The impact of illness‐related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness

Abstract

This study explores the impact of illness-related shame on the quality of social relationships and psychological health in chronic patients. We aimed to examine the roles of fear of receiving compassion from others and experiential avoidance as potential mediators of this relationship. Although some studies have demonstrated the negative impact of chronic illness-related shame on psychological functioning, the mechanisms that may underlie this link remain understudied. The sample was comprised by 115 college students, which had been diagnosed with at least 1 chronic illness. Participants completed self-report measures on an online platform. This study's design was cross-sectional. A path analysis was conducted using structural equation modelling. Results showed that the impact of illness-related shame on both psychological health (R = .45) and the quality of social relationships (R = .33) was fully accounted by fear of compassion from others and experiential avoidance. This model revealed an excellent fit. Fear of receiving compassion from others was the main mediator of the illness-related shame link with the quality of social relationships (β = -.22). The main mediator of the association between shame-related chronic illness and psychological health was experiential avoidance (β = -.21).This study shed light on possible psychological mechanisms linking feelings of shame associated with having a chronic condition and impaired social relationships and mental health. On one hand, resisting feelings of compassion and care from others and, on the other hand, avoiding difficult internal experiences and situations that might trigger them seem to underlie the impact of shame on psychological and social functioning in chronic patients.

Chronic illness‐related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients

“…Chronic illness‐related cognitive fusion seemed to influence depression symptoms and partially mediated the effects of body dissatisfaction and chronic illness‐related shame on this outcome. The result regarding the impact of cognitive fusion related to chronic illness on depression symptoms corroborates literature on inflammatory bowel disease (Trindade, Duarte, et al, ) and add to it by suggesting similar results in breast cancer patients. A study by Gillanders et al () in a mixed sample of cancer patients also presented a link between cognitive fusion and decreased quality of life, although the measure of cognitive fusion regarded general cognitions.…”

“…Given these data, we hypothesize that the impact of body image dissatisfaction (Begovic-Juhant et al, 2012;Von Ah & Kang, 2008) and chronic illness-related shame (Trindade, Duarte, et al, 2018) on depression symptoms is indeed not direct, being explained by the mechanisms of chronic illness-related cognitive fusion. This examination is the aim of the present study, conducted with a sample of women with nonmetastatic breast cancer.…”

“…Cognitive Fusion Questionnaire—Chronic Illness (CFQ‐CI; Trindade, Duarte, et al, ) assesses the level of cognitive fusion specifically associated with the experience of having a chronic illness and its associated symptomatology (e.g., “ I tend to get very entangled in my thoughts about my illness and/or symptoms”; “I over‐analyse situations associated with my illness to the point where it's unhelpful to me (for example, conversations with my friends; school or work situations)”). The CFQ‐CI's 7 items are measured on a 5‐point Likert scale (from 0 = never true to 4 = always true ), with higher scores revealing higher levels of chronic illness‐related cognitive fusion.…”

“…This specific dimension of shame was found to be linked to depression symptoms in inflammatory bowel disease patients (Trindade, Ferreira, & Pinto‐Gouveia, ). This construct has also been suggested as a predictor of psychosocial functioning in a mixed sample of chronic patients (Trindade, Duarte, Ferreira, Coutinho, & Pinto‐Gouveia, ) and in a sample of inflammatory bowel disease patients (Trindade, Ferreira, & Pinto‐Gouveia, ). Nevertheless, there is no existing data on the relationship between shame specifically related to chronic illness and mental health in breast cancer patients.…”

‘I’m on the train and I can't stop it': Western Canadians' reactions to prediabetes and the role of self-compassion

“…Participants felt further guilt and shame when failing, in the present, to stick to health behaviours. The guilt and shame reactions prevalent within our sample have been documented in the experience of other chronic illnesses (Trindade, Duarte, Ferreira, Coutinho, & Pinto‐Gouveia, ), but have been less often mentioned in prediabetes research. One exception to this is Andersson and colleagues () who noted participants' experience of guilt and shame for health behavioural transgressions.…”