shame

A Comprehensive Review of Generalized Shame Measures: What Clinicians and Researchers Need to Know 

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Shame is a complex, self-conscious emotion that plays a significant role in both social functioning and psychological well-being. While shame can be a healthy response in certain contexts, chronic and intense feelings of shame have been linked to a variety of mental health issues, including depression, post-traumatic stress disorder (PTSD), and substance misuse. Given the profound impact of shame on mental health, the need for reliable and valid measures of this emotion is paramount. A recent systematic review, conducted by a team of researchers including Kati Lear, PhD and Jason Luoma, PhD from Portland Psychotherapy, offers valuable insights into the current state of self-report measures of generalized shame. 

The Complexity of Measuring Shame 

Shame is not a straightforward emotion to assess. It encompasses a wide range of experiences, from a fleeting twinge of self-consciousness to a deeply ingrained sense of personal failure. This complexity is reflected in the variety of approaches researchers have taken to measure shame. Some measures focus on the frequency and intensity of shame-related emotions, while others assess how likely individuals are to experience shame in hypothetical situations. 

This review highlights the diverse conceptualizations of shame, noting that it can manifest as both an emotional reaction to how one sees themself (internalized shame) and how one perceives themself to be viewed by others (external shame). This dual nature of shame adds another layer of complexity to its measurement, with some tools focusing on internalized shame, others on external shame, and a few attempting to capture both dimensions. 

Strengths and Limitations of Existing Measures 

The review identified 19 different self-report measures of generalized shame, each with its own strengths and limitations. While some measures, such as the Internalized Shame Scale (ISS) and the Test of Self-Conscious Affect (TOSCA), are widely used and have shown promising psychometric properties, the review found that none of the existing measures fully meet the criteria for recommended use based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. 

One of the key challenges identified in the review is the lack of studies assessing the development and content validity of these measures. Content validity, which refers to how well a measure captures all aspects of the construct it intends to assess, is particularly important for complex emotions like shame. However, the review found that many measures lacked comprehensive development studies, and those that did exist often had methodological shortcomings. 

Another significant issue is the difficulty distinguishing between shame and closely related emotions like guilt. While some measures attempt to separate these emotions, the review notes that this distinction is not always clear in practice. This overlap can complicate the interpretation of results and may limit the utility of certain measures in clinical settings. 

Implications for Clinical Practice 

For clinicians, the review’s findings underscore the importance of selecting shame measures with intention. While generalized shame measures can provide valuable insights, they may not always capture the specific aspects of shame that are most relevant to a particular client or context. For example, scenario-based measures, which assess how individuals might respond to hypothetical situations, may be more useful for understanding how shame manifests in specific contexts, whereas experience-based measures, which assess the frequency of shame-related emotions, might be better suited for tracking changes in shame over time. 

The review also highlights the potential benefits of using multidimensional measures that assess different components of shame separately. For instance, distinguishing between internal and external shame could help clinicians better understand the specific triggers and consequences of a client’s shame, allowing for more targeted interventions. 

Moving Forward: Recommendations for Future Research 

This systematic review provides a clear roadmap for future research on shame measures. The authors call for more rigorous development and validation studies, particularly those that include diverse populations and examine the cross-cultural validity of shame measures. They also suggest that future research should focus on creating measures that can reliably distinguish between shame and related constructs, such as guilt and self-criticism. 

Additionally, the review points to the need for measures that can assess the impact of clinical interventions on shame. While some existing measures have shown promise in this area, more work is needed to establish their responsiveness to change, particularly in clinical populations. 

In conclusion, while the field of shame measurement has made significant strides, there is still much work to be done. By addressing the gaps identified in this review, researchers can develop more reliable and valid tools for assessing shame, ultimately improving our understanding of this complex emotion and its role in mental health. For clinicians, this review offers valuable guidance on selecting and using shame measures in practice, helping to ensure that clients receive the most effective and personalized care possible. 

You can find the full pre-print text here.

Addressing Internalized Shame in Justice-Involved Women with Substance Use Disorders: Insights from a New Study 

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Internalized shame presents a significant challenge for people seeking recovery, particularly among justice-involved women with substance use disorders (SUD). Shame, compounded by societal stigma, often impedes the recovery process. For this population, mindfulness-based relapse prevention (MBRP) emerges as a promising approach to addressing internalized shame and fostering justice-involved women’s recovery. A recent study, co-authored by Dr. Jason Luoma, explores how internalized shame evolves during SUD treatment and highlights MBRP’s potential as a therapeutic intervention. 

Why Focus on Shame and Justice-Involved Women? 

Shame, a deeply personal emotion, can develop when people internalize stigmatizing beliefs about themselves. For justice-involved women, societal stigma can be especially pervasive, intersecting with gendered expectations around roles such as motherhood. Research highlights that internalized shame can impair treatment outcomes, reduce self-esteem, and lead to avoidance behaviors that hinder recovery. Studies have also shown a correlation between shame and relapse rates, making it crucial to address shame for long-term recovery success. 

Study Overview 

This secondary analysis focused on 105 women undergoing residential SUD treatment in a nonprofit facility in the Pacific Northwest. Participants, many of whom had faced incarceration or nonviolent substance-related charges, were randomized into two groups: one received MBRP, while the other received traditional relapse prevention (RP). Both interventions aimed to equip participants with strategies for managing cravings and high-risk situations. Mindfulness, a key component of MBRP, emphasized acceptance and non-judgment of present-moment experiences—a potential cornerstone for reducing internalized shame in substance use disorder (SUD) recovery. 

Key Findings 

The study identified significant reductions in internalized shame across both treatment groups from baseline to post-treatment. While participants in the MBRP group showed slightly greater reductions, the difference was not statistically significant. These findings suggest that both interventions, when delivered in a supportive group setting, can foster an environment that alleviates feelings of shame and isolation. 

Importantly, the study also confirmed the reliability of the Internalized Shame Scale (ISS) in this context, establishing that it accurately measures internalized shame across different treatment conditions and time points. This marks a critical step for future research into shame as a measurable construct within SUD treatment. 

Mindfulness and Its Role in Shame Reduction 

Mindfulness-based interventions have shown promise in addressing shame by encouraging people to observe their thoughts and feelings without criticism. Previous studies have linked increased mindfulness with improved self-esteem and reduced emotional distress. In this study, MBRP’s mindfulness practices appeared to help participants develop greater acceptance and reduce avoidance behaviors, potentially lessening the grip of shame over their self-perception. 

For justice-involved women, who often face unique societal and systemic pressures, these benefits are especially noteworthy. The structured group setting, shared experiences, and mindfulness techniques may collectively work to break the cycle of self-stigmatization and promote recovery. 

Implications for Practice 

This study provides valuable insights into the potential for addressing shame within SUD treatment settings. Here are some practical takeaways: 

Incorporating Mindfulness Practices: Whether through MBRP or integrated into traditional approaches, mindfulness can empower people to confront and accept their experiences, fostering resilience in recovery. 

Tailored Interventions for Justice-Involved Women: Treatment programs should consider the unique stigma-related challenges faced by this group, such as the societal judgment of mothers with SUD histories. 

Building Supportive Group Environments: The group dynamic in both MBRP and RP was identified as a key factor in reducing feelings of isolation, an emotion often intertwined with shame. 

Looking Ahead 

While this study offers promising insights, it also underscores the need for further research. Future studies could explore how specific components of MBRP, or other mindfulness-based interventions contribute to reducing shame. Additionally, expanding sample sizes and exploring long-term outcomes beyond 15 weeks post-treatment could provide a more comprehensive understanding of these interventions’ effectiveness. 

Conclusion 

This study highlights the complex interplay of shame, stigma, and recovery in justice-involved women with SUD. Mindfulness-based relapse prevention (MBRP) offers a promising approach to reducing internalized shame in substance use disorder (SUD) treatment. By integrating mindfulness techniques and fostering group support, MBRP can empower justice-involved women’s recovery, offering hope for those navigating the challenges of stigma and shame. As research continues to illuminate effective strategies, treatment programs can better address these barriers, paving the way for more compassionate and inclusive recovery pathways. 

Download a pre-print copy here 

There’s no Shame in Having OCD – Addressing Shame in OCD Treatment

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Shame is all too common among people with obsessive-compulsive disorder (OCD). Almost every person who I have worked with has expressed feeling ashamed and embarrassed about the content of their intrusive thoughts or the nature of the compulsions they engage in to combat them. This has been true for my clients whether they have been struggling with obsessions about contamination, self-harm, relationships, or something else. A common question I hear is “Why can’t I do X, Y, or Z like a ‘normal person’?” Along with such questions usually comes a barrage of self-critical thoughts like, “I’m such a weirdo” or “I’m so weak for repeatedly giving in to my intrusive thoughts.” In addition, it certainly doesn’t help to hear friends, family, and strangers – even if unintentionally – belittle your struggle when they talk about “being so OCD” as if this were a punchline.

Hopefully you are already well aware that highly effective, evidence-based treatments for OCD exist (e.g., Exposure and Response Prevention, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy)and are provided by our expert clinicians in the Portland Psychotherapy Anxiety Clinic. A lesser known component of these treatments is that they often involve an explicit focus on developing skills to more effectively respond to shame and self-criticism. Below are two examples of how evidence-based OCD treatments might address shame and self-criticism related to OCD, including links to helpful resources.

ADDRESSING SHAME VIA ENHANCING SELF-COMPASSION

People, including individuals with OCD, are often naturally skillful at acting compassionately towards others. However, it can be much harder to turn that compassion inwards. Therapeutic approaches to enhancing self-compassion include learning about self-compassion, understanding how it operates in your own life, and developing a consistent self-compassion routine via practicing self-compassion-focused exercises. To learn more about self-compassion and to see example exercises, use the following links:

ADDRESSING SHAME VIA COMBATING OCD STIGMA & MISINFORMATION

The reality is that most people’s understanding of OCD is limited to media caricatures they have seen of people who are highly perfectionistic and/or extremely focused on cleanliness. One of the most common initial tasks of OCD treatment is to dispel common myths about OCD and provide more factual information. Whenever possible, I like to incorporate individuals’ main support systems in this “de-mystifying OCD” process. It becomes easier to feel less ashamed about OCD when you and the people around you understand OCD and feel like you’re on the same team in treating it. For folks who encounter OCD-related stigma especially frequently, treatment may also involve learning and rehearsing ways to practice self-advocacy. Lastly, people often find it helpful to develop a sense of community in order to feel less isolated and alone in their struggles with OCD. To learn more about OCD and to see example exercises and resources, use the following links:

https://iocdf.org/about-ocd/

https://iocdf.org/realocd/

https://iocdf.org/programs/conferences/

The Newest Study Supported by Portland Psychotherapy: Helping People with the Stigma of Injection Drug Use and HIV in Russia

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Stigma is a pervasive problem that can negatively impact healthcare outcomes for those affected by it. Stigmatized groups, such as people living with HIV who inject drugs, can face many barriers to care that stem from societal attitudes toward their condition. HIV and substance use stigma, when combined, can lead to further avoidance of care and poor health outcomes.

The findings from the SCRIPT (Stigma Coping to Reduce HIV Risks and Improve substance use Prevention and Treatment) study were recently published. This study was conducted by Karsten Lunze, MD, of Boston University Medical School, in collaboration with Jason Luoma, the CEO of Portland Psychotherapy. This study aimed to test an intervention developed by Dr. Luoma to help people cope with intersectional HIV and substance use stigma. The research studied people with HIV who inject drugs, who often face significant barriers to accessing care due to both HIV and substance use stigma.

To develop the intervention, the research team modified an Acceptance and Commitment Therapy (ACT) approach to target people with HIV who inject drugs. ACT is a type of cognitive-behavioral therapy that focuses on accepting difficult emotions and thoughts rather than trying to eliminate them. By teaching people how to cope with stigma through acceptance-based approaches, the study aims to reduce the link between internalized attitudes, fears, and shame, and healthcare avoidance behaviors.

The SCRIPT study aimed to evaluate the intervention’s effects on HIV and substance use stigma, care engagement, and injection drug use frequency. The study will also assess the intervention’s implementation by looking at participant satisfaction, intervention fidelity, and uptake.

The study found that people who received the intervention were more likely to start HIV and substance use treatment than those who did not receive the intervention. The increase in care engagement may be due to the fact that the intervention helped people to cope with stigma and reduced their avoidance of healthcare settings. The intervention was not designed to directly reduce shame and fears related to stigma, but rather focused on helping people to cope with stigma and improve their behavior and care seeking.

The implications for practice are that acceptance-based approaches can be effective in reducing stigma and improving care engagement in people with HIV who inject drugs. Healthcare providers should be trained to recognize and address intersectional stigma in their patients and use interventions that incorporate acceptance-based approaches to reduce stigma’s negative impact.

Portland Psychotherapy’s involvement in this study exemplifies the organization’s commitment to using its resources to address societal problems. By supporting research that aims to improve healthcare outcomes for stigmatized populations, Portland Psychotherapy is helping to make a positive impact on the community.

The Effects of Sexual Assault on the Brain and Body

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While it is common knowledge that sexual assault can be traumatizing, many people do not fully understand the profound effects it has on a survivor. As a society, we do not always discuss the immediate and long-term impact on the brain and body, but it’s important for both survivors and the people who support them … Read more

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