shame states.

The Contribution of Creative Responses to the Experience of Shame in Couple Psychotherapy

This paper describes how the emotional states of shame and humiliation are interconnected. Recent neurophysiological findings are drawn on together with an appreciation of the developmental significance of shame in mother–infant interactions in the first two years of life to explain the importance of the application of these concepts to couple therapy. Object relations theory is also cited to explore some of the unconscious dynamics that might be operating in couples where shame and humiliation form the core of their relational dynamic. This is followed by the description of how partners can be helped to manage the other's shame effectively and, in so doing, give rise to a novel and much longed-for experience within the relationship. Finally, the clinical challenges of working with shame and humiliation in couple psychotherapy are considered.

Childhood Maltreatment, Shame-Proneness and Self-Criticism in Social Anxiety Disorder: A Sequential Mediational Model.

Previous research has shown a robust link between emotional abuse and neglect with social anxiety symptoms. However, the mechanisms through which these links operate are less clear. We hypothesized a model in which early experiences of abuse and neglect create aversive shame states, internalized into a stable shame-based cognitive-affective schema. Self-criticism is conceptualized as a safety strategy designed to conceal flaws and prevent further experiences of shame. However, self-criticism maintains negative self-perceptions and insecurity in social situations. To provide preliminary, cross-sectional support for this model, a nonclinical community sample of 219 adults from Israel (110 females, mean age = 38.7) completed measures of childhood trauma, shame-proneness, self-criticism and social anxiety symptoms. A sequential mediational model showed that emotional abuse, but not emotional neglect, predicted shame-proneness, which in turn predicted self-criticism, which in turn predicted social anxiety symptoms. These results provide initial evidence supporting the role of shame and self-criticism in the development and maintenance of social anxiety disorder. The clinical implications of these findings are discussed. Previous research has shown that histories of emotional abuse and emotional neglect predict social anxiety symptoms, but the mechanisms that underlie these associations are not clear. Using psycho-evolutionary and emotion-focused perspectives, the findings of the current study suggest that shame and self-criticism play an important role in social anxiety and may mediate the link between emotional abuse and symptoms. These findings also suggest that therapeutic interventions specifically targeting shame and self-criticism should be incorporated into treatments for social anxiety, especially with socially anxious patients with abuse histories.

Shame-related functions of and motivations for self-injurious behavior.

Drawing on the self-injury and self-conscious emotion literatures, this study examined the functions of and motivations for self-injury in 67 women, 25 of whom had a history of nonsuicidal self-injury (NSSI). Specifically, the present study tested whether women with a history of NSSI engaged in such behavior in order to reduce shame, in particular, and whether shame-related constructs represent important motivational factors for NSSI. To do so, participants completed (a) self-reports of NSSI functions and relevant personality dimensions (e.g., shame-proneness; shame aversion); and (b) a pain-inducing laboratory task with assessments of state emotions pre- and post-task. Elevations in aversion to general negative affect were associated with presence (vs. absence) of an NSSI history. However, consistent with a role for shame in NSSI, among women with an NSSI history, endorsement of shame regulation functions was positively associated with the frequency of NSSI. Moreover, elevations in shame-proneness were associated with more frequent NSSI, even after taking relevant, broader personality dimensions (e.g., proneness to general negative affect) into account. Finally, following the laboratory task, women with and without an NSSI history experienced reductions in state shame. Future directions for and clinical implications of the present research are discussed.

Researching State Shame With the Experiential Shame Scale

ABSTRACTAlthough debilitating effects of experiencing shame are posited in several theories of emotion and motivation, little research has been conducted on individuals’ “in-the-moment” feelings of shame (i.e., state shame). However, researching state shame is challenging because individuals may deny or underreport their feelings of shame, tend to self-isolate when they feel shame, and may be unwilling or unable to express themselves when feeling shame. The Experiential Shame Scale (ESS), an “opaque” measure of physical, emotional, and social markers of shame experiences, was developed to address the difficulties of assessing state shame. Evidence obtained in three studies of individuals’ emotional reactions following personally important exam feedback suggests that students' ESS ratings were uniquely related to feelings of state shame and not to state guilt. Findings also reveal that state shame is specifically related to feelings of shock and not surprise. As intended, findings suggested that the ESS has low face validity and is not related to social desirability.

Social Emotions and Cognition: Shame, Guilt and Working Memory

The relation between cognition and emotion has been increasingly explored in literature but few studies have explored the relation between social emotions and cognitive performances.To this end, 60 undergraduate female students were assigned to a dual-task condition in order to test their working memory abilities. They were then randomly assigned to three different writing disclosure tasks: shame condition, guilt condition and neutral condition. They were finally assigned to a new dual-task condition in order to assess differences on cognitive performances between the emotional and the neutral conditions. Statistically significant differences of dual-task performances related to the shame, guilt and neutral writing conditions were found. Shame and guilt conditions were related to lower cognitive performances than neutral condition subjects. In particular, state shame was a significant predictor of impairment in working memory performances. Furthermore shame-prone individuals were found to perform lower in working memory tests than guilt-prone participants suggesting a greater interference of shame (as emotional experience and as personal predisposition on working memory than guilt- related condition.

The Interpersonal Shame Inventory for Asian Americans: Scale development and psychometric properties.

This article reports the development and psychometric properties of the Interpersonal Shame Inventory (ISI), a culturally salient and clinically relevant measure of interpersonal shame for Asian Americans. Across 4 studies involving Asian American college students, the authors provided evidence for this new measure's validity and reliability. Exploratory factor analyses and confirmatory factor analyses provided support for a model with 2 correlated factors: external shame (arising from concerns about others' negative evaluations) and family shame (arising from perceptions that one has brought shame to one's family), corresponding to 2 subscales: ISI-E and ISI-F, respectively. Evidence for criterion-related, concurrent, discriminant, and incremental validity was demonstrated by testing the associations between external shame and family shame and immigration/international status, generic state shame, face concerns, thwarted belongingness, perceived burdensomeness, self-esteem, depressive symptoms, and suicide ideation. External shame and family shame also exhibited differential relations with other variables. Mediation findings were consistent with a model in which family shame mediated the effects of thwarted belongingness on suicide ideation. Further, the ISI subscales demonstrated high alpha coefficients and test-retest reliability. These findings are discussed in light of the conceptual, methodological, and clinical contributions of the ISI.

Shame in patients with narcissistic personality disorder

Shame has been described as a central emotion in narcissistic personality disorder (NPD). However, there is a dearth of empirical data on shame in NPD. Patients with NPD (N=28), non-clinical controls (N=34) and individuals with borderline personality disorder (BPD, N=31) completed self-report measures of state shame, shame-proneness, and guilt-proneness. Furthermore, the Implicit Association Test (IAT) was included as a measure of implicit shame, assessing implicit shame-self associations relative to anxiety-self associations. Participants with NPD reported higher levels of explicit shame than non-clinical controls, but lower levels than patients with BPD. Levels of guilt-proneness did not differ among the three study groups. The implicit shame-self associations (relative to anxiety-self associations) were significantly stronger among patients with NPD compared to nonclinical controls and BPD patients. Our findings indicate that shame is a prominent feature of NPD. Implications for diagnosis and treatment are discussed.

Self-Compassion Soothes the Savage EGO-Threat System: Effects on Negative Affect, Shame, Rumination, and Depressive Symptoms

Self-compassion, involving self-kindness, common humanity, and mindfulness, appears well-suited to soothing feelings of threat following negative events and thereby reducing depressive sequellae. Study 1 found a strong negative association between self-compassion and depressive symptoms in 335 university students and evaluated four markers of threat that potentially mediate this relation. A test of multiple mediation revealed shame as a significant mediator, along with rumination and self-esteem. In Study 2, shame-prone students recalled an experience of shame and then were randomly assigned to (1) write about it self-compassionately, (2) express their feelings about it in writing, or (3) do neither. Participants completed their assigned task three times in one week. Immediately after writing, participants in the self-compassion condition reported less state shame and negative affect than those in the expressive writing condition. At two-week follow-up, participants in the self-compassion condition alone showed reductions in shame-proneness (d = .53), and depressive symptoms (d = .49). It appears that self-compassion promotes soothing, “hypo-egoic” (Leary, 2012) responses to negative outcomes that reduce threat system activation and depressive symptoms.

Psychoanalytic Mommies and Psychoanalytic Babies: A Long View

I offer a retrospective view of the evolving baby metaphor in relational thinking. Early relational critiques of developmental tilt models and the concept of holding in clinical work, amplified by feminist writers, sharply skewed relationalists toward a vision of the patient-as-adult and a view of the analytic dialogue as inherently intersubjective. Bringing my own Winnicottian/relational perspective to this critique, I expanded the notion of holding and proposed a way to bridge Winnicottian holding with a relational perspective by exploring the analyst's participation in establishing and maintaining a holding experience. Here, I review and update this controversy, offering new ideas about holding's clinical function in buffering shame states.

Body-related state shame and guilt in women: Do causal attributions mediate the influence of physical self-concept and shame and guilt proneness

Guided by the process model of self-conscious emotions, this study examined whether physical self-concept (PSC) and shame and guilt proneness were associated with body-related self-conscious emotions of state shame and guilt and if these relationships were mediated by attributions of stability, globality, and controllability. Female participants (N=284; Mean age=20.6±1.9 years) completed measures of PSC and shame and guilt proneness before reading a hypothetical scenario. Participants completed measures of attributions and state shame and guilt in response to the scenario. Significant relationships were noted between state shame and attributions of globality and controllability, and shame proneness, guilt proneness, and PSC. Similar relationships, with the additional predictor of stability, were found for state guilt. Mediation analysis partially supported the process model hypotheses for shame. Results indicate PSC and shame proneness are important in predicting body-related emotions, but the role of specific attributions are still unclear.