Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD)

Abstract

Background: Despite considerable progress in the treatment of post-traumatic stress disorder (PTSD), a large percentage of individuals remain symptomatic following gold-standard therapies. One route to improving care is examining affective disturbances that involve other emotions beyond fear and threat. A growing body of research has implicated shame in PTSD’s development and course, although to date no review of this specific literature exists. This scoping review investigated the link between shame and PTSD and sought to identify research gaps. Methods: A systematic database search of PubMed, PsycInfo, Embase, Cochrane, and CINAHL was conducted to find original quantitative research related to shame and PTSD. Results: Forty-seven studies met inclusion criteria. Review found substantial support for an association between shame and PTSD as well as preliminary evidence suggesting its utility as a treatment target. Several design limitations and under-investigated areas were recognized, including the need for a multimodal assessment of shame and more longitudinal and treatment-focused research. Conclusion: This review provides crucial synthesis of research to date, highlighting the prominence of shame in PTSD, and its likely relevance in successful treatment outcomes. The present review serves as a guide to future work into this critical area of study.

A scoping review of adult survivors’ experiences of shame following sexual abuse in childhood

“…Studies refer to different shame measures but fundamentally they measure trait shame (shame‐proneness, generalised shame) or state shame (abuse‐related shame, situational shame), or both. The difficulties comparing results obtained from different shame measures is discussed extensively in the research literature (Blum, ; Saraiya & Lopez‐Castro, ), with concerns centring on specificity and validity. In addition, self‐report measures potentially limit an in‐depth understanding of survivors’ definitions and experiences of shame.…”

“…There is a need for further investigation of the relationship between shame and interrelated concepts and experiences, such as stigmatisation and how each independently and in combination influence survivors’ experiences. Further scrutiny and empirical validation of research measures of shame will explore the appropriateness of comparing shame measures across studies (Saraiya & Lopez‐Castro, ).…”

Spiritual Needs of PTSD Patients in Croatia and Bosnia-Herzegovina: A Quantitative Pilot Study

“…Perhaps for this reason, personal prayer is viewed as providing a greater source of comfort. On the other hand, it is also possible that PTSD patients (like others) experience shame when asking for (spiritual) support from others and therefore indicated lower needs for prayer with or from others (Saraiya & Lopez-Castro 2016).…”

Emotion dysregulation moderates the effect of cognitive behavior therapy with prolonged exposure for co-occurring PTSD and substance use disorders

“…Interventions efforts have focused on ameliorating disturbances found in the fear conditioning and extinction networks. However, a growing body of research suggests that in addition to pathological fear, regulation of other emotional responses (e.g., anger, shame, and guilt) may be central to the development, maintenance, and treatment of trauma-related disorders (Resick & Miller, 2009; Saraiya & Lopez-Castro, 2016). Emotion regulation is broadly defined as the ability to monitor, assess and modulate emotional reactions, particularly in the context of goal-oriented behavior (Gratz & Roemer, 2004).…”