Differential relationships of guilt and shame on posttraumatic stress disorder among veterans.

Bannister, Jenny A.; Colvonen, Peter J.; Angkaw, Abigail C.; Norman, Sonya B.

doi:10.1037/tra0000392

Cited by 30 publications

(29 citation statements)

References 40 publications

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“…Shame is a self-conscious emotion characterized by global feelings of inadequacy and low self-worth ( Tangney and Dearing, 2003 ). Shame has been linked to myriad negative psychological constructs, such as depression, anxiety, stress, PTSD, paranoia, and non-suicidal self-injury ( Andrews et al, 2000 ; Robinaugh and McNally, 2010 ; Pinto-Gouveia and Matos, 2011 ; Johnson et al, 2014 ; Schoenleber et al, 2014 ; Bannister et al, 2018 ). Shame is also related to pain experiences in general; shame proneness has been found to be higher in those with chronic pain relative to those without ( Turner-Cobb et al, 2015 ), and shame is a common theme described in qualitative reports examining pain experiences ( Asbring and Närvänen, 2002 ; Turner-Cobb et al, 2015 ; Nicola et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Shame Mediates the Relationship Between Pain Invalidation and Depression

et al. 2021

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The experience of pain is subjective, yet many people have their pain invalidated or not believed. Pain invalidation is associated with poor mental health, including depression and lower well-being. Qualitative investigations of invalidating experiences identify themes of depression, but also social withdrawal, self-criticism, and lower self-worth, all of which are core components of shame. Despite this, no studies have quantitatively assessed the interrelationship between pain invalidation, shame, and depression. To explore this relationship, participants recounted the frequency of experienced pain invalidation from family, friends, and medical professionals, as well as their feelings of internalized shame and depressive symptoms. As shame has been shown to be a precursor for depression, we further explored the role of shame as a mediator between pain invalidation and depressive symptoms. All sources of pain invalidation were positively associated with shame and depressive symptoms, and shame fully mediated the relationship between each source of pain invalidation and depression. Relative to other sources, pain invalidation from family was most closely tied to shame and depression. Overall, findings indicate that one mechanism by which pain invalidation may facilitate depression is via the experience of shame. Future research may explore shame as a potential upstream precursor to depression in the context of pain. Findings provide more insight into the harmful influence of pain invalidation on mental health and highlight the impact of interpersonal treatment on the experiences of people in pain.

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Section: Introductionmentioning

confidence: 99%

Shame Mediates the Relationship Between Pain Invalidation and Depression

et al. 2021

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“…Such studies have found that while trauma-related guilt occurs as a result of feeling bad about particular actions or behaviors, trauma-related shame involves more global negative attributions about the self (e.g., Lee et al, 2001;Leskela et al, 2002). Furthermore, previous work has found that shame is a better predictor of PTSD symptoms than is guilt (Bannister et al, 2019). Thus, shame can be characterized as a unique emotional response to trauma that, accordingly, may contribute to negative trauma-related outcomes in unique ways.…”

mentioning

confidence: 99%

Avoidance Coping Partially Accounts for the Relationship Between Trauma-Related Shame and PTSD Symptoms Following Interpersonal Trauma

Tipsword

Brown-Iannuzzi

Jones

et al. 2021

Violence Against Women

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Research has demonstrated that individuals experiencing trauma-related shame exhibit greater posttraumatic stress disorder (PTSD) symptoms. However, little research has investigated additional factors relevant to the shame–PTSD relationship. The current study examined the role of avoidance and approach coping in accounting for the trauma-related shame–PTSD association among 60 women who had experienced interpersonal trauma. Indirect effects tests revealed that avoidance coping partially accounted for the association between shame and interviewer-assessed PTSD symptoms, β = .21, SE = 0.08, 95% confidence interval (CI) = [0.03, 0.36]. These findings offer a novel contribution to the growing literature examining negative outcomes following interpersonal trauma.

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“…Moral injury and PTSD are often said to be distinguishable by the prominence of guilt and shame in the former, compared with the latter (Jinkerson, 2016). However, burgeoning data suggest that shame and guilt are inextricably linked to PTSD severity, particularly for veterans and interpersonal trauma victims (Andrews, Brewin, Rose, & Kirk, 2000; Bannister, Colvonen, Angkaw, & Norman, 2019). And, evidence-based treatments of PTSD frequently make reference to guilt and self-blame attributions in ways that might lead researchers and practitioners to perceive moral injury shame-and-guilt phenomena in terms of a more expanded PTSD construct, thereby rendering it treatable within approved methods.…”

Section: Moral Injury Betrayal Trauma and “Soul Repair”mentioning

confidence: 99%

Potential ethical pitfalls and dilemmas in the promotion and use of American Psychological Association-recommended treatments for posttraumatic stress disorder.

Gnaulati

2019

Psychotherapy

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A variety of potential unrecognized ethical concerns arise from the American Psychological Association’s (APA, 2017) Clinical Practice Guideline for the Treatment of PTSD in Adults. In privileging short-term treatments that underscore symptom reduction as the predominant index of outcome, such as cognitive processing therapy and prolonged exposure, there is a susceptibility to mislead mental health professionals and clients alike to believe that lasting improvements in socioemotional well-being, and a time-intensive approach, are unrealistic, rather than realistic psychotherapy expectations. There are ethical implications to incompletely addressing clients’ preferences and clinicians’ judgments on matters such as preferred socioemotional outcomes, and desirable qualities in a therapist and therapy. As regard combat veterans, treating trauma-related guilt and shame as symptoms to be eliminated, rather than moral feelings to be acknowledged, expressed, and self-forgiven, warrants special ethical consideration. The high dropout rates of cognitive processing therapy and prolonged exposure raise questions as to whether their protocol-driven methods alienate substantial numbers of traumatized clients.

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Differential relationships of guilt and shame on posttraumatic stress disorder among veterans.

Cited by 30 publications

References 40 publications

Shame Mediates the Relationship Between Pain Invalidation and Depression

Shame Mediates the Relationship Between Pain Invalidation and Depression

Avoidance Coping Partially Accounts for the Relationship Between Trauma-Related Shame and PTSD Symptoms Following Interpersonal Trauma

Potential ethical pitfalls and dilemmas in the promotion and use of American Psychological Association-recommended treatments for posttraumatic stress disorder.

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