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Compass of shame-avoidant behaviours and masking emotions (Webb, 2010, developed from Nathanson, 1992).  

Compass of shame-avoidant behaviours and masking emotions (Webb, 2010, developed from Nathanson, 1992).  

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Background: While 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 articl...

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... As such, trauma has been positioned as a significant public health issue which, as Magruder et al. (2017) argue, necessitates a 'trauma-informed approach' (TIA) to public health policy agendas. Shame is key emotional aftereffect of trauma, and an emerging literature argues that we may "have failed to see the obvious" by neglecting to acknowledge the influence of shame on post-trauma disorders (Taylor, 2015). In this article, we argue that effectively addressing the posttraumatic state necessitates a clear understanding of shame, its phenomenology and its effects. ...
... Shame has recently been included in the diagnostic criteria for PTSD in the DSM-V under the umbrella of "persistent negative emotional states" (Taylor, 2015). Hence, shame has recently come to be identified in the trauma literature as part of a constellation of negative emotions (along with fear, horror, anger, guilt) that are common for trauma survivors in post-trauma states. ...
... In addition, shame itself is shameful and taboo. As such, shame is an "iterated emotion," (Dolezal and Lyons, 2017, p. 258); its experience can lead to an intensification or multiplication of itself, leading to a "feeling trap" (Herman, 2011, p. 266) where "one can become ashamed because one is ashamed" (Taylor, 2015). For these reasons shame is usually avoided, shunned or kept secret at all costs, both individually and collectively. ...
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In this article, we outline and define for the first time the concept of shame-sensitivity and principles for shame-sensitive practice. We argue that shame-sensitive practice is essential for the trauma-informed approach. Experiences of trauma are widespread, and there exists a wealth of evidence directly correlating trauma to a range of poor social and health outcomes which incur substantial costs to individuals and to society. As such, trauma has been positioned as a significant public health issue which many argue necessitates a trauma-informed approach to health, care and social services along with public health. Shame is key emotional after effect of experiences of trauma, and an emerging literature argues that we may ‘have failed to see the obvious’ by neglecting to acknowledge the influence of shame on post-trauma states. We argue that the trauma-informed approach fails to adequately theorise and address shame, and that many of the aims of the trauma-informed are more effectively addressed through the concept and practice of shame-sensitivity. We begin by giving an overview of the trauma-informed paradigm, then consider shame as part of trauma, looking particularly at how shame manifests in post-trauma states in a chronic form. We explore how shame becomes a barrier to successful engagement with services, and finally conclude with a definition of the shame-sensitive concept and the principles for its practice.
... Given that higher levels of shame have been associated with slower recovery from PTSD (Taylor, 2015), balancing micro skills with macro frames may represent an underexplored method for treating the cognitive distortions, selfblame and shame that often accompany trauma exposure (APA, 2013). An example would be exploring with a survivor the extent to which her experience of sexual trauma is connected to rape culture (social norms whereby men prioritize their sexual urges over the rights of others) vs. the decision to consume alcohol or her particular wardrobe choice. ...
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Decades of social science data have illuminated how oppression and inequality on the macro levels of society can manifest as trauma and deprivation on the individual or micro level. However, clinical pedagogies within human services fields (social work, substance use disorder treatment, psychology, psychiatry) do not adequately reflect these advances. This creates barriers for service providers seeking to address socially-engineered trauma, i.e., trauma occurring in the context of oppressive macro structures such as white supremacist racism, neoliberal economic policies and cisgender-heteropatriarchy. Service provision that is structurally competent, on the other hand, exists at the intersection of macro and micro and offers both ethical and clinical advantages. Given its traditional focus on eliciting behavior change on the micro level, the therapeutic modality of motivational interviewing (MI) may not attract attention as a tool for addressing systemic social injustice. However, by integrating key elements of MI with SHARP – a framework for addressing oppression and inequality – new options for structural competence emerge. The resulting hybrid, Macro MI, offers tools to join with clients to assess the impact of structural oppression on individual problems, as well as to envision solutions that include macro systems change. Underpinning this approach is a belief that the collective work of tearing down and replacing the systems that create trauma is central to healing the wounds inflicted by oppression. Within Macro MI, activism, organizing and consciousness-raising are interventions to treat PTSD as well as tools for preventing trauma from occurring to other members of the community.
... Because of the importance of shame and social acceptance for survival, feelings of shame and social rejection are regulated by some of the same brain areas as physical pain and fear (61)(62)(63). Situations that elicit shame can activate the same defenses as bodily harm (60,64), particularly defensive withdrawal (65). It may, therefore, be vital to address parental shame related to a child's weight to avoid passive, avoidant health behaviors and responses to interventions. ...
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Background Childhood obesity (ChO) and eating disorders are on the rise, with concerning effects on health. Early prevention is essential as interventions after problems arise are costly and with a low success rate. In Norway, prevention of ChO has been largely weight-centered, without desired effects. Confident Body, Confident Child (CBCC) is a universal program aimed at preventing ChO, disturbed eating, and body image problems through a health-centered intervention for parents of children between 2 and 6 years. The current study is part of a cultural adaptation and translation of CBCC into Norwegian. Methods Focus groups with parents ( n = 16) and professionals ( n = 11) were held around healthy eating, activity, and body image, with an emphasis on possible barriers for prevention as well as approaches considered helpful. The interviews were analyzed using interpretative phenomenological analysis. Results Parents and professionals described parental stress connected to high standards, conflicting information, and parental comparison. A narrowing sense of normality around healthy living was described with little flexibility resulting in “all-or-nothing” thinking. Parents were anxious to say or do the wrong thing when regulating children's food intake and when faced with comments about appearance. Parents and professionals described parental concern around children not eating enough, and professionals described an increase in parents using food as regulation. Both parents and professionals expressed that having a child with overweight was tied to a sense of failure and shame. Interventions related to overweight seemed to increase stress and shame, further complicating follow-up. As an alternative, parents and professionals expressed a desire for interventions with normalizing information around “good-enough” parenting related to food and weight. Discussion The described fear of doing something wrong and lack of flexibility is interpreted within a stress-sensitive understanding, where stress and shame can influence parents toward mobilizing action or disengagement, presenting as dichotomous behaviors of “all-or-nothing”. Conclusion Interventions that can normalize parental concerns in a non-moralizing way may reduce stress and shame. CBCC addresses all the major concerns raised in this study, providing parents with evidence-based information they can implement into everyday life. The Norwegian cultural adaptation added extra emphasis on normalization and shame-reduction.
... Typical behavioral responses to shame such as avoiding eye contact and withdrawal can be viewed as defensive behaviors designed to avoid interpersonal conflict and the ire of others which might otherwise risk possible exclusion or rejection (Gilbert, 1997(Gilbert, , 2000. While the pain experienced from shame can therefore perform maladaptive functions of withdrawal from valued activities and social connections, the experience may, in particular contexts, also have an adaptive function (Taylor, 2015) of keeping one's behavior in line with socially acceptable norms. ...
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Self-stigma and shame are overlapping experiences that can have significant negative effects on many areas of life. This systematic review aimed to determine the effectiveness of mindfulness-based and third wave interventions in addressing self-stigma and shame and the impact of these interventions have on psychosocial functioning areas including community participation, quality of life, wellbeing, vocational achievement, help-seeking behavior, relationships and psychological health. Adverse effects were also reviewed. A search was completed using six electronic databases, two trial registries, contact with subject matter experts and a hand search of reference lists of included studies to identify randomized controlled trials of relevant studies. Twenty nine studies were included in the review, comprising 2051 participants, the majority of whom identified as female (73.4%), white and adults less than 40 years of age. Most studies took place in North American or European countries. The majority of studies were assessed as having high risk of bias using the Cochrane Risk of Bias tool. Caution is therefore advised in interpretation. Results suggested that interventions aiming to enhance self-compassion or those based on acceptance and commitment therapy may have particular utility in addressing self-stigma and shame. Mindfulness-based and third wave interventions may also have a positive impact on quality of life and aspects of psychological health. Implications for practice and future research are discussed.
... The inclusion of shame as a symptom for PTSD in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5; Taylor, 2015) is in line with findings of a significant relationship between shame and PTSD (Beck et al., 2011;Leskela et al., 2002). The presence of shame 6 months after the traumatic experience was found to be the only emotion to predict PTSD, even when controlling for shame and anger feelings assessed in the first month after the traumatic event (Andrews et al., 2000). ...
... In addition, the authors also showed that peritraumatic shame mediated the relationship between the number of experienced traumatic events and PTSD symptoms. Unacknowledged shame in PTSD treatment may even worsen the symptoms experienced by the individual (Taylor, 2015). ...
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Background: Shame is an emotion reflecting an anticipated social devaluation of the self. It is strongly associated with experiences of humiliation and rejection in early life. Individuals suffering from posttraumatic stress disorder (PTSD) often struggle with shame. However, little is known about how shame contributes to the development and maintenance of PTSD symptoms in children. The present study investigated the ways childhood exposure to human-induced traumatic events promotes a coping mechanism of defeat and withdrawal facilitated by the experience of shame. We tested a dose-response relationship between lifetime experienced traumatic event types and PTSD in children using shame as a mediator. Methods: We conducted semi-structured interviews with 33 male children who lived and worked on the streets of Bujumbura, the capital of Burundi at the time of data collection. We assessed self-reported PTSD symptom severity, lifetime traumatic event load, violence experienced on the streets, and shame intensity. Results: Mediation analyses revealed a significant indirect effect of lifetime traumatic events on PTSD symptom severity through shame intensity and a significant indirect effect of violence experienced on the streets on PTSD symptom severity through shame intensity. Conclusion: Our study suggests the mediating role of shame between traumatic experiences as well as violent experiences and PTSD symptom severity in children living on the streets. Shame in children suffering from PTSD seems to play a crucial role in the development and maintenance of PTSD symptoms.
... Our results indicated that the mediating effect of posttraumatic negative self-appraisals on the association between maladaptive schemas and PTSD symptom severity was primarily through posttraumatic shame, rather than self-blame. Posttraumatic shame may be a stronger pathway from maladaptive schemas to PTSD symptom severity due to an increased self-critical burden (Cunningham et al., 2018;Taylor, 2015). Maladaptive schemas, operating through posttraumatic shame, may be intensified by self-critical beliefs following a traumatic event (e.g., "I deserved to be assaulted"), which have been shown to increase PTSD symptom severity (Brown et al., 2019). ...
... Through posttraumatic shame, they are further inhibited from processing trauma-related emotions by distancing themselves from other people who may provide support. Internalized emotional distress has been indicated in the development and maintenance of PTSD symptoms through the prevention of adaptive emotional and cognitive processing (Taylor, 2015). ...
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Maladaptive schemas have been linked with increased posttraumatic stress disorder (PTSD) symptoms. Posttraumatic negative self-appraisals (i.e., posttraumatic shame and self-blame) have also been empirically supported as contributors to PTSD symptom severity following traumatic events. These associations are well known; however, the pathways between maladaptive schemas and PTSD symptoms remain largely unclear. The present study aimed to examine the mediating effects of posttraumatic negative self-appraisals (shame and self-blame) on the association between maladaptive schemas and PTSD symptom severity in patients completing a partial hospitalization program. Patients (N = 98) completed measures of early maladaptive schemas, posttraumatic shame, posttraumatic self-blame, and PTSD symptom severity at intake. Posttraumatic negative self-appraisals mediated the association between maladaptive schemas and PTSD symptom severity. When we examined the specific mediating effects of shame and blame – rather than negative self-appraisals overall – shame was a significant mediator (b = .153, 95% CI [.031, .296]), but not blame (b = .038, 95% CI [−.083, .204]). Further, posttraumatic shame mediated the association between two of the four schema domains – disconnection & rejection (b = .092, 95% CI [.030, .201]) and impaired autonomy & performance (b = .047, 95% CI [.002, .124]) – and PTSD symptom severity. These findings highlight the importance of posttraumatic shame in the association between maladaptive schemas and PTSD symptom severity. Theoretical and practical implications are discussed.
... They include persistent and exaggerated negative expectations of oneself, as well as a distorted sense of self-or other-focused blame regarding the causes and consequences of the traumatic event (1). A patient with PTSD often experiences pervasive, negative emotional states, of which the most common are self-conscious, internally-directed emotions such as guilt and shame (29,30). Symptoms related to SRP abnormalities may play an important role in the maintenance or exacerbation of the symptoms of PTSD, and the development of comorbidities. ...
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Background: Post-traumatic stress disorder (PTSD) is a psychiatric illness with high prevalence in civil and military environments. The clinical course regardless of management is chronic for number of patients, especially for veterans. The persistence of symptoms interacts with the body and person representations and may impact the rehabilitation process. Sport is known to help psychiatric patient, as PTSD, for improving body connection and physiological emotional regulation. However, the impact of sport on self-representations has not yet been studied. First, this study aims to explore the person and body representations in patients suffering from chronic PTSD in a specific population of veterans according to the PTSD clinical severity. Second, it aims to explore how a nine-days military sports program, including socio-professional rehabilitation, changes the person and body representations. Methods: A qualitative exploratory study used inductive words of "body" and of "person" for studying self-representation of veterans with chronic PTSD before the rehabilitation sports program. At the same time, PTSD severity and mind-body connection were assessed using the post-traumatic checklist (PCL-5) and the Freiburg Mindfulness Inventory (FMI), respectively. Parasympathetic activity at rest was recorded. A part of the veterans participated in post-program session recording the same semantic, psychological and physiological variables. Results: Although the veterans exhibited more negative than positive words, no difference was observed on the number of verbal representations according to the PTSD severity. At the post-program, changes were observed in terms of categories of body and person words: some negative categories of words disappeared, and some positive categories of words appeared. This was associated with a decrease in PTSD severity, an increase in mind-body connection but also with a decrease in the level of parasympathetic activation. Conclusions: This study highlighted a negative representation of the Self for veterans with chronic PTSD. The specific program including regular sport practice improved the self-representations related to both person and body. This was associated with less PTSD suffering.
... Any equivocal responses (e.g., exhibiting disgust, seeming overcome by the content, appearing rejecting, judgmental or dismissive) may result in the patient's silence about this content and can result in premature treatment termination. In addition, because witnessing the shame of another can be shame-inducing in some sense, the clinician may feel conflicted about pointing out this emotion, which communicates nonverbally that this content must remain unspoken [19]. Useful resources for clinicians who work with patients with histories of extremely shameful indignities and humiliations include receiving clinical supervision and attending regular psychotherapy. ...
... Taylor recommends that, when trying to address excessive shame, the clinician focus on three potential domains: intrapersonal shame which can be evident through changes in self-concept; interpersonal shame at the intimate level, which can result in changes within the interpersonal realm; and interpersonal shame at a societal level, which could be represented through social loss, isolation, and segregation from health workers, family, friends, staff at work or school. In addition, it is recommended that the therapist be alert to signs of "unacknowledged shame" which may be represented by maladaptive shame regulation strategies such as acting out behaviours or substance abuse or the unconscious process of dissociation and seizures [19]. ...
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Previous research has established a link between Psychogenic Nonepileptic Seizures (also known as dissociative or functional seizures) and abnormal emotion processing. In a companion article to this multidisciplinary narrative review, we have argued that, in the context of a biopsychosocial understanding of the condition, the emotion of shame is particularly likely to contribute to the aetiology, manifestation, semiology and perpetuation of psychogenic non-epileptic seizures (PNES). Here we demonstrate how unrecognised and unaddressed shame may cause difficulties when clinicians explain the diagnosis, attempt to engage patients in psychological treatment, construct a diagnostic formulation and undertake psychotherapy. Case vignettes are used to bring theoretical considerations to life and to illustrate the complex interactions which may be observed between high shame proneness, chronic and dysregulated shame, stigma and PNES. The particular focus on shame does not mean that recent explanatory models of PNES are obsolete. Rather, we demonstrate how the inclusion of shame helps to embed the emotional, cognitive and behavioral aspects of the Integrative Cognitive Model (ICM) of PNES in a social / interpersonal context. While we describe how a number of different psychotherapeutic approaches can help to address shame-related processes we conclude that specific modalities are less important than the eventual enhancement of emotional literacy and tolerance through a healing relationship with the psychotherapist.
... Factors such as trauma type, trauma severity, age at trauma, lack of social support, or additional life stress are known risk factors for the development of PTSD in traumaexposed adults (Brewin, Andrews, & Valentine, 2000). Results from a sample of sexual assault survivors (Ullman, Townsend, Filipas, & Starzynski, 2007) suggest that negative social reactions and avoidance coping are the strongest predictors for PTSD symptoms and that negative social reactions from others may contribute to both self-blame and PTSD (see also Taylor, 2015). Findings from another study on sexual assault survivors suggest that behavioural self-blame (i.e. ...
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Background: The context in which individuals are exposed to child sexual abuse (CSA) and reactions to the disclosure of such abuse experiences play a major role in post-traumatic mental health. Female-perpetrated CSA is an under-recognized issue in society and mental health care, and is therefore supposed to be a breeding ground for stigmatization. Objective: The aim of the current study was to examine the mediating role of internalized and anticipated stigma on the effects of so-called victim-blaming experiences and the perception of abuse in the childhood of survivors of female-perpetrated CSA on their post-traumatic symptom severity. Method: A total of 212 individuals who reported experiences of female-perpetrated CSA were assessed in an anonymous online survey. The International Trauma Questionnaire (ITQ) served as the primary outcome parameter for detecting differences in post-traumatic symptom severity within mediation analyses, where victim-blaming and abuse awareness served as predictors and anticipated as well as internalized stigma served as mediator variables. Results: Internalized stigma fully mediated the deteriorating effect of victim-blaming on post-traumatic symptom severity, while abuse awareness and anticipated stigma showed no statistically significant effects as predictor and mediator variables. Yet, victim-blaming had a significant increasing effect on anticipated stigma. Conclusions: Efforts to enhance awareness of female-perpetrated CSA in society are needed and mental health care professionals should pay attention to the adverse effects of victim-blaming and internalized stigma on post-traumatic symptoms in individuals affected by female-perpetrated CSA.
... There is research that suggests that the inclusion of interventions designed to address excessive shame could be a useful component within treatment (Beck et al., 2011). Theorists have proposed that shame and guilt contribute to the emotional aversiveness of the trauma memory, and thus to increased frequency and intensity of intrusive memories of the trauma (Goldblatt, 2013;Taylor, 2015). Exposure to the traumatic memory may also lead to an exacerbation of these feelings if they are not directly addressed and treated (Lee, Scragg, & Turner, 2001;Taylor, 2015), thus harming the emotional processing of the traumatic event (Cunningham, 2020;. ...
... Theorists have proposed that shame and guilt contribute to the emotional aversiveness of the trauma memory, and thus to increased frequency and intensity of intrusive memories of the trauma (Goldblatt, 2013;Taylor, 2015). Exposure to the traumatic memory may also lead to an exacerbation of these feelings if they are not directly addressed and treated (Lee, Scragg, & Turner, 2001;Taylor, 2015), thus harming the emotional processing of the traumatic event (Cunningham, 2020;. Although fear is current or future oriented, guilt is a retrospective emotion and less amenable to change through exposure-it may prevent the successful integration of the traumatic events with prior beliefs, and maintain avoidant coping strategies that sustain PTSD (Vermetten & Jetly, 2018). ...
... When unprocessed traumatic emotions are relived with one's therapist, the reliving is almost always accompanied by a dissociated shame experience (Bromberg, 2009;Luyten & Fonagy, 2019). Shame may also remain unidentified as it is shameful in and of itself (Taylor, 2015). The presence of other emotional states alongside fear may require a different and more integrative treatment approach to treating PTSD. ...