Self-compassion and shame-proneness in five different mental disorders

Good evening ladies and gentlemen. Both the lack of self-compassion and shame-proneness may be important factors hidden behind many symptoms of different mental disorders. In this talk I will present research on self-compassion and shame-proneness in five different mental disorders and healthy controls. Let’s begin with some background. In my clinical practice I work with patients with different diagnoses and it appears to me that there is a common factor in following five disorders: anxiety disorders, depressive disorders, eating disorders, borderline personality disorder and alcohol addiction. The common factor is shame. What is shame? Shame is a self-conscious emotion associated with feelings of inadequacy,
inferiority and worthlessness and with a desire to hide or conceal deficiencies. It’s a social or moral emotion that can be seen as a resulting from the comparison of the self’s action and experiences with the self’s standards. Shame-proneness is closely related to self-criticism. It’s important to differentiate shame and guilt. The fundamental difference between shame and guilt concerns the role of the self. Shame involves fairly global negative evaluations of the self. For example: “I’m not good enough. I’m
worthless.” Guilt involves a more articulated condemnation of a specific behavior. For example: “I did a bad thing.” Shame is therefore a much more problematic maladaptive feeling. Let’s have a short look at shame in above-mentioned disorders. According to my experience in anxiety disorders the anxiety results from
unconscious catastrophic expectations. When I ask clients, what is the worst that could happen, we uncover that there is a fear of condemnation, rejection or abandonment. These clients feel reprehensible. In other words they feel shame. In depressive disorders we can see that depressive rumination very often includes negative self-narratives. These clients think: “I’m impossible, unacceptable.” And connected with these thoughts there are feelings of inferiority, humiliation, loneliness. In other words shame again. In personality disorders Schoenleber and Berenbaum (2012) differentiated three maladaptive shame regulation strategies: The first is prevention: For example the person avoids taking responsibility for tasks. The second is escape: For example it includes self-promotion or social withdrawal. And the third is aggression: For example the person refocuses self-hate onto others and reacts accordingly. All these strategies are common in borderline personality disorders and all are indirect indicators of shame. In eating disorders self esteem is closely
linked to body weight or shape and feelings of shame are closely connected to body dissatisfaction and criticism of body image. But the hope for recognition, respect or admiration is of course never satisfied by body perfection. And that’s why we can observe persistent feeling of shame in eating disorders as well. In alcohol addiction alcohol provides immediate alleviation of negative affect. It is a very simple pattern. 1. I feel bad. That’s the trigger. 2. I drink some alcohol. That’s behavior. and 3. I feel good. It’s reward. And the pattern is reinforced. But what kind of negative affect is the trigger? Honestly, I don’t have experience with alcoholics. However our theoretical assumption was
it might be shame. But let’s now ask what is the best protection or antidote against shame? In our opinion it’s self-compassion. What is self-compassion? According to Neff (2011b), self-compassion is a cognitive coping strategy that reflects an emotionally positive self-attitude in instances of perceived inadequacy, failure or general suffering. It’s a counterpart of excessive self-criticism, self-rejection, “hardness of heart” or “self-coldness”. Self-compassion is not self-pity. When individuals feel self-pity they become immersed in their own problems and forget that others have similar problems. They are often blaming others and they feel like if they were the poorest men on earth. In self-compassion there is not such disconnection between the person and others. The person understands that to err is human and that nobody is less than anybody else. He or she is blaming nobody. Takes responsibility for oneself and cares for oneself. Self-compassion inspired the development of many new psychotherapeutic procedures in last years. Existing research confirms that self-compassion is most likely an important predictor of mental health and well-being and the lack of self-compassion probably plays an important role in the etiopathogenesis of mental disorders. As this diagram shows we suppose that every single experienced phenomenon can be either accepted or rejected. If it’s accepted the experiencing flows and everything is okay. if it’s rejected and related to the self the feeling of shame originates and since shame is a painful feeling various defense or coping mechanisms are then automatically activated resulting in various psychopathological symptoms of various disorders. Now we are ready to introduce our research. The aim of this study was to compare the levels of self-compassion and shame-proneness in samples of patients with anxiety disorders, depressive disorders, eating disorders, borderline personality disorder, alcohol addiction and in healthy controls. All participants were at least 18 years
old. For the anxiety sample the inclusion criteria were primary diagnosis of phobic anxiety disorders or other anxiety disorders and rating of 10 or higher on the GAD-7 scale. For the depressed sample the inclusion criteria were primary diagnosis of major depressive disorder, single episode or major depressive disorder, recurrent and rating of 10 or higher on the PHQ-9
scale. For the BPD sample the inclusion criteria was primary diagnosis of emotionally unstable personality disorder. For the eating disorders sample
the inclusion criteria were primary diagnosis of anorexia nervosa or bulimia nervosa and rating of 15 or higher on the three eating disorder specific
subscales of the EDI scale. For the alcohol addiction sample the inclusion criteria were primary diagnosis of alcohol dependence and rating of 20 or higher on the AUDIT scale. Finally for the healthy controls the inclusion criteria were rating 9 or less on the GAD-7 scale and rating 9 or less on the PHQ-9 scale. The two main measures we used were the Self-Compassion Scale and the Test of Self-Conscious Affect – third shortened version. Because recently the critique has been raised regarding the factor structure of the Self-Compassion Scale and the validity of the Self-Compassion Scale total score we used only compassionate self-responding subscale from this scale. It has 13 items. To measure shame-proneness we used only shame-proneness subscale from the Test of Self Conscious Affect-3S. As you can see some other measures were further used to measure severity of clinical symptoms in clinical samples. Data was analyzed using the IBM SPSS statistics software, version 23. Associations between study variables were analyzed by calculating the Pearson’s correlation coefficients. Differences in self-compassion and shame-proneness were analyzed using a two-way analysis of covariance with Bonferroni correction. The effect sizes of the group comparisons were then calculated in terms of Cohen’s d. In this table you can see the number of
participants in each sample, the gender distribution and the mean age of each sample. Here are the correlations between compassionate self-responding and shame-proneness in each sample. Generally these results were as expected. The exception is alcohol addiction sample where there wasn’t significant correlation between the study variables. We don’t know why. Now let’s take a look at the boxplot of
compassionate self-responding scores by group. It is evident here that as expected healthy controls had the highest compassionate self-responding scores of all groups. Surprisingly alcoholics achieved the second highest scores. Again we don’t know why. However, the same but reverse pattern we see in the boxplot of shame-proneness scores by group. Healthy controls had the lowest shame-proneness scores of all groups. Alcoholics the second lowest. The samples differed significantly in age and gender. To determine if there were significant group differences in study variables two two-way ANCOVAs were conducted with the group and gender as fixed factors age as a covariate and compassionate self-responding and shame-proneness as dependent variables. For pairwise comparisons post hoc t-tests with Bonferroni correction were then performed. Post hoc t-tests with Bonferroni correction indicated that all 5 clinical samples showed significantly lower compassionate self-responding and significantly higher shame-proneness than healthy controls. When we look at this table we can see that the magnitudes of difference in compassionate self-responding and shame-proneness between all clinical groups and healthy controls were almost all large. The only exception is the difference in shame-proneness between alcohol addiction sample and healthy controls which is of medium size. In the present study all five clinical
samples were found to have significantly lower self-compassion and significantly higher shame-proneness than healthy controls. Both the lack of self-compassion and shame-proneness thus proved to be transdiagnostic factors of these disorders. The lack of self-compassion was essentially associated with shame in almost all samples except alcohol addiction sample. We hypothesize that the lack of self compassion leads to the formation of shame whenever one experiences something that is perceived to be “wrong” in comparison with one’s self-ideal. And since shame is a painful feeling, various defense or coping mechanisms are then automatically activated resulting in various psychopathological symptoms. Further study of these mechanisms may lead to a new understanding of the etiology of many mental disorders as well as a new understanding of the mechanisms of therapeutic change in these disorders. Clients suffering from all investigated disorders may benefit from treatments or particular interventions that facilitate the development of self-compassion or shame management. With regard to the critique of the Self-Compassion Scale we recommend to replicate this study with another measure of self-compassion such as the Sussex-Oxford Compassion for the Self Scale. As a measure of shame we recommend to use the Internalized Shame Scale. It would be desirable to closely compare findings of transdiagnostic research, research on self compassion and research on shame. We believe, that this so far rather independent research streams have much to offer each other. The same can probably be said for therapies focused on the treatment of shame and on the development of compassion or self-compassion. Another interesting comparison could then be made between existing knowledge of self-compassion, shame and some relevant new findings of neuroscience research. In conclusion I would like to thank all facilities that allowed us to assess their clients for
their kind cooperation. Thank you.

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