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Siegel DM, Burke TA, Hamilton JL, Piccirillo ML, Scharff A, Alloy LB. Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress. ANXIETY STRESS AND COPING 2018; 31:526-538. [PMID: 29855206 DOI: 10.1080/10615806.2018.1482723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together. DESIGN The current study extended prior research by examining the role of social anxiety in the occurrence of negative and positive interpersonal events and evaluated whether interpersonal distress moderated these associations. METHODS Undergraduate students (N = 243; M = 20.46 years; 83% female) completed self-report measures of social anxiety, perceived burdensomeness, and thwarted belongingness, as well as a self-report measure and clinician-rated interview assessing negative and positive interpersonal events that occurred over the past six weeks. RESULTS Higher levels of social anxiety were associated only with a higher occurrence of negative interpersonal dependent events, after controlling for depressive symptoms. This relationship was stronger among individuals who also reported higher levels of perceived burdensomeness, but not thwarted belongingness. CONCLUSIONS It may be important to more strongly consider interpersonal stress generation in models of social anxiety.
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Affiliation(s)
- David M Siegel
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | - Taylor A Burke
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | - Jessica L Hamilton
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | | | - Adela Scharff
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | - Lauren B Alloy
- a Department of Psychology , Temple University , Philadelphia , PA , USA
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Changes in perceived centrality of anxious events following cognitive behavioral therapy for social anxiety disorder and panic disorder. J Behav Ther Exp Psychiatry 2018; 59:150-156. [PMID: 29425950 DOI: 10.1016/j.jbtep.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of the present study was to explore the association between reductions in symptoms of psychopathology and perceived centrality of negative autobiographical memories in participants with social anxiety disorder (SAD) or panic disorder (PD). METHODS Thirty-nine individuals with SAD or PD recalled and rated four negative autobiographical memories before and after ten sessions of cognitive behavioral therapy (CBT) over a three-month period. Twenty-eight healthy controls did the same before and after a three-month period. RESULTS As hypothesized, results showed a decrease in perceived centrality following CBT. This decrease in perceived centrality was larger, although at the trend level, for individuals who experienced reliable change on disorder-specific symptoms. LIMITATIONS The correlational nature of the study prevents establishing the causal relationship between changes in perceived centrality and psychopathology, and future studies should explore such mechanisms. CONCLUSIONS The present study adds to the emerging body of literature, investigating changes in centrality of event following psychotherapy.
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Carvalho CB, da Motta C, Pinto-Gouveia J, Peixoto E. Psychosocial roots of paranoid ideation: The role of childhood experiences, social comparison, submission, and shame. Clin Psychol Psychother 2018; 25:650-661. [PMID: 29744971 DOI: 10.1002/cpp.2195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Social experiences have a significant impact on cognitive functioning and appraisals of social interactions. Specifically, recalls of antipathy from parents, submissiveness, and bullying during childhood can have a significant influence on paranoid ideation later in life. METHOD Multiple hierarchical regression analysis was performed on a sample of 91 patients diagnosed with paranoid schizophrenia in remission and active phase, their first-degree relatives (n = 32) and unaffected controls (n = 64). OBJECTIVES Exploring the impact of distal (events from childhood) and proximal factors (current cognitive, emotional, and behavioural aspects of social functioning) in the frequency, degree of conviction, and distress resulting from paranoid ideation in the participants from 4 samples. RESULTS Proximal and distal factors (shame, submissive behaviour, negative social comparison, antipathy from father) predicted several aspects of paranoid ideation. Those variables had a differential impact in affected patients and healthy controls. DISCUSSION Finding suggests different variables being involved in paranoid ideation, and the specificities of patients with paranoid schizophrenia should be considered in the development of more effective psychotherapeutic interventions.
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Affiliation(s)
- Célia Barreto Carvalho
- Faculty of Social and Human Sciences, Psychology Department, Azores University, Ponta Delgada, Portugal.,Cognitive-Behavioural Research Centre (CINEICC) of the Psychology Department, University of Coimbra, Coimbra, Portugal
| | - Carolina da Motta
- Faculty of Social and Human Sciences, Psychology Department, Azores University, Ponta Delgada, Portugal.,Cognitive-Behavioural Research Centre (CINEICC) of the Psychology Department, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC) of the Psychology Department, University of Coimbra, Coimbra, Portugal
| | - Ermelindo Peixoto
- Faculty of Social and Human Sciences, Psychology Department, Azores University, Ponta Delgada, Portugal
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Lazarus G, Shahar B. The Role of Shame and Self-Criticism in Social Anxiety: A Daily-Diary Study in a Nonclinical Sample. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018. [DOI: 10.1521/jscp.2018.37.2.107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We sought to explore the daily association between shame and self-criticism, and the extent to which this association varies as a function of social anxiety symptoms. Fifty-nine undergraduate students completed a measure of social anxiety symptoms at a baseline meeting and then completed measures of shame experienced during significant social interactions and self-criticism following those interactions twice daily for 10 days. Social anxiety symptoms predicted more shame during daily social interactions and more self-criticism following them. Additionally, shame predicted subsequent self-criticism. This relationship was moderated by levels of social anxiety symptoms, such that those with higher levels of social anxiety symptoms exhibited high levels of self-criticism following daily social interactions characterized by both high and low shame, whereas those with lower levels of social anxiety symptoms showed high levels of self-criticism only after interactions with high levels of shame. These findings are consistent with the notion that self-criticism may serve as a regulatory coping method when experiencing shame, and that social anxiety difficulties are related to an inflexibly high level of self-criticism.
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Affiliation(s)
| | - Ben Shahar
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
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Carona C, Rijo D, Salvador C, Castilho P, Gilbert P. Compassion-focused therapy with children and adolescents. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.115.015420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryCompassion-focused therapy (CFT) is embedded in an evolutionary, functional analysis of psychopathology, with a focus on affiliative, caring and compassion processes. CFT has been applied in a number of adult settings, but its clinical applications in child and adolescent psychopathology and psychotherapy have not been systematically explored. This article describes the applications of CFT in paediatric populations. Specifically, the following developmental considerations are discussed: the unique importance of parent-child and attachment relationships for the development of self-compassion, being open to compassion from others and being compassionate to others; the potential effect of com passion training on the maturing brain (affective regulation systems); and the therapeutic targeting of shame and self-criticism to alleviate psychological distress and enhance the effectiveness of cognitive-behavioural interventions.Learning Objectives• Understand and differentiate the three affect regulation systems and their links to different forms of child and adolescent psychopathology• Recognise the main components of compassionate mind training with children and adolescents, and related specific therapeutic strategies and exercises• Acknowledge the importance of adopting a parent-child approach in CFT
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Muris P, Meesters C, van Asseldonk M. Shame on Me! Self-Conscious Emotions and Big Five Personality Traits and Their Relations to Anxiety Disorders Symptoms in Young, Non-Clinical Adolescents. Child Psychiatry Hum Dev 2018; 49:268-278. [PMID: 28710592 PMCID: PMC5856863 DOI: 10.1007/s10578-017-0747-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study explored the relations between self-conscious emotions, personality traits, and anxiety disorders symptoms in non-clinical youths. One-hundred-and-eighteen adolescents aged 12-15 years completed the brief shame and guilt questionnaire for children (BSGQ-C) and items of the youth self-report (YSR) to measure shame and guilt, the big five personality questionnaire for children, and the youth anxiety measure for DSM-5. Results for shame indicated that this self-conscious emotion-either measured by the BSGQ-C or the YSR-was uniquely and positively associated with a broad range of anxiety disorders symptoms, and correlated positively with neuroticism and negatively with extraversion. Guilt did not show significant associations with anxiety disorders symptoms once controlling for the influence of shame, and links with personality traits varied dependent on the assessment instrument that was used (BSGQ-C or YSR). Finally, when controlling for neuroticism and extraversion, shame consistently remained a significant correlate of anxiety disorders symptoms. Altogether, these results add to the growing body of evidence indicating that high levels of shame are clearly associated with anxiety pathology.
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Affiliation(s)
- Peter Muris
- Maastricht University & Virenze-RIAGG, Maastricht, The Netherlands. .,Stellenbosch University, Stellenbosch, South Africa. .,Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Cor Meesters
- 0000 0001 0481 6099grid.5012.6Maastricht University & Virenze-RIAGG, Maastricht, The Netherlands
| | - Mike van Asseldonk
- 0000 0001 0481 6099grid.5012.6Maastricht University & Virenze-RIAGG, Maastricht, The Netherlands
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Cunha M, Xavier AMDJ, Cherpe S, Gouveia JP. Avaliação da Vergonha em Adolescentes: ‘The Other as Shamer Scale’. PSICOLOGIA: TEORIA E PESQUISA 2017. [DOI: 10.1590/0102.3772e3336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A vergonha, entendida como uma emoção autoconsciente, multifacetada e socialmente focada, desempenha um papel central na saúde mental dos indivíduos. Nos adolescentes, é também uma experiência frequente, sendo importante a sua avaliação para a investigação e prática clinica. Este estudo pretende validar uma medida breve de vergonha externa (Escala de Vergonha Externa - Versão breve para Adolescentes [OASB-A]). Participaram 834 adolescentes com uma média de 15 anos. O modelo final da OASB-A (8 itens), obtido por meio da Análise Fatorial Confirmatória, apresenta um bom ajustamento aos dados, invariância para o sexo, boa consistência interna e fidedignidade temporal adequada. As correlações com as experiências traumáticas de vergonha (IES-R) e sintomatologia psicopatológica (DASS-21) são significativas. A OASB-A é uma medida válida e econômica para avaliação da vergonha externa em adolescentes.
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Abstract
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.
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Martins MJ, Castilho P, Carvalho CB, Pereira AT, Carvalho D, Bajouco M, Madeira N, Santos V, Macedo A. Pathways from paranoid conviction to distress: exploring the mediator role of Fears of Compassion in a sample of people with psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1349830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria João Martins
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Célia Barreto Carvalho
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
- Faculty of Human and Social Sciences, Department of Psychology, University of Azores, Ponta Delgada, Portugal
| | - Ana Telma Pereira
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Diana Carvalho
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Miguel Bajouco
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Nuno Madeira
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Vitor Santos
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
| | - António Macedo
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
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60
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The Role of Environmental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social/performance situations, and a number of key environmental factors have been implicated in the aetiology of the disorder. Hence, the current article reviews theoretical and empirical evidence linking the development of SAD with parenting factors, traumatic life events, and aversive social experiences. Specifically, research suggests that the risk of developing SAD is increased by over-controlling, critical and cold parenting, an insecure attachment style, aversive social/peer experiences, emotional maltreatment, and to a lesser extent other forms of childhood maltreatment and adversity. Moreover, these factors may lead to posttraumatic reactions, distorted negative self-imagery, and internalised shame-based schemas that subsequently maintain SAD symptomatology. However, further research is necessary to clarify the nature, interactions, and relative contributions of these factors. It is likely that SAD develops via a complex interplay of biological and environmental factors, and that multiple aetiological pathways underlie the development of the disorder.
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61
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Misiak B, Krefft M, Bielawski T, Moustafa AA, Sąsiadek MM, Frydecka D. Toward a unified theory of childhood trauma and psychosis: A comprehensive review of epidemiological, clinical, neuropsychological and biological findings. Neurosci Biobehav Rev 2017; 75:393-406. [PMID: 28216171 DOI: 10.1016/j.neubiorev.2017.02.015] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 01/05/2023]
Abstract
There is a growing body of research focused on the relationship between childhood trauma and the risk of developing psychosis. Numerous studies, including many large-scale population-based studies, controlling for possible mediating variables, provide persuasive evidence of a dose-response association and are indicative of a causal relationship. Existing evidence supports the specificity model, showing differential associations between particular adversities and clinical symptoms, with cumulative adversity causing less favorable clinical and functional outcomes in psychotic patients. To date, several psychological and biological models have been proposed to search for underlying developmental trajectories leading to the onset of psychosis, influencing psychopathological manifestation and negative functional outcomes due to a history of childhood trauma. In this article, we provide a unified review on the relationship between childhood trauma and psychosis by integrating results of epidemiological, clinical, neuropsychological and biological studies. The question whether psychosis with a positive history of childhood trauma should be considered as a new psychotic phenotype, requiring specific therapeutic interventions, warrants further investigation.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Maja Krefft
- Department of Psychiatry, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Tomasz Bielawski
- Department of Psychiatry, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, University of Western Sydney, Penrith, NSW, Australia
| | - Maria M Sąsiadek
- Department of Genetics, 1 Marcinkowski Street, 50-368 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, 10 Pasteur Street, 50-367 Wroclaw, Poland
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Duarte C, Pinto-Gouveia J. Self-Defining Memories of Body Image Shame and Binge Eating in Men and Women: Body Image Shame and Self-Criticism in Adulthood as Mediating Mechanisms. SEX ROLES 2016. [DOI: 10.1007/s11199-016-0728-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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63
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Cibich M, Woodyatt L, Wenzel M. Moving beyond “shame is bad”: How a functional emotioncanbecome problematic. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2016. [DOI: 10.1111/spc3.12263] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Arditte KA, Morabito DM, Shaw AM, Timpano KR. Interpersonal risk for suicide in social anxiety: The roles of shame and depression. Psychiatry Res 2016; 239:139-44. [PMID: 27137975 DOI: 10.1016/j.psychres.2016.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/13/2016] [Accepted: 03/07/2016] [Indexed: 01/04/2023]
Abstract
Though research indicates that individuals with social anxiety disorder may experience elevated levels of thwarted belongingness and perceived burdensomeness, two interpersonal risk factors critical for the development of suicidal desire, it remains unclear why. The current investigation considered how shame and depression may help to explain the relationship between social anxiety and interpersonal suicide risk factors. Participants (N=259), recruited using Amazon.com's Mechanical Turk, completed measures of social anxiety, interpersonal suicide risk factors, shame, and depression. Social anxiety was associated with greater thwarted belongingness and perceived burdensomeness. In addition, shame partially explained the association between social anxiety and thwarted belongingness, though the indirect effect was no longer significant after considering depression as a moderator. As predicted, shame was found to fully explain the association between social anxiety and perceived burdensomeness and this indirect effect was most pronounced among individuals with high comorbid depression. The clinical implications of these findings are discussed.
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Affiliation(s)
- Kimberly A Arditte
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, USA
| | - Danielle M Morabito
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, USA
| | - Ashley M Shaw
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, USA
| | - Kiara R Timpano
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, USA.
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Luoma JB, Platt MG. Shame, self-criticism, self-stigma, and compassion in Acceptance and Commitment Therapy. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2014.12.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Matos M, Ferreira C, Duarte C, Pinto-Gouveia J. Eating disorders: when social rank perceptions are shaped by early shame experiences. Psychol Psychother 2015; 88:38-53. [PMID: 24665043 DOI: 10.1111/papt.12027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 01/27/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Recent research has shown that early adverse experiences can be an important risk factor for eating disorders. However, the role of early shame memories and how they are structured as traumatic and central memories to self-identity in eating disorders has never been investigated. This study explores the phenomenology of shame memories involving attachment figures and other agents from the wider social domain in patients with eating disorders, and examines the relationship between their traumatic and centrality features, social comparison based on physical appearance, and the severity of eating psychopathology. DESIGN The study has a cross-sectional design using a structured interview to assess retrospective data. METHODS Participants in this study were 36 patients with an eating disorder diagnosis, who were assessed using Eating Disorder Examination (EDE 16.0D), the Shame Experiences Interview (SEI), and self-report instruments measuring the traumatic features and centrality to identity of shame memories and social comparison. RESULTS Results indicated that the traumatic and centrality qualities of shame memories involving social agents other than attachment figures (e.g., peers) are significantly correlated with unfavourable social rank perceptions and with increased eating psychopathology severity. Furthermore, the impact of such shame memories on eating psychopathology is fully mediated by social comparisons based on physical appearance. CONCLUSIONS These findings highlight the importance of early shame experiences involving peers and other social agents that become traumatic memories, central to self-identity, to eating disorder patients' perceptions of inferiority and their core psychopathology features. PRACTITIONER POINTS Early shame experiences of patients with eating disorders should be carefully assessed. Shame traumatic memories involving social agents outside the family circle (e.g., peers) seem to be especially damaging for patients with eating disorders, and influence how physical appearance is used as a central dimension to establish their social rank. Practitioners should directly work with these shame memories, focusing on diminishing their traumatic nature and reconstruct their central meaning to self-identity.
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Affiliation(s)
- Marcela Matos
- Cognitive and Behavioural Research Centre, University of Coimbra, Portugal
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Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C. The Other As Shamer Scale – 2: Development and validation of a short version of a measure of external shame. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2014.09.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johnson J, Jones C, Lin A, Wood S, Heinze K, Jackson C. Shame amplifies the association between stressful life events and paranoia amongst young adults using mental health services: Implications for understanding risk and psychological resilience. Psychiatry Res 2014; 220:217-25. [PMID: 25086764 DOI: 10.1016/j.psychres.2014.07.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/09/2014] [Accepted: 07/10/2014] [Indexed: 12/27/2022]
Abstract
Shame is associated with a range of psychological disorders, and is a trans-diagnostic moderator of the association between stressors and symptoms of disorder. However, research has yet to investigate shame in relation to specific psychotic symptoms in clinical groups. In order to address this, the present study investigated shame in young adults with mental health problems, to test whether shame was i) directly associated with paranoia, a prevalent psychotic symptom, and ii) a moderator of the association between stress and paranoia. Sixty participants completed measures of stressful events, paranoia, shame, depression and anxiety. Results from a cross-sectional regression analysis suggested that shame was associated with paranoia after the stressful life event measure was entered into the model, and shame moderated the association between stress and paranoia. For individuals scoring high on shame, shame amplified the association between stress and paranoia, but for low-shame individuals, the association between stress and paranoia was non-significant. These findings suggest that high levels of shame could confer vulnerability for paranoia amongst clinical groups, and that resistance to experiencing shame could be a marker of resilience.
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Affiliation(s)
- Judith Johnson
- Institute of Psychological Sciences, University of Leeds, Leeds LS29JT, UK; Bradford Institute of Health Research, Bradford, UK.
| | - Christopher Jones
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Stephen Wood
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK; Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Parkville, Australia
| | - Kareen Heinze
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Christopher Jackson
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
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Scheel CN, Bender C, Tuschen-Caffier B, Brodführer A, Matthies S, Hermann C, Geisse EK, Svaldi J, Brakemeier EL, Philipsen A, Jacob GA. Do patients with different mental disorders show specific aspects of shame? Psychiatry Res 2014; 220:490-5. [PMID: 25219613 DOI: 10.1016/j.psychres.2014.07.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 06/01/2014] [Accepted: 07/27/2014] [Indexed: 10/25/2022]
Abstract
Shame is related to several mental disorders. We assume that facets of shame, namely bodily, cognitive and existential shame, may occur in typical patterns in mental and personality disorders. An excessive level of shame may lead to psychopathological symptoms. However, a lack of shame may also lead to distress, for instance as it may facilitate violation of social norms and thus may promote interpersonal problems. In this study we investigated facets of shame in females suffering from various mental disorders and personality disorders presumably associated with specific aspects of shame. Women suffering from borderline personality disorder (BPD, n=92), attention deficit hyperactivity disorder (ADHD, n=86), major depressive disorder (MDD, n=17), social anxiety disorder (SAD, n=33), and a community sample (COM, n=290) completed the SHAME questionnaire, which is a newly developed instrument to assess adaptive and maladaptive aspects of shame. BPD patients reported the highest level of existential shame compared to all other groups. Compared to the controls, SAD patients displayed stronger bodily and cognitive shame, and ADHD showed lower bodily shame. As assumed, specific aspects of shame were found in different patient groups. It may be important to specifically address these specific aspects of shame in psychotherapy.
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Affiliation(s)
- Corinna N Scheel
- Department of Clinical Psychology and Psychotherapy, University Freiburg, Germany; Department of Clinical Psychology and Psychotherapy Research, University Zurich, Switzerland.
| | - Caroline Bender
- Department of Clinical Psychology and Psychotherapy, University Freiburg, Germany
| | | | - Anne Brodführer
- Department of Clinical Psychology and Psychotherapy, University Freiburg, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany
| | - Christiane Hermann
- Department of Clinical Psychology and Psychotherapy, University Giessen, Germany
| | - Eva K Geisse
- Department of Clinical Psychology and Psychotherapy, University Giessen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University Freiburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University Freiburg, Germany; Psychologische Hochschule, Berlin, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany
| | - Gitta A Jacob
- Department of Clinical Psychology and Psychotherapy, University Freiburg, Germany
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Hoyer J, Wiltink J, Hiller W, Miller R, Salzer S, Sarnowsky S, Stangier U, Strauss B, Willutzki U, Leibing E. Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial. Clin Psychol Psychother 2014; 23:35-46. [PMID: 25504802 DOI: 10.1002/cpp.1936] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/30/2014] [Accepted: 11/03/2014] [Indexed: 11/09/2022]
Abstract
UNLABELLED We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed. METHOD Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied. RESULTS Up to 37% of the post-treatment variance (LSAS) could be explained by all pre-treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end-state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end-state functioning and response, but not with remission. Self-esteem was positively associated with higher end-state functioning and more shame with better response. Attrition could not be significantly predicted. CONCLUSIONS The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical-based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level. KEY PRACTITIONER MESSAGE Personality, self-esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively. Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Juergen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Joerg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wolfgang Hiller
- Clinical Psychology and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Miller
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Simone Salzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Goettingen, Goettingen, Germany
| | - Stephan Sarnowsky
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Ulrike Willutzki
- Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Eric Leibing
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Goettingen, Goettingen, Germany
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Duarte C, Pinto-Gouveia J, Ferreira C, Batista D. Body Image as a Source of Shame: A New Measure for the Assessment of the Multifaceted Nature of Body Image Shame. Clin Psychol Psychother 2014; 22:656-66. [PMID: 25316416 DOI: 10.1002/cpp.1925] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Cristiana Duarte
- CINEICC-Cognitive and Behavioural Centre for Research and Intervention; University of Coimbra; Coimbra Portugal
| | - José Pinto-Gouveia
- CINEICC-Cognitive and Behavioural Centre for Research and Intervention; University of Coimbra; Coimbra Portugal
| | - Cláudia Ferreira
- CINEICC-Cognitive and Behavioural Centre for Research and Intervention; University of Coimbra; Coimbra Portugal
| | - Diana Batista
- Faculty of Psychology and Educational Sciences; University of Coimbra; Coimbra Portugal
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Ferreira C, Matos M, Duarte C, Pinto-Gouveia J. Shame Memories and Eating Psychopathology: The Buffering Effect of Self-Compassion. EUROPEAN EATING DISORDERS REVIEW 2014; 22:487-94. [DOI: 10.1002/erv.2322] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Cláudia Ferreira
- Cognitive and Behavioural Research Centre (CINEICC); University of Coimbra; Coimbra Portugal
| | - Marcela Matos
- Cognitive and Behavioural Research Centre (CINEICC); University of Coimbra; Coimbra Portugal
| | - Cristiana Duarte
- Cognitive and Behavioural Research Centre (CINEICC); University of Coimbra; Coimbra Portugal
| | - José Pinto-Gouveia
- Cognitive and Behavioural Research Centre (CINEICC); University of Coimbra; Coimbra Portugal
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Shahar B, Doron G, Szepsenwol O. Childhood Maltreatment, Shame-Proneness and Self-Criticism in Social Anxiety Disorder: A Sequential Mediational Model. Clin Psychol Psychother 2014; 22:570-9. [PMID: 25196782 DOI: 10.1002/cpp.1918] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/24/2014] [Accepted: 08/01/2014] [Indexed: 11/07/2022]
Abstract
UNLABELLED Previous research has shown a robust link between emotional abuse and neglect with social anxiety symptoms. However, the mechanisms through which these links operate are less clear. We hypothesized a model in which early experiences of abuse and neglect create aversive shame states, internalized into a stable shame-based cognitive-affective schema. Self-criticism is conceptualized as a safety strategy designed to conceal flaws and prevent further experiences of shame. However, self-criticism maintains negative self-perceptions and insecurity in social situations. To provide preliminary, cross-sectional support for this model, a nonclinical community sample of 219 adults from Israel (110 females, mean age = 38.7) completed measures of childhood trauma, shame-proneness, self-criticism and social anxiety symptoms. A sequential mediational model showed that emotional abuse, but not emotional neglect, predicted shame-proneness, which in turn predicted self-criticism, which in turn predicted social anxiety symptoms. These results provide initial evidence supporting the role of shame and self-criticism in the development and maintenance of social anxiety disorder. The clinical implications of these findings are discussed. KEY PRACTITIONER MESSAGE Previous research has shown that histories of emotional abuse and emotional neglect predict social anxiety symptoms, but the mechanisms that underlie these associations are not clear. Using psycho-evolutionary and emotion-focused perspectives, the findings of the current study suggest that shame and self-criticism play an important role in social anxiety and may mediate the link between emotional abuse and symptoms. These findings also suggest that therapeutic interventions specifically targeting shame and self-criticism should be incorporated into treatments for social anxiety, especially with socially anxious patients with abuse histories.
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Affiliation(s)
- Ben Shahar
- Interdisciplinary Center, School of Psychology, Herzliya, Israel
| | - Guy Doron
- Interdisciplinary Center, School of Psychology, Herzliya, Israel
| | - Ohad Szepsenwol
- Interdisciplinary Center, School of Psychology, Herzliya, Israel
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Zimmerman J, Morrison AS, Heimberg RG. Social anxiety, submissiveness, and shame in men and women: A moderated mediation analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 54:1-15. [DOI: 10.1111/bjc.12057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 04/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob Zimmerman
- Department of Psychology; Temple University; Philadelphia Pennsylvania USA
| | - Amanda S. Morrison
- Department of Psychology; Temple University; Philadelphia Pennsylvania USA
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Gumley A, Braehler C, Macbeth A. A meta-analysis and theoretical critique of oxytocin and psychosis: prospects for attachment and compassion in promoting recovery. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:42-61. [PMID: 24588761 DOI: 10.1111/bjc.12041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/17/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES There is now considerable evidence that affiliative processes are linked to oxytocin (OXT), which is linked to a range of social-cognition competences underpinning interpersonal functioning. There is evidence that OXT circuitry is involved in psychosis and emerging evidence for OXT in treatment. Therefore, this study explored studies investigating OXT and improvements in symptoms and social cognition among individuals diagnosed with psychosis. METHOD We conducted a systematic review of randomized controlled trials investigating OXT and psychosis. Specifically we asked, (1) what is the evidence that OXT is associated with improved overall, positive, negative and general symptoms and (2) what is the evidence that OXT is associated with improved social cognition? RESULTS There were seven randomized controlled trials that met the inclusion criteria for this review. We conducted an exploratory meta-analysis of data from four of these studies on a total sample size of n = 105. For overall symptoms, using a random-effects model OXT versus placebo was associated with an effect size of d = 0.52 (95% CI = 0.34-0.70; z = 5.66; p < .01). There was evidence of significant heterogeneity (Q = 96.4, p < .001; I(2) = 96.5%). Similar patterns of findings were observed for positive, negative, and general symptoms. We found significant evidence of high risk of bias across all studies. We also identified that one particular study had an undue effect on overall effect size estimates. Finally, evidence regarding OXT was linked to improved social cognition was inconsistent. CONCLUSIONS There are significant problems in interpreting the current evidence base for OXT in psychosis. However, OXT may provide a useful biomarker for exploring mechanisms of change occurring in psychological therapies including compassion-focused therapy (CFT), which through its engagement of the attachment system may directly influence OXT.
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Affiliation(s)
- Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, UK
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77
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The Short-Term Impact of a Paranoid Explanation on Self-esteem: An Experimental Study. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9600-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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78
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Abstract
Compassion-focused therapy was developed to enhance physiological systems related to well-being, safeness, and connectedness in people where shame and self-criticism inhibited progress in therapy (Gilbert, 2000; Gilbert & Irons, 2005). This system links attachment experiences with emotion regulation capacities, with integrative capacities of the mind and also with the interplay between different motivational systems, which are played out in multiple self-states (Cortina & Liotti, 2010; Cozolino, 2010; Gilbert, 2009; Liotti & Gilbert, 2011). Hence, a compassionate focus could potentially prove valuable in eye movement desensitization and reprocessing (EMDR), particularly where shame or attachment trauma is involved or for those traumas that have impacted on the structure of the self, for example, dissociation. A structured compassion-focused EMDR (CF-EMDR) seems likely to be particularly useful for therapists wishing to pay positive attention to strengths and well-being. The primary task of the CF-EMDR therapist would therefore be to facilitate a warm and wise relationship to the problems that brought the person to EMDR. This article outlines the potential benefit of a compassionate focus in the processing phases of EMDR to address self-critical blocks, giving clinical examples in tables to illustrate the process and language.
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Pinto-Gouveia J, Castilho P, Matos M, Xavier A. Centrality of shame memories and psychopathology: The mediator effect of self‐criticism. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cpsp.12044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hedman E, Ström P, Stünkel A, Mörtberg E. Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PLoS One 2013; 8:e61713. [PMID: 23620782 PMCID: PMC3631156 DOI: 10.1371/journal.pone.0061713] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 03/17/2013] [Indexed: 11/18/2022] Open
Abstract
Social anxiety disorder (SAD), characterized by fear of being scrutinized by others, has features that that are closely linked to the concept of shame. Despite this, it remains to be investigated whether shame is elevated in persons with SAD, and if cognitive behavior therapy (CBT) for SAD could reduce shame experience. In the present study, we focused on internal shame, i.e. the type of shame that pertains to how we judge ourselves. Although guilt is distinctly different from shame, we also viewed it as important to investigate its role in SAD as the two emotions are highly correlated. The aim of this study was to investigate: (I) if persons with SAD differ from healthy controls on shame and guilt, (II) if shame, guilt, depressive symptoms, and social anxiety are associated in persons with SAD, and (III) if CBT can reduce internal shame in patients with SAD. Firstly, we conducted a case-control study comparing a sample with SAD (n = 67) with two samples of healthy controls, a main sample (n = 72) and a replication sample (n = 22). Secondly, all participants with SAD were treated with CBT and shame, measured with the Test of Self-Conscious affect, was assessed before and after treatment. The results showed that shame was elevated in person with SAD compared to the control replication sample, but not to the main control sample. In addition, shame, social anxiety, and depressive symptoms were significantly associated among participants with SAD. After CBT, participants with SAD had significantly reduced their shame (Cohen's d = 0.44). Guilt was unrelated to social anxiety. We conclude that shame and social anxiety are associated and that it is likely that persons with SAD are more prone to experience shame than persons without SAD. Also, CBT is associated with shame reduction in the treatment of SAD.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden.
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Internalizing Early Memories of Shame and Lack of Safeness and Warmth: The Mediating Role of Shame on Depression. Behav Cogn Psychother 2013; 41:479-93. [DOI: 10.1017/s1352465812001099] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background:Growing evidence supports the association between early memories of shame and lack of safeness and current shame and depression. Nevertheless, it is unclear whether shame serves as a mediator between such early memories and depressive symptoms.Aims:This study aimed at testing whether the impact of shame traumatic memory, centrality of shame memory, early memories of warmth and safeness (predictors), on depressive symptoms (outcome) would be mediated by current external and internal shame.Method:Student participants (N= 178) recalled an early shame experience and completed self-report instruments measuring centrality and traumatic characteristics of the shame memory, early memories of warmth and safeness, external and internal shame and depressive symptoms.Results:Path analysis’ results revealed that internal shame fully mediated the relationship between shame traumatic memory, centrality of shame memory, and early memories of warmth and safeness, and depression. However, current feelings of external shame, highly linked to internal shame, did not significantly predict depression.Conclusion:These findings shed light on the role of internalizing early shame and lack of safeness memories into a sense of self as globally self-condemning in the vulnerability to experience depressive symptoms.
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Turner MH, Bernard M, Birchwood M, Jackson C, Jones C. The contribution of shame to post-psychotic trauma. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 52:162-82. [DOI: 10.1111/bjc.12007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 09/06/2012] [Accepted: 08/30/2012] [Indexed: 12/28/2022]
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Matos M, Pinto-Gouveia J, Duarte C. Above and beyond emotional valence: The unique contribution of central and traumatic shame memories to psychopathology vulnerability. Memory 2012; 20:461-77. [DOI: 10.1080/09658211.2012.680962] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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