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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 

Exploring the Role of Psychological Inflexibility, Mindfulness, and Self-Compassion in PTSD  

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Post-Traumatic Stress Disorder (PTSD) remains a significant mental health challenge, especially among veterans. A recent study published in the Journal of Contextual Behavioral Science delves into the interplay between psychological inflexibility, mindfulness, and self-compassion in the context of PTSD. The study, led by a team of researchers including Jason Luoma PhD from Portland Psychotherapy, provides critical insights into how these psychological mechanisms may influence PTSD symptoms and treatment outcomes.

Psychological Inflexibility: A Barrier to Recovery

Psychological inflexibility, a core concept in Acceptance and Commitment Therapy (ACT), is defined as the tendency to avoid or escape from uncomfortable internal experiences such as distressing thoughts, emotions, or memories and the impacts this has on people’s abilities to live according to their values and goals. This avoidance can lead to a range of maladaptive behaviors, which exacerbate PTSD symptoms rather than alleviate them. The study found that veterans with PTSD exhibited significantly higher levels of psychological inflexibility compared to those without PTSD. This finding underscores the importance of targeting psychological inflexibility in therapeutic interventions, as it may be a key barrier to recovery.

The Role of Mindfulness in Managing PTSD

Mindfulness, which involves focused and nonjudgmental attention to the present moment, has been widely promoted as a beneficial practice for managing PTSD symptoms. However, the study presents a nuanced view of how different facets of mindfulness interact with PTSD. Notably, the “observing” facet of mindfulness was associated with higher levels of PTSD symptoms, while the “describing” facet, which involves putting internal experiences into words, was linked to lower PTSD severity.

These findings suggest that not all mindfulness practices may be equally beneficial for individuals with PTSD. For example, mindfulness practices that emphasize observing one’s experiences without judgment might inadvertently increase hypervigilance or distress in some individuals with PTSD. However, practices that encourage describing and verbalizing experiences may help process trauma and reduce symptoms.

Self-Compassion: A Complex Relationship with PTSD

Self-compassion, which involves treating oneself with kindness and understanding in times of difficulty, has been found to have a generally protective effect against PTSD. However, the study’s findings complicate this narrative. While initial analyses showed that higher levels of self-compassion were associated with lower PTSD symptoms, this relationship diminished when psychological inflexibility was controlled for. This suggests that self-compassion alone may not be sufficient to counteract the effects of psychological inflexibility in individuals with PTSD.

This finding highlights the need for a more integrated approach in PTSD treatment, where self-compassion is combined with interventions aimed at reducing psychological inflexibility. Such an approach could potentially provide more robust and enduring relief from PTSD symptoms.

Implications for PTSD Treatment

The findings from this study have important implications for the treatment of PTSD, particularly among veterans. By identifying psychological inflexibility as a significant predictor of PTSD severity, the research suggests that treatments like ACT, which specifically target this inflexibility, may be particularly effective. Additionally, the nuanced understanding of mindfulness and self-compassion offered by the study can help clinicians tailor their interventions more effectively to meet the needs of their clients.

For veterans struggling with PTSD, addressing psychological inflexibility through targeted therapeutic interventions could be a crucial step toward recovery. Moreover, combining mindfulness practices that emphasize description and verbalization with self-compassion training may offer a more comprehensive approach to reducing PTSD symptoms.

Follow this link to find a pre-print version of this paper.

How Self-Criticism Impacts Emotional Responses in Social Contexts

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A recent study led by researchers from Portland Psychotherapy, including Kati Lear PhD and Jason Luoma PhD, delves into the complex relationship between self-criticism, emotional regulation, and interpersonal connections.

Published in Motivation and Emotion, this study investigates how highly self-critical people (HSCs) react to affiliative stimuli—cues that invite social bonding—and how these reactions may perpetuate feelings of social isolation.

Understanding Self-Criticism and Affiliative Stimuli

Self-criticism involves negative self-evaluation and is often employed as a self-protective mechanism to avoid rejection. However, it has been linked to interpersonal problems, such as reduced relationship satisfaction and heightened loneliness. This research tried to understand this link between self-criticism and interpersonal problems by focusing on how HSCs emotionally respond to two types of affiliative video stimuli: one intended to feeling related to caregiving and another intended to elicit feelings related to cooperative interactions.

Key Findings in Low and High Self-Criticism

The researchers observed that HSCs experienced more negative emotions, such as shame and distress, in response to both types of videos compared to people with low self-criticism (LSCs). These negative emotions were particularly pronounced in response to the caregiving video, which often elicited feelings of shame and defensiveness. Contrary to expectations, people’s self-criticism did not predict lower experiences of positive emotions like warmth, suggesting that HSCs’ challenges in social bonding may stem more from the presence of negative emotions rather than the absence of positive ones.

The Role of Expressive Suppression

In addition to experiencing more negative emotions, HSCs were more likely to use inhibit the expression of these emotion, across both video conditions. This suggests that part of how self-criticism is linked to interpersonal problems is through the tendency to inhibit the expression of emotion. Research has hiding your true emotions makes it more likely that people will feel anxious and uncomfortable around that person. The flat or masked expressions that result are often make others want to get some distance.

Implications for Therapy and Social Connection

The findings highlight the importance of addressing self-criticism in therapeutic settings. Helping HSCs process and understand their negative emotions in safe environments could be an essential step toward improving their interpersonal relationships. Interventions like group therapy or compassion-focused meditations may also help HSCs reframe their emotional experiences in response to affiliative stimuli or how to express negative emotions in an adaptive way that doesn’t cause interpersonal problems.

Conclusion

This important study by Portland Psychotherapy researchers sheds light on how self-criticism influences emotional dynamics in social situations. By understanding these patterns, therapists and clinicians can develop tailored strategies to support people struggling with self-criticism and improve their capacity for meaningful social connection. For those interested in learning more, you can access the full study in Motivation and Emotion.

Download a pre-print version of this paper here.

New Research Sheds Light on How Self-Criticism Damages Social Relationships 

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The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness. 

A team of researchers from Portland Psychotherapy recently published an intriguing study that sheds light on how self-criticism can damage social relationships. Self-criticism, defined as the tendency to negatively and harshly evaluate oneself, has been linked to poorer interpersonal functioning and social isolation. However, the specific mechanisms underlying this association have been unclear. In this new study, published in Current Psychology, the research team identified some likely interpersonal behaviors through which self-criticism exacerbates social disconnection. 

The researchers, Jason B. Luoma, PhD and Christina Chwyl surveyed over 300 participants from the community. They measured self-criticism along with three interpersonal variables – expressive suppression, expression of positive emotions, and self-concealment. Expressive suppression involves inhibiting the outward display of emotions. Self-concealment refers to the tendency to hide personal information perceived as negative or distressing. 

The results showed that higher self-criticism was associated with greater expressive suppression, less expression of positive emotions, and more self-concealment. These relationships held even after accounting for the roles of depressive symptoms and emotional intensity. Among these variables, reduced positive emotional expression had the strongest link to lower feelings of social belonging among self-critical participants. 

The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness. 

Suppressing positive emotions, in particular, may deprive self-critical people of opportunities for social connection. Expressing positive emotions promotes relationship development and maintenance. Failing to outwardly share happiness, excitement, and affection could impair self-critical individuals’ ability to form close bonds. This intriguing study thus highlights the importance of fostering positive emotional expression for self-critical people’s social wellbeing. 

As the researchers note, their cross-sectional design precludes firm causal conclusions. Experimental and longitudinal research is needed to further test the study’s model. However, these results move our understanding forward by pinpointing specific interpersonal pathways that may fuel the isolating effects of self-criticism. 

The findings suggest that psychotherapies which help clients express emotions openly, authentically share about themselves, and connect with positive emotions could aid self-critical individuals in building fulfilling social relationships. By targeting key interpersonal behaviors, clinicians may be able to alleviate self-critical people’s loneliness and foster a greater sense of belonging. Remediating deficits in positive emotional expression seems particularly promising based on this study. Overall, these insights enhance our grasp of how self-criticism operates interpersonally and point toward avenues for reducing its detrimental social impacts. 

Portland Psychotherapy’s Clinical Trial of MDMA-Assisted Therapy for Social Anxiety Disorder: Recruitment Underway!

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Many have been watching as the psychedelic renaissance has taken off and more clinical trials for psychedelic-assisted therapy have begun. Here at Portland Psychotherapy, our research team has been working tirelessly to prepare for our Clinical Trial of MDMA-Assisted Therapy for Social Anxiety Disorder (SAD), recently mentioned in the MAPS Investigator-Initiated Trial update here. Our trial aims to test the efficacy and safety of MDMA-Assisted Therapy for SAD, as well as identify and examine how MDMA-assisted therapy works.

Once screened into the study, participants will be randomized into two groups – one group will proceed  immediately into treatment and the other will receive treatment after a delay. Both groups will receive two MDMA-assisted therapy sessions, as well as preparation sessions before and integration sessions after the MDMA-assisted therapy sessions.

Recruitment has begun!

We recently started recruitment and are screening volunteers to see if they are eligible. If you are interested in looking into being a participate or want to let someone else know more about trial, we have an informational page on the website.

To stay in the loop about our trial milestones and updates, you can sign up for our mailing list here.

To learn more about our study, including our team, how to donate, information about the study procedure, or how to participate, please visit our website.

What Makes Us Unique

Portland Psychotherapy is a clinic, research & training center with a unique business model that funds scientific research. This results in a team of therapists who are exceptionally well-trained and knowledgeable about their areas of specialty.