A longitudinal test of problematic alcohol use and binge eating among college women: The moderating role of shame

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time.

OBJECTIVE

Examine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating.

METHOD

In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives.

RESULTS

Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking.

CONCLUSION

Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women.

Shame and guilt for alcohol-related transgressions and hazardous drinking among male and female college students

Objective: Shame and guilt are often present prior to and consequent to alcohol use among college students. Little is known about the propensity to experience these emotions in the context of transgressions that occur while drinking alcohol. We examined the association between shame and guilt propensity for alcohol-related transgressions with hazardous drinking, and the role of gender in these relationships. Participants: College student drinkers (N = 130; Mage=19.39; 68% females; 86% White) from a Mid-south college. Methods: An online confidential survey included measures of hazardous drinking, guilt and shame propensity, and guilt and shame propensity specific to alcohol-related transgressions. Results: Our preliminary findings suggest that experiencing guilt (but not shame) after alcohol-related transgressions was related to less hazardous drinking when controlling for general guilt and shame propensity for male and female students. Conclusions: Targeting components of guilt (e.g., reparative behaviors) after alcohol-related transgressions may help to reduce problematic drinking among college students.

Examining the daily relationship between guilt, shame, and substance use among veterans with psychiatric disorders

Background

Shame and guilt are key emotions known to amplify trauma-related symptoms in veterans. Maintenance of symptoms is facilitated by avoidance behaviors, such as substance use. However, limited research has examined the associations between shame, guilt, and substance use in daily life.

Methods

The current study sought to examine the cross-lagged association between shame, guilt, and substance use. Forty veterans completed 28 days of experience sampling reporting on their current emotional experiences and use of substances.

Results

Results suggest a reciprocal relationship among shame and guilt and substance use, such that shame and guilt separately predicted subsequent substance use, and substance use predicted subsequent shame and guilt.

Conclusions

These results highlight the dynamic relationship among shame, guilt, and substance use and suggest the potential value of conceptualizing these clinical targets as mutually reinforcing to inform integrative intervention strategies that can interrupt the in-the-moment cascade of negative consequences.

Shame-and-guilt-proneness, interpersonal sensitivity, and alcohol: Results from a moderated mediation

BACKGROUND

Shame-proneness has been consistently associated with more problematic alcohol outcomes, and guilt-proneness has been associated with fewer. The aim of this study was to determine if the associations of shame-and-guilt-proneness with alcohol outcomes vary as a function of interpersonal sensitivity.

METHOD

A longitudinal study examined shame-proneness and guilt-proneness as predictors of alcohol consumption and related problems one month later. This research was conducted at a large public university in the United States.

RESULTS

Participants (N=414) were heavy-drinking college students (51% female) with a mean age of 21.76 (SD=2.02) who consumed an average of 12.13 (SD=8.81) standard drinks per week. Shame-proneness, but not guilt-proneness, was directly associated with increased drinking and indirectly associated with increased problems. The indirect effects of shame on problems through drinking were stronger at higher levels of interpersonal sensitivity.

CONCLUSIONS

Results suggest that shame-proneness may increase alcohol consumption and subsequent problems among those high in interpersonal sensitivity. Alcohol may be used as a means to withdraw from social threats that are amplified by interpersonal sensitivity.

Guilt in alcohol use: A systematic review

For decades, alcohol use disorder has been investigated in an attempt to understand its processes and implications. However, among all of the factors involved in alcohol use disorder, the role of guilt in alcohol use remains poorly explained, with many contradictory results. Therefore, the purpose of this review is to conduct a systematic analysis of the literature from 1990 to 2022 to review the studies investigating the link between guilt and alcohol consumption. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, 31 studies were included in this review. The results of this work enable to highlight the plurality of guilt that has been studied in the literature. Grouped in two categories: state guilt and trait guilt, they seem to have diverse implications towards alcohol use or misuse. Guilt proneness seems to act as a protective factor towards alcohol use, except for the few studies conducted on a clinical population. Numerous studies indicated that state guilt is deleterious toward alcohol use, even if some results are contradictory. Furthermore, this work allows us to shed light on the limits of the studies currently carried out, and thus to propose new directions for future studies.

Cultural Differences in Fear of Negative Evaluation After Social Norm Transgressions and the Impact on Mental Health

Social norm transgressions are assumed to be at the root of numerous substantial negative outcomes for transgressors. There is a prevailing notion among lay people and scholars that transgressing social norms can negatively impact one's mental health. The present research aimed to examine this assumption, focusing on clinically relevant outcomes such as anxiety and depression. The present research further aimed to examine a social cognitive process for these outcomes in the form of fear of negative evaluations as a result of one's norm transgressing behavior. Specifically, it examined whether it is negative evaluations about ourselves or about those close to us that mediates the effect of social norm transgressions, and whether those may vary as a function of culture. Results of the present research, including a study with a community sample (N = 410), suggest a positive association between social norm transgressions and psychological distress. Results also suggest that increased fear of negative evaluation mediates that association but does so differently for people from more collectivistic cultures and people from less collectivistic cultures. For people from more collectivistic cultures increased fear of negative evaluation of close others may mediate the association between social norm transgressions and psychological distress. However, for people from less collectivistic cultures that association may be mediated by increased fear of negative evaluation of oneself. Implications for research on consequences of social norm transgressions and cross-cultural differences in perceptions of such consequences are discussed as are practical implications for motivating social norm adherence and the maintenance of constructive social norms.

The shame spiral of addiction: Negative self-conscious emotion and substance use

BACKGROUND

The bidirectional associations between negative self-conscious emotions such as shame and guilt and substance use are poorly understood. Longitudinal research is needed to examine the causes, consequences, and moderators of negative self-conscious emotions in people who use substances.

METHODS

Using parallel process latent growth curve modeling, we assessed bidirectional associations between shame and guilt and substance use (i.e., number of days in the past 30 used stimulants, alcohol to intoxication, other substances, or injected drugs) as well as the moderating role of positive emotion. Emotions were assessed using the Differential Emotions Scale. The sample included 110 sexual minority cisgender men with biologically confirmed recent methamphetamine use, enrolled in a randomized controlled trial in San Francisco, CA. Participants self-reported emotions and recent substance use behaviors over six time points across 15 months.

RESULTS

Higher initial levels of shame were associated with slower decreases in stimulant use over time (b = 0.23, p = .041) and guilt was positively associated with stimulant use over time (β = 0.85, p < .0001). Initial levels of guilt and alcohol use were positively related (b = 0.29, p = .040), but over time, they had a negative relationship (β = -0.99, p < .0001). Additionally, higher initial levels of other drug use were associated with slower decreases in shame over time (b = 0.02, p = .041). All results were independent of depression, highlighting the specific role of self-conscious emotions.

CONCLUSIONS

Shame and guilt are barriers to reducing stimulant use, and expanded efforts are needed to mitigate the deleterious effects of these self-conscious emotions in recovery from a stimulant use disorder.

Guilt and Shame of What Might Have Been in Optimistic Offender Drivers

Habitual offender drivers are required to recover points lost on their driving license by attending reeducation courses, an experience that may, upon reflection of the incident in question, induce feelings of guilt or shame for the infractions they committed. A simulated driving task studied optimistic offender drivers to analyze the extent to which the controllability of the situational context influenced their use of internal and external factors in counterfactual thoughts and emotions such as guilt and shame. The study involved 160 drivers, of whom 54 were categorized as repeat offender drivers while 106 drivers attended courses for advanced professional driving licenses. The participants drove along a route in a driving simulator, which had been previously adjusted for the difficulty to generate a perception of high or low control. Based on the outcome obtained by the participants in this stage, each driver had to report which resources they required to improve their outcomes. Different factor ANOVAs were used to analyze our findings. The results indicated that optimistic offenders, unlike other groups (i.e., optimistic non-offender and pessimistic non-offender), thought that their results could have been better if external factors had been present (i.e., upward counterfactuals), both under conditions of high and low control. They believed their results would have been worse had it not been for their internal resources (i.e., downward counterfactuals), especially under conditions of low control. Concerning emotions of guilt and shame, offender optimists had the lowest values in both conditions compared with the other groups. We may contend that optimistic offender drivers thought they could have obtained better outcomes if external factors had been involved. In the low control condition, they justified that if it were not for such internal skills, their results could have been worse. When they generated such thoughts, the emotions of guilt and shame were minimal.

Why do people follow social norms?

Norms prescribe how to make decisions in social situations and play a crucial role in sustaining cooperative relationships and coordinating collective action. However, following norms often requires restricting behavior, demanding to curtail selfishness, or suppressing personal goals. This raises the question why people adhere to norms. We review recent theories and empirical findings that aim at explaining why people follow norms even in private, when violations are difficult to detect and are not sanctioned. We discuss theories of norm internalization, social and self-image concerns, and social learning (i.e. preferences conditional on what others do/believe). Finally, we present two behavioral, incentivized tasks that can be used to elicit norms and measure the individual propensity to follow them.

Shame's Associations with Depression and Problem Drinking: An Ecological Momentary Study

INTRODUCTION

Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems.

METHODS

One hundred and eighty-four emerging adults (M_age= 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses.

RESULTS

In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use.

CONCLUSION

After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.

Guilt Enhances the Persuasive Effects of Injunctive But Not Descriptive Social Norms

The focus theory of normative conduct asserts that distinct processes are involved in responding to injunctive norms versus descriptive norms. This research tested the prediction that guilt would be more strongly involved in motivating conformity to injunctive than descriptive norms. Study 1 demonstrates that people anticipate feeling guiltier following injunctive than descriptive norm violations. Studies 2 and 3 demonstrate that guilt proneness and state-level guilt enhance the persuasiveness of messages framed with injunctive norms but not control-framed or descriptive norm–framed messages. Finally, Study 4 shows that a guilt-arousing public service announcement is more effective if framed using an injunctive norm than a descriptive norm or a control message. These results augment understanding of the different ways that injunctive and descriptive norms influence behavior and have applied implications for social norms marketing interventions.

Roles of attitudes and injunctive norms in decisional conflict and disclosure following receipt of genome sequencing results

RATIONALE

Individuals who choose to obtain genetic information may learn that their genetic profile confers health risks to themselves or offspring. Individuals may react more negatively to this information when personal attitudes, perceived norms, and/or the decision to receive results conflict with one another.

OBJECTIVE

We predicted that holding more negative attitudes (personal evaluations) or injunctive norms (perceptions of others' approval) toward obtaining genetic test results would prospectively predict greater conflict about the decision to undergo sequencing and less disclosure of sequencing results to family members. We also expected attitudes and norms to interact, such that attitudes would be negatively associated with decisional conflict and positively associated with disclosure when injunctive norms were positive, but weakly associated with outcomes when injunctive norms were negative.

METHOD

Participants (N=312) were enrolled in a genomic sequencing trial focused on identifying carrier genetic variants, reflecting a variant that might affect their biological children's or grandchildren's health. Participants reported attitudes and injunctive norms, underwent sequencing, and later received results indicating carrier status for at least one variant. Decisional conflict was assessed at immediate post-test, and 1- and 6-month follow-ups. Disclosure of results to children and siblings were assessed at 1 and 6 months.

RESULTS

In structural equation models with covariates, attitudes were negatively associated with post-test and 1-month decisional conflict. Injunctive norms were negatively associated with decisional conflict at 1 and 6 months and positively associated with disclosure to children and siblings at 1 month. The significant attitudes by injunctive norms interaction predicting post-test decisional conflict supported lower decisional conflict when attitudes, norms, and the decision to receive results were all aligned. Exploratory analyses supported indirect effects of attitudes and norms on 6-month sibling disclosure via 1- month decisional conflict.

CONCLUSION

Results support roles of psychosocial factors in decisional conflict and disclosure after receiving sequencing results.

Measuring Alcohol Use-Related Shame and Guilt: Development and Validation of the Perceptions of Drinking Scale

Background: The dispositional tendency to experience guilt is inversely related to disordered alcohol use, while dispositional shame-proneness appears to share a positive relationship with alcohol problems. Objective: In order to further research in this domain, a new measure of alcohol use-related shame and guilt is described. Methods: Using exploratory and confirmatory factor analysis (CFA), the psychometric properties of the Perceptions of Drinking Scale (PODS) were validated across two independent samples (Sample 1 N = 293, Sample 2 N = 429). Results: A four factor model of the PODS was identified in exploratory factor analysis. The hypothesized four-factor PODS model was validated in an independent sample using CFA (RMSEA = .046; CFI = .99; TLI = .99). Alcohol use-related shame and guilt were reliably differentiated, and test re-test stability, divergent and convergent validity was established. Alcohol use-related shame was not clearly related to taking action to address problematic alcohol use, but was positively related with measures of negative affect and using avoidance-based coping strategies. Conversely, alcohol use-related guilt was generally unrelated to measures of negative affect and was clearly associated with the taking of action to address problematic alcohol use. Conclusions: The Perceptions of Drinking Scale has good psychometric properties and also appears to reliably distinguish between experiences of alcohol use-related shame and guilt. Both alcohol use-related shame and guilt appear to be positively associated with the contemplation of changing one's alcohol use-related behaviors. Only alcohol use-related guilt was clearly linked to the taking of action to address problematic drinking behavior.

Is shame a proximal trigger for drinking? A daily process study with a community sample

Between-subjects studies show that people with higher levels of shame tend to experience more negative drinking-related consequences than people with lower levels of shame. However, within-subjects studies of the association between daily fluctuations in shame and subsequent drinking have yielded mixed findings. This study aimed to resolve these inconsistencies by examining the association between daily fluctuations in shame, between-subjects differences in shame, and subsequent evening alcohol consumption in a sample of 70 community-dwelling drinkers. In addition, we examined whether the previous night's drinking predicted shame the next day based on the theory that shame may operate in a cyclical fashion in some people to maintain problematic drinking patterns. Multilevel model analyses showed a cross-level interaction in which individuals' average levels of ashamed mood moderated the effect of daily fluctuations in shame on solitary drinking. In contrast, previous day's drinking was only weakly related to shame the next day. This study contributes to existing literature by refining models of negative mood-related drinking and further elucidating the patterns by which shame serves as a trigger for drinking, particularly among high shame individuals. The authors interpret results in terms of self-control theory and demonstrate the importance of disaggregating between- and within-subjects variance when examining longitudinal data. (PsycINFO Database Record

The relative role of cognitive and emotional reactions in mediating the effects of a social comparison sun protection intervention

OBJECTIVE

This experiment examined the cognitive and emotional impact of two social comparison-based sun protection interventions in a sample of Southern California college students (N = 223). One of the interventions employed comparison UV photos of peers who had either much more (downward social comparison) or much less (upward social comparison) skin damage than did participants themselves. The second intervention consisted of descriptive norms information suggesting that a large majority of the participants' peer group regularly protect their skin from the sun.

DESIGN

Participants were randomly assigned to one of eight conditions in a 4 (Social Comparison Information: no photo vs. no comparison photos vs. upward comparison photos vs. downward comparison photos) × 2 (Descriptive Norms Information: Received vs. not received) design.

MAIN OUTCOME MEASURES

Emotional reactions (e.g. worry, embarrassment, relief) and sun-related cognitive reactions (perceived susceptibility, sun protection intentions) were assessed immediately. Sun protection behaviours were assessed in a surprise telephone follow-up five weeks following the intervention.

RESULTS

The results demonstrated that the combination of seeing photos of peers who had very little sun damage and learning that a majority of one's peers engage in regular sun protection resulted in reliably greater subsequent sun protection than all other conditions. Further, there was relatively direct evidence that both negative emotional reactions and sun protection intentions mediated this effect.

CONCLUSIONS

These findings add to the growing literature suggesting the importance of thoroughly examining the role of emotions in health behaviour decisions. Both theory and intervention efficacy would benefit from a better understanding of the relative role of cognitions and emotions in behaviour change.