ashamed womanShame is the feeling that a person is, at their core, bad or wrong. A person might feel shame for no reason at all, or long after they have made amends for a misdeed.

Shame can lead to a host of mental health challenges, including depression and anxiety. It may also make it difficult to get close to others. Some people are so paralyzed by shame that they are unable to be productive at work or school.

Shame researcher Brené Brown argues that guilt serves an important social purpose. It can drive people to apologize to others and avoid doing harm. Shame, Brown says, serves no purpose. It’s simply a source of suffering. Therapy can help people understand why they feel ashamed and work to break free from shame.

Shame Definition: What Is Toxic Shame?

Toxic shame is shame that leads to chronic negative emotions, or behavior that harms oneself or others. People who feel chronic shame may think they are unworthy of love. Others may fear connecting to others, convinced that others will eventually see the “real” person and reject them. This can cause numerous relationship issues, including:

  • Trouble forming or sustaining friendships or romantic relationships.
  • Difficulty being honest in interpersonal relationships.
  • Feelings of isolation and loneliness.
  • Abusive behavior.
  • Getting into abusive relationships.

People experiencing shame may engage in self-harm such as cutting, binge eating, or restrictive eating. Some people attempt to mask or overcome their feelings of shame through:

  • Substance abuse such as alcoholism or drug addiction.
  • Compulsive behaviors such as shopping or gambling addiction.
  • Workaholism.

Numerous studies have linked shame to suicidal thoughts and gestures. This may be because shame cuts deeply to a person’s core. People overwhelmed by feelings of shame may feel unable to solve their problems or unworthy of a better life. They may believe treatment won't help. The social stigma surrounding mental health issues, and especially surrounding suicidal thoughts, can compound these feelings. This can deter a person from seeking help.

How to Get Help for Shame

Getting help for shame begins with identifying shameful emotions. Some people are not conscious of their shame. Others know they feel ashamed, but worry that seeking help will force them to disclose their shame to others. Because shame is linked to feelings of unworthiness and low self-esteem, some people fear that those from whom they seek help will eventually discover that the shame is deserved. They fear exposure, and worry that others will reject them when they see the truth.

These are self-defeating thoughts. Shame is treatable, no matter where it comes from. If you feel that your shame is deserved, it’s important to know that your shame serves no purpose. Instead, it may cause you to harm yourself or others.

Brown’s shame resilience theory is a comprehensive approach for preventing and overcoming shame. Brown argues that resilience to shame has four components:

  • Recognizing signs of shame and understanding a person’s triggers for shame.
  • Critical awareness of shame, including its cultural and interpersonal function.
  • Reaching out to others to share your story.
  • Giving voice to feelings of shame, since shame derives much of its power from secrecy.

Shame Psychology: Therapy for Shame

Shame often stems from a traumatic experience. A person may fear that they deserved the trauma, experience guilt and shame about having survived, or feel ashamed of sexual or other abuse. When shame is due to trauma, it’s critical that therapy is trauma-sensitive, addressing the root cause of shame. Some treatment options include:

  • Cognitive behavioral therapy (CBT): CBT helps people understand the connection between their thoughts, emotions, and behaviors. Therapists focus on automatic thoughts that typically go unnoticed—such as “I don’t deserve love if I make a mistake.”
  • Prolonged exposure (PE): Prolonged exposure therapy steadily exposes a person to larger and larger doses of stimuli linked to the trauma. For instance, a person who was stabbed might begin by holding or looking at a knife, then gradually work up to discussing the stabbing or being in a setting that reminds them of the stabbing. The goal of PE is to steadily remove the power of the traumatic event, and in so doing, reduce the severity of emotions such as shame, guilt, and anxiety.
  • Cognitive processing therapy (CPT): CPT occurs over 12 sessions, during which a person talks about their trauma, works to understand how their trauma affects their emotions and behavior, and then implements strategies for controlling the effects of trauma, including shame.
  • Stress inoculation training (SIT): Stress inoculation training is a variant of CBT that teaches people how to respond to stress before it overwhelms them. It includes training on breathing techniques, muscle relaxation, noticing and changing automatic negative thoughts, and role-playing exercises.
  • Eye movement desensitization and reprocessing (EMDR): EMDR is a stage-based approach to treatment that uses specific eye movements to help a person talk about a trauma. Over time, a person learns to manage their emotions and to integrate the trauma into their life story.

These techniques may also work for other forms of shame, such as shame due to depression. Research consistently finds that the best predictor of therapy’s success is a strong relationship between the therapist and the person in therapy. Finding a therapist who respects your values and helps you set goals is key.

Some other forms of therapy that may help with shame, especially shame that is not due to trauma, include:

  • Compassionate mind training (CMP): This brief therapy encourages people who are highly self-critical to become more self-compassionate.
  • Emotionally focused couples therapy (EFCT): Grounded in attachment theory, this approach fosters feelings of connection and intimacy among couples. It may help with shame related to the relationship, or shame that interferes with closeness.

Case Examples of Therapy for Shame

  • Shame after an affair: Trudy, 47, enters therapy due to anxiety and problems with her husband, to whom she has been married more than 20 years. Talking with the therapist, she is tearful, and soon begins to disclose that she had an affair early in her marriage. Therapy helps her achieve emotional release and move past her shame into remorse and self-forgiveness. She then resolves to disclose the secret to her husband. When she does so, he is hurt. This re-triggers Trudy’s shame, but their relationship survives, and Trudy is eventually able to feel a sense of peace.
  • Adult shame after childhood molestation: Pablo, 21, is starting to date seriously and finds himself anxious and ashamed about sexual matters. After a few sessions with a therapist, he is able to disclose that he was a victim of sexual molestation 10 years earlier. Pablo feels ashamed of this event, though he is not sure why. The shame interferes with his ability to be relaxed with a partner. The therapist helps Pablo uncover and examine the beliefs that reinforce his shame, and he attempts to discard the beliefs that are untrue and unhelpful and develop new beliefs that more accurately reflect reality and lead to a stronger sense of self and hope.

References:

  1. Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services, 87(1), 43-52. Retrieved from https://www.researchgate.net/publication/259982000_Shame_Resilience_Theory_A_Grounded_Theory_Study_on_Women_and_Shame
  2. Brown, B. (2013, January 14). Shame v. guilt. Retrieved from https://brenebrown.com/blog/2013/01/14/shame-v-guilt/
  3. Chard, K., & Gilman, R. (2018, April 16). Counseling trauma victims: 4 brief therapies meet the test. Retrieved from https://www.mdedge.com/psychiatry/article/60392/counseling-trauma-victims-4-brief-therapies-meet-test
  4. Cognitive processing therapy. (n.d.). Retrieved from http://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy.aspx
  5. Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353-379. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/cpp.507
  6. Hastings, M. E., Northman, L. M., & Tangney, J. P. (2002). Shame, guilt, and suicide. Suicide Science, 67-79. Retrieved from https://link.springer.com/chapter/10.1007/0-306-47233-3_6