Publications of Interest

Publications of Interest

Dear Colleagues

This quarter our Publications of Interest focuses on the role of shame in trauma and dissociation. Within this broad theme we bring you six articles which we hope you will find interesting.

You may notice, I am not the POI Editor. We are still looking for a new POI Editor. So, if you like new information on treatment and science, if you hang out to read the latest articles, this job is for you, and is an interesting and relatively easy way to contribute to ISSTD. Once a quarter you’d pick a topic you are interested in and find us links to 5-8 articles of your choice. In fact, the only pain is reducing it to such a low number! You don’t need to review the articles, just record the information. Have a look below and if this interests you contact me on:

Kind Regards

Kate McMaugh
ISSTD News Editor (NOT POI Editor!)

Highlighted articles on Shame, Trauma and Dissociation for 2017

Platt, Melissa G.; Luoma, Jason B.; Freyd, Jennifer J. (Jan 2017) Shame and Dissociation in Survivors of High and Low Betrayal Trauma, Journal of Aggression, Maltreatment & Trauma; Abingdon, V26 (1): 34-49.

Shame and dissociation co-occur in trauma survivors. Bypassed shame theory posits that dissociation reduces pain by interrupting shame. We tested this theory by inducing dissociation. The hypothesis that higher baseline shame would predict larger increases in dissociation following the induction was marginally supported. However, in contrast to bypassed shame theory, shame scores increased rather than decreased following the induction. An alternative theory, betrayal trauma theory (BTT), proposes that dissociation reduces awareness of betrayal to protect a needed relationship. Shame might also serve this function. We aimed to replicate prior research indicating traumas higher in betrayal (HBT) are uniquely related to both shame and dissociation compared to traumas lower in betrayal (LBT). The hypothesis that HBT would relate to higher shame was supported. The results suggest that other explanations than bypassed shame theory, such as BTT, might better account for the relationship between shame and dissociation in trauma survivors.
Free Access Article:

Cunningham, Katherine C; Davis, Joanne L Wilson, Sarah M Resick, Patricia A (October 23, 2017). A relative weights comparison of trauma-related shame and guilt as predictors of DSM-5 posttraumatic stress disorder symptom severity among US veterans and military members. The British Journal of Clinical Psychology, Oct 2017


OBJECTIVES: Veterans and military service members have increased risk for post-traumatic stress disorder (PTSD) and consequent problems with health, psychosocial functioning, and quality of life. In this population and others, shame and guilt have emerged as contributors to PTSD, but there is a considerable need for research that precisely demonstrates how shame and guilt are associated with PTSD. This study examined whether a) trauma-related shame predicts PTSD severity beyond the effects of trauma-related guilt and b) shame accounts for a greater proportion of variance in PTSD symptoms than guilt.

DESIGN: We collected cross-sectional self-report data on measures of PTSD symptom severity based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, trauma-related shame, and trauma-related guilt via online survey.

METHOD: Participants included 61 US veterans and active duty service members. Hierarchical multiple regression and relative weights analysis were used to test hypotheses.

RESULTS: In step 1 of regression analysis, guilt was significantly associated with PTSD. However, when shame was added to the model, the effect of guilt became non-significant, and only shame significant predicted PTSD. Results from relative weights analysis indicated that both shame and guilt predicted PTSD, jointly accounting for 46% of the variance in PTSD. Compared to guilt, trauma-related shame accounted for significantly more explained variance in PTSD.

CONCLUSIONS: This study provided evidence that among US veterans and service members, trauma-related shame and guilt differ in their association with PTSD and that trauma-related shame, in particular, is associated with the severity of PTSD.

PRACTITIONER POINTS: Trauma-related shame and guilt explained almost half of the observed variance in PTSD symptom severity among this sample of US military veterans and service members. Trauma-related shame and guilt each made a unique contribution to PTSD severity after accounting for the similarity between these two emotions; however, shame was particularly associated with increased PTSD severity. These results highlight the importance of assessing and addressing trauma-related shame and guilt in PTSD treatment among military populations. We suggest that emotion- and compassion-focused techniques may be particularly relevant for addressing trauma-related shame and guilt. Limitations of the study Cross-sectional data does not allow for determination of causal relationships. Although sufficiently powered, the sample size is small. The present sample self-selected to participate in a study about stress and emotions.

Correspondence author: Katherine Cunningham:
Dyer, Kevin F W, Dorahy, Martin J, Corry, Mary, Black, Rebecca, Matheson, Laura, Coles, Holly, Curran, David, Seager, Lenaire, Middleton, Warwick (March 2017). Comparing shame in clinical and nonclinical populations: Preliminary findings.  Psychological trauma : theory, research, practice and policy Vol. 9(2), 173-180.


OBJECTIVES: To conduct a preliminary study comparing different trauma and clinical populations on types of shame coping style and levels of state shame and guilt.

METHODS: A mixed independent groups/correlational design was employed. Participants were recruited by convenience sampling of 3 clinical populations-complex trauma (n = 65), dissociative identity disorder (DID; n = 20), and general mental health (n = 41)-and a control group of healthy volunteers (n = 125). All participants were given (a) the Compass of Shame Scale, which measures the four common shame coping behaviors/styles of “withdrawal,” “attack self,” “attack other,” and “avoidance,” and (b) the State Shame and Guilt Scale, which assesses state shame, guilt, and pride.

RESULTS: The DID group exhibited significantly higher levels of “attack self,” “withdrawal,” and “avoidance” relative to the other groups. The complex trauma and general mental health groups did not differ on any shame variable. All three clinical groups had significantly greater levels of the “withdrawal” coping style and significantly impaired shame/guilt/pride relative to the healthy volunteers. “Attack self” emerged as a significant predictor of increased state shame in the complex trauma, general mental health, and healthy volunteer groups, whereas “withdrawal” was the sole predictor of state shame in the DID group.

CONCLUSIONS: DID emerged as having a different profile of shame processes compared to the other clinical groups, whereas the complex trauma and general mental health groups had comparable shame levels and variable relationships. These differential profiles of shame coping and state shame are discussed with reference to assessment and treatment.

Holl, Julia; Wolff, Sebastian; Schumacher, Maren; Höcker, Anja; Arens, Elisabeth A, Spindler, Gabriela; Stopsack, Malte; Südhof, Jonna; Hiller, Philipp; Klein, Michael; Schäfer, Ingo; Barnow, Sven (Aug 2017) Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect, Development and Psychopathology; Cambridge, 29 (3), 737-749.

Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (trauma SUD group), healthy controls with CAN (trauma HC group), and without CAN (non-trauma HC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The trauma SUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the trauma HC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the trauma SUD group. Our findings provide evidence for the drinking to cope model. The trauma SUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the trauma HC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic pre-interventions and interventions for SUD after CAN.

Dorahy MJ, Gorgas J, Seager L, Middleton W (Nov 2017) Engendered Responses to, and Interventions for, Shame in Dissociative Disorders: A Survey and Experimental Investigation. Journal of Nervous and Mental Disease ;205(11):886-892.

This study examined shame and responses to it in adult dissociative disorder (DD; n = 24) and comparison psychiatric (n = 14) samples. To investigate how helpful different therapeutic responses are after shame disclosures in therapy, participants heard two vignettes from “mock” patients disclosing a) shame and b) surprise. Participants rated the helpfulness of five potential responses. Interventions covered withdrawing from the affect (withdrawal focused) to feeling it (feeling focused), with other interventions on cognitions (cognitive focused), management strategies (management focused), and previous experiences (history focused). The DD sample reported higher characterological and bodily shame, and more shame avoidance and withdrawal. There was no difference across groups for intervention ratings. For shame, interventions focused on feelings, cognitions, or previous shame experiences were deemed most helpful, but this was qualified by experiencing dissociation while hearing the script, where the history intervention was reported less helpful. Exposure to shame while monitoring dissociation should accompany therapy for DDs.
McCarthy-Jones, Simon (Aug 2017): Is Shame Hallucinogenic? Frontiers in psychology Vol. 8,  1310.

Research into the causes of “hearing voices,” formally termed auditory verbal hallucinations (AVH), has primarily focused on cognitive mechanisms. A potentially causative role for emotion has been relatively neglected. This paper uses historical and contemporary case studies of AVH to tentatively generate the hypothesis that shame can be a causal factor in the onset of AVH. Other sources of support for the generation of this hypothesis are then sought. First, evidence is examined for a role of shame in the etiology of post-traumatic stress disorder, a condition that is characterized by phenomena related to AVH (intrusions and dissociation) and in which a substantial minority of sufferers report AVH. Second, the effect on AVH of a psychological therapy specifically designed to counteract shame(Compassion Focused Therapy) is noted. The hypothesis generation process is then expanded to propose mechanisms that could mediate a relation between shame and AVH. It is proposed that employing absorbed or avoidant strategies to deal with shame may lead to AVH through mediating mechanisms such as rumination, suppression, and dissociation. Evolutionary reasons for a relation between shame and AVH are also proposed, including that AVH may be an evolved mechanism to encourage self-protective behaviors in the wake of trauma. It is concluded that existing research supports the generation of this paper’s hypothesis, which is now worthy of dedicated empirical testing.
Free Access Article:

Other Relevant Articles (no abstracts available)
Ken Benau (May 2017). Shame, Attachment and Psychotherapy: Phenomenology, Neurophysiology, Relational Trauma and Harbingers of Healing, Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 11 (1), pp 1-27
Richard A Chefetz (August 2017) Dignity is the Opposite of Shame and Pride is the Opposite of Guilt, Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 11 (2), pp 119-133