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Shame in social anxiety disorder

Changing pathological shame experience in social anxiety disorder

Shame can be understood in the broadest sense as a global devaluation of the self and is characterized by a critical, judgmental and condemning self-verbalization. Because shame motivates people to view themselves critically, they behave in a more reserved and distant manner in social situations.  When a strong desire for positive reactions from others is associated with high levels of insecurity, people experience exaggerated shame (Schuster et al., 2021), and to avoid experiencing this shame, social situations are avoided (see, e.g., Clark & Wells, 1995). Subsequently, exaggerated shame plays an important role in the development and maintenance of a number of psychopathological disorders (e.g., depression, eating disorders, posttraumatic stress disorder, somatoform disorders), particularly social anxiety disorder (SAD; Gilbert & Miles, 2000; Hedman et al., 2013).

Excessive self-attention and adopting an observer perspective (the self as object) are central components of Clark and Wells' psychopathological model of social anxiety. Both mechanisms lead to increased shame in a fundamentally self-critical belief. In our research, we aim to examine the efficacy and mechanisms of interventions in shame regulation. 

One way to change shame is through Paul Gilbert's self-compassion-based therapy. Self-compassion is a central construct of CFT that can be understood as a kind and understanding perspective of self in difficult situations, characterized by an understanding that suffering is an inevitable part of human nature while accepting it in a mindful way (Neff, 2003b). Self-compassion, however, is more than just kindness; it is about being aware of the pain that may be present and having the intention to try to alleviate it (Gilbert, 2010).

Cooperations with

Interventions used (use freely available)

For the induction of shame  (For use in experiments; Fink-Lamotte, Hoyer et al., under revision):

For the treatment of shame:

Social anxiety disorder and ambivalence to exposure.

Ambivalence is the simultaneous presence of positive and negative associations to certain objects and subjects. Accordingly, prior to exposure therapy, patients are often in an ambivalent state. On the one hand, exposure therapy is one of the most successful and effective psychotherapy interventions for a wide range of disorders (e.g., anxiety disorders; Stangier & Frydrich, 2002); on the other hand, exposure requires patients to confront their worst fears. For example, Purdon & Clark (2005) demonstrated in a qualitative study that individuals with social anxiety disorder (SAD), panic disorder, or obsessive-compulsive disorder (OCD) reported worry and anxiety about the upcoming exposure therapy. Here, it is likely that these motivational causes reduce the success of therapy (e.g., Abramowitz & Arch, 2014). In social anxiety, social situations in which aversive emotions such as fear might occur are reduced or avoided through safety behaviors, resulting in short-term symptom reduction and contributing to the maintenance of the disorder (Clark & Wells, 1995). Accordingly, affected individuals are ambivalent toward confrontation with aversive stimuli, which reduces motivation for therapy. Accordingly, it can be assumed that therapy elements (e.g., motivation, values) oriented toward a long-term goal reduce ambivalence toward confrontation in the context of ERP and strengthen intrinsic therapy motivation. Various approaches to this are discussed in the literature:

  • Putting patients in contact with other patients who have successfully completed an exposure
  • In addition, the direct increase of motivation through Motivational Interviewing or via the reinforcement of self-reference ("Why do I want to do this?") and action skills ("I can do this!") are discussed (Fink-Lamotte, Lüders, and Exner, 2021).
  • As a third idea for changing ambivalence, the extent to which values activation according to Acceptance and Commitment Therapy (Twohig et al., 2015, 2018) can lead to a reduction of ambivalence is discussed.

In the research project, we examine the role of shame on ambivalence and how values techniques and self-compassion has motivation to seek out ambivalent situations.

Shame, Social Anxiety and the Climate Crisis

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