A New Dawn: Reclaiming Life After Confronting Shame
A New Dawn: Reclaiming Life After Confronting Shame
Shame is a deeply rooted emotion that can have profound psychological impacts. Chronic or intense shame can lead to significant psychological and behavioral challenges.
Shame is a self-conscious emotion that invokes a negative evaluation of oneself, often about perceived failures, wrongdoings, or social expectations. Unlike guilt, which concerns one's actions, shame tends to be related to one's sense of self-worth and identity. Key points include:
- Definition and Characteristics: Shame is characterized by feelings of worthlessness, exposure, and a desire to hide or escape attention. It can emerge from personal transgressions and instances where individuals feel they have failed to meet societal or personal standards (Lewis, 1971).
- Differentiation from Guilt: While both are self-conscious emotions, guilt is about a specific behavior, and shame concerns the self. Feeling guilty might motivate reparative actions, while intense shame might induce avoidance or withdrawal (Tangney, Wagner, & Gramzow, 1989).
- Developmental Origins: Early experiences with caregivers are crucial in shaping how individuals experience and respond to shame. Adverse or critical reactions from caregivers can foster shame-proneness in children (Tangney & Dearing, 2002).
- Sociocultural Aspects: Culture plays a pivotal role in shaping the experience of shame. Different cultures may have distinct triggers and manifestations of shame based on societal norms and values (Fessler, 2004).
- Clinical Implications: Chronic feelings of shame can contribute to various mental health disorders, including depression, anxiety, and even traumatic stress reactions. Addressing shame can be fundamental to healing and growth (Gilbert, 2003).
Before one can feel shame, there must be a capacity for self-reflection and evaluation. This self-awareness allows individuals to assess their behaviors and traits against personal or societal standards (Lewis, 1971). Shame can arise if there is a perceived discrepancy between one's behavior and these standards. Here are some significant psychological processes that fuel shame.
External Judgments and Feedback: Often, shame is triggered by perceived negative judgments from others. It is not always about negative feedback, but sometimes the mere perception or fear of it can induce shame (Scheff, 2003).
Comparison to Social Norms and Standards: Shame tends to arise when an individual believes they have failed to meet specific societal or cultural norms. These norms act as benchmarks, and deviation from them can lead to feelings of inferiority or "not being good enough" (Tangney & Dearing, 2002).
Attribution to Global Self: While guilt is about a specific act ("I did something bad"), shame involves attributing the adverse event to one's global self ("I am bad"). This process involves seeing the self as fundamentally flawed because of the event (Tangney et al., 1989).
Desire to Hide or Disappear: Given the painful nature of shame and the sense of exposure it can create, there is often a subsequent desire to hide, escape, or even disappear. This is a protective mechanism aimed at preventing further judgment or negative feedback (Gilbert, 2003).
Rumination: Once shame is triggered, individuals may ruminate on the event or their perceived flaw, further intensifying the emotion and possibly leading to a spiral of negative self-talk and self-criticism (Orth, Berking, & Burkhardt, 2006).
The Psychological Impact of Shame
Shame is a deeply rooted emotion that can have profound psychological impacts. While occasional feelings of shame are a natural part of the human experience, chronic or intense shame can lead to significant psychological and behavioral challenges. Here is an overview of the psychological impact of shame:
- Self-Esteem and Self-Worth: Shame often targets an individual's core sense of self, leading to decreased self-worth and self-esteem. Over time, persistent shame can foster a negative self-concept, where individuals may view themselves as fundamentally flawed or unworthy (Lewis, 1971).
- Social Withdrawal and Isolation: The discomfort and vulnerability associated with shame often lead to avoidance behaviors. Individuals may withdraw from social interactions or avoid situations where they feel at risk of experiencing shame (Gilbert & Procter, 2006).
- Depression: Chronic feelings of shame have been linked to depressive symptoms. Rumination of shameful events or perceived personal inadequacies can contribute to the onset and maintenance of depressive episodes (Orth, Berking, & Burkhardt, 2006).
- Anxiety and Stress: The anticipation or fear of experiencing shame in social situations can exacerbate feelings of anxiety. Over time, this can contribute to developing social anxiety disorder or other anxiety-related conditions (Gilbert, 2003).
- Defensiveness and Aggression: Some individuals may exhibit defensive or even aggressive behaviors to protect themselves from the painful experience of shame. This can manifest as externalizing blame, lashing out at others, or adopting a hostile stance toward perceived threats to self-worth (Tangney, Wagner, Fletcher, & Gramzow, 1992).
- Risk of Addictive Behaviors: Some people might resort to substance abuse or other addictive behaviors to cope with or numb feelings of shame. This escapism can lead to addiction, further complicating an individual's psychological well-being (Dearing, Stuewig, & Tangney, 2005).
- Impact on Relationships: Shame can hinder the development of intimate and trusting relationships. Individuals burdened with shame might fear vulnerability, making it difficult to open up to others or trust connections' authenticity (Hartling et al., 2000).
- Challenges in Therapy: While therapy can be immensely beneficial for those grappling with shame, the very nature of the emotion can pose challenges. Patients may have difficulty opening up about shameful experiences or be excessively self-critical, hampering therapeutic progress (Gilbert & Procter, 2006).
At its core, shame revolves around a deeply ingrained belief that one is inherently flawed or inadequate. When individuals internalize such beliefs, it can lead to a cascade of negative psychological consequences. Persistent feelings of shame can erode self-esteem and self-worth, causing individuals to view themselves through a lens of perpetual insufficiency. This negative self-view can foster social withdrawal and isolation, as individuals may anticipate judgment or rejection from others, even when none is present. The vulnerability associated with shame often pushes individuals to avoid situations that might expose their perceived flaws, reducing social interaction and potential loneliness.
Moreover, the ruminative nature of shame—constantly replaying perceived failures or inadequacies—can be a significant driver of depressive symptoms. The emotional weight of shame can become so overwhelming that some individuals might engage in self-destructive behaviors, such as substance abuse, as a temporary escape or self-punishment. Furthermore, to defend against the painful introspection of shame, some people may exhibit externalizing behaviors, lashing out in anger or deflecting blame, complicating interpersonal relationships and sometimes leading to social conflicts. Over time, the cumulative effects of shame can create a breeding ground for disorders like depression, anxiety, and substance use disorders, which further compound the challenges to an individual's mental well-being.
Shame's Destructive Impacts on Mental Health
Shame is a potent emotion with a deeply embedded capacity to erode one's mental well-being. When experienced recurrently or intensely, its destructive impacts on mental health are manifold:
- Erosion of Self-worth: Shame inherently targets an individual's core sense of self, leading them to internalize beliefs of personal inadequacy or inherent flaws. This can drastically reduce self-esteem and create a persistent self-concept of unworthiness (Lewis, 1971).
- Social Isolation: People may avoid social interactions to escape potential judgment due to vulnerability and shame exposure. Over time, this can lead to isolation and loneliness, significant risk factors for various mental health issues (Gilbert & Procter, 2006).
- Depression: Chronic shame can be a significant driver for depressive symptoms. Continual rumination over perceived inadequacies and failures amplifies negative self-perception, leading to hopelessness and despondency (Orth, Berking, & Burkhardt, 2006).
- Anxiety Disorders: Anticipating or fearing situations that might provoke shame can give rise to heightened anxiety, potentially culminating in disorders like social anxiety, where individuals fear negative evaluation in social settings (Gilbert, 2003).
- Addictive Behaviors: To numb the discomfort of shame or to momentarily escape its grasp, some individuals might engage in substance abuse or other addictive behaviors. Self-medication, while providing transient relief, can lead to addiction, exacerbating mental health challenges (Dearing, Stuewig, & Tangney, 2005).
- Externalizing Behaviors: As a defensive mechanism against the internal pain of shame, some individuals might project their feelings outward, manifesting in anger, aggression, or blame-shifting. This can strain interpersonal relationships and lead to additional mental health complications (Tangney, Wagner, Fletcher, & Gramzow, 1992).
- Reduced Coping Abilities: Those grappling with intense shame might find it challenging to deploy effective coping strategies during stressful situations. The constant internal negative dialogue can overshadow adaptive coping mechanisms, leaving individuals vulnerable to stress and its associated health repercussions (Gilbert & Procter, 2006).
- Deterrence from Seeking Help: The very nature of shame can discourage individuals from seeking help or opening up about their struggles. They might fear further judgment or exposure, leading them to endure their psychological challenges in silence (Hartling et al., 2000).
Anxiety and Shame
Shame and anxiety are intricately linked emotions that can influence and exacerbate one another. Here is how they relate from a psychological perspective:
- Social Anxiety: One of the most direct connections between shame and anxiety can be observed in the context of social anxiety disorder. Social anxiety often stems from a fear of negative evaluation by others. Shame, an emotion that emerges from perceived negative judgments about oneself or fear of exposure to one's inadequacies, can fuel this anxiety. Individuals deeply attuned to feelings of shame might avoid social situations entirely to prevent experiencing further shame (Gilbert, 2003; Rapee & Heimberg, 1997).
- Rumination: Both shame and anxiety can lead to rumination, where individuals engage in repetitive and obsessive thoughts about past events, potential future events, or perceived inadequacies. Rumination can serve as a bridge between feelings of shame (about a past action, for example) and anxiety (about potential future consequences or judgments) (Orth, Berking, & Burkhardt, 2006).
- Avoidance Behaviors: Shame can lead to avoidance behaviors where individuals might avoid certain situations or interactions to prevent feelings of shame. This avoidance, in turn, can intensify anxiety, especially if the individual anticipates situations where their perceived inadequacies might be exposed (Gilbert & Procter, 2006).
- Physiological Responses: Both shame and anxiety can trigger similar physiological responses, including increased heart rate, muscle tension, and shallow breathing. Over time, recurring physiological responses can create a cycle where the body's reaction to shame reinforces feelings of anxiety and vice versa (Gruenewald, Kemeny, Aziz, & Fahey, 2004).
- Self-worth and Fear of Failure: Chronic shame can erode an individual's sense of self-worth, making them more susceptible to fears of failure or inadequacy. This fear, in turn, can generate anxiety, particularly in situations where performance or competence is evaluated (Tangney, Miller, Flicker, & Barlow, 1996).
Shame and anxiety are intertwined emotions that can create a self-reinforcing cycle where one amplifies the other, potentially leading to various psychological challenges and disorders.
Trauma and Shame
Trauma and shame are deeply interconnected, with their relationship often reinforcing and cyclical. The relationship can manifest in various ways:
- Origins in Traumatic Experiences: Traumatic events, especially those that involve personal violations such as sexual assault or abuse, often instill deep feelings of shame in survivors. The survivor might internalize the trauma, leading them to believe that they are fundamentally flawed or somehow deserved or caused the event (Feiring, Taska, & Lewis, 2002).
- Reinforcement of Negative Self-beliefs: Traumatic experiences can reinforce pre-existing feelings of shame, especially if an individual already harbors beliefs of self-worthlessness or inadequacy. The trauma can serve as "proof" of these negative self-beliefs, exacerbating feelings of shame (Van der Kolk, 2015).
- Avoidance and Secrecy: Due to the intense shame associated with traumatic experiences, many survivors might avoid discussing or confronting their trauma, keeping it a secret. This avoidance can prevent healing and perpetuate the cycle of shame, as the individual might constantly ruminate on the event in isolation (Dorahy & Clearwater, 2012).
- Shame as a Barrier to Treatment: Shame can be a significant barrier to seeking treatment or support for trauma. Victims might fear judgment exposure or believe revealing their trauma would further confirm their perceived flaws or inadequacies (Deblinger, Pollio, & Dorsey, 2016).
- Physiological Links: Both trauma and shame can activate similar physiological responses, including hyperarousal and dissociation. Over time, these patterns can entrench the trauma-shame connection, as the body's response to one can activate feelings of the other (Lanius, Vermetten, & Pain, 2010).
- Perpetuation of Traumatic Cycles: In some cases, unresolved shame stemming from trauma can lead individuals to place themselves in situations where they are re-traumatized, perpetuating a cycle of trauma and shame (Van der Kolk, 2015).
Like anxiety, trauma, and shame are deeply interconnected, with each potentially amplifying the effects of the other. The internalization of traumatic experiences can foster shame, and this shame can further reinforce negative beliefs, behaviors, and physiological responses related to the trauma. Addressing trauma and shame is crucial in therapeutic interventions to promote healing and recovery.
The Long-Term Impacts of Shame
Shame, when experienced persistently or intensely, can have profound long-term impacts on an individual's psychological, social, and even physical well-being. These impacts are multifaceted and can permeate various aspects of a person's life:
- Psychological Consequences: Shame can severely erode self-esteem and self-worth, leading individuals to internalize a sense of inherent flaw or deficiency. Over time, these internalized beliefs can manifest as chronic depression, anxiety disorders, and suicidal ideation. Persistent shame can also result in patterns of negative rumination, wherein individuals constantly reflect on their perceived inadequacies, further exacerbating depressive and anxious symptoms (Orth, Berking, & Burkhardt, 2006).
- Social Implications: People who consistently experience shame often suffer social withdrawal and isolation, fearing judgment or exposure of their perceived flaws. This can result in strained interpersonal relationships, difficulty forming new relationships, and a pervasive sense of loneliness. Furthermore, individuals grappling with intense shame might display externalizing behaviors, projecting their internal pain through anger, aggression, or blame-shifting, further straining their social connections (Tangney, Wagner, Fletcher, & Gramzow, 1992).
- Physical Health Effects: Chronic shame has been linked to various physical health issues, including sleep disturbances, reduced immune function, and cardiovascular problems. The continuous stress response triggered by recurrent feelings of shame can harm physical health over the long term (Gruenewald et al., 2004).
- Behavioral Outcomes: Some individuals might resort to substance abuse or other self-destructive behaviors to cope with the distressing feelings of shame. These actions, while providing transient relief, can lead to addiction, further complicating mental health and social dynamics (Dearing et al., 2005).
- The barrier to Treatment: Shame can make individuals hesitant to seek help or open up about their challenges. They might fear further judgment, exacerbating feelings of isolation and making therapeutic interventions more challenging to initiate (Hartling et al., 2000).
The long-term impacts of shame are profound, touching every facet of an individual's life, from their internal psychological state to their external relationships and physical health. Recognizing and addressing shame is crucial in promoting holistic well-being.
Recent Psychological Research Findings
Understanding this research's core drivers and importance is vital to comprehending its relevance to the broader psychological community.
Recent Trends in Shame Research:
- Neurobiological Aspects of Shame: In recent years, there has been an increasing interest in understanding the neural substrates of shame. Functional MRI (fMRI) studies have started mapping brain regions associated with feelings of shame, emphasizing the interplay between emotion and cognition in processing shame (Wagner et al., 2011).
- Shame in Digital Environments: With the rise of social media and online communication, researchers have become interested in how shame is experienced and conveyed in digital settings. This includes research on cyberbullying, online shaming, and its mental health implications (Patchin & Hinduja, 2010).
- Cultural and Societal Dimensions of Shame: More studies examine cultural variations in experiencing, expressing, and coping with shame. Recognizing that shame's manifestation and implications can differ across cultures has become vital to cross-cultural psychology (Tangney et al., 1996).
- Shame Resilience and Therapeutic Approaches: Brown's work on shame resilience has opened new avenues for therapeutic interventions. Therapists and researchers are increasingly focusing on how individuals can navigate, cope with, and grow from experiences of shame (Brown, 2006).
Core Drivers of Recent Shame Research:
- Increasing Awareness of Mental Health: With mental health concerns rising globally, understanding emotions like shame that play a pivotal role in disorders such as depression, anxiety, and PTSD becomes paramount.
- Technological and Societal Changes: The proliferation of digital platforms has led to new ways of experiencing shame, making it crucial for researchers to understand these dynamics in modern contexts.
- Globalization: As the world becomes more interconnected, understanding cultural and emotional nuances becomes vital for creating practical, globally applicable therapeutic tools.
Importance for Psychological Understanding:
- Holistic Emotional Comprehension: Shame is a complex emotion that intertwines with other feelings like guilt, embarrassment, and pride. A deep understanding of shame contributes to a more comprehensive understanding of human emotion.
- Therapeutic Interventions: By understanding shame better, psychologists can develop more effective interventions, leading to more successful therapy outcomes.
- Social Implications: Understanding shame has wide-ranging implications for educational settings, workplaces, and online environments. By comprehending its dynamics, communities can create more supportive and nurturing spaces.
Psychotherapy Approaches for Managing Shame
Shame is a profound and complex emotion with deep-rooted impacts on mental health. It is intricately tied to one's self-concept, identity, relationships, and overall well-being. Here is why psychotherapy is often required to help manage the mental health impacts of shame:
Deep-seated Nature of Shame: Shame is not merely a surface-level emotion. Instead, it often stems from deep-seated beliefs about one's worth and identity. Unearthing and addressing these foundational beliefs requires the structured and safe environment that psychotherapy provides (Tangney & Dearing, 2002).
Interconnectedness with Other Issues: Shame rarely exists in isolation. It is often intertwined with other mental health issues such as depression, anxiety, substance abuse, and trauma. Addressing shame can, therefore, be crucial in treating these co-existing conditions (Dearing & Tangney, 2011).
Social Isolation: Individuals with profound shame often isolate themselves, fearing judgment and exposure. Psychotherapy offers a confidential and empathetic space where feelings can be expressed and understood without judgment (Brown, 2006).
Cognitive Distortions: Shame can lead to cognitive distortions, in which individuals perceive themselves and the world around them negatively and biasedly. Psychotherapists use techniques to challenge and change these distortions, promoting healthier thought patterns (Beck, 1976).
Potential for Self-Harm: Intense shame can lead to harmful behaviors, including self-harm or suicidal ideation. Psychotherapy provides immediate intervention and equips individuals with coping mechanisms for the future (Hedman et al., 2013).
Chronic Nature: For many, shame is not a transient emotion but a chronic one, persistently affecting their mental health. Such long-standing patterns necessitate a sustained, systematic therapeutic intervention (Hedman et al., 2013).
Body's Physiological Responses: Shame can trigger physiological responses such as increased heart rate or cortisol levels, impacting overall health. Addressing shame in therapy can alleviate some of these physiological stressors (Dickerson et al., 2004).
The following are psychotherapy-effective and commonly used approaches to manage shame.
- Cognitive-behavioral therapy (CBT) focuses on challenging and changing negative thought patterns and behaviors. For individuals struggling with shame, CBT helps identify triggers for shameful feelings and offers cognitive restructuring tools to alter these negative thought patterns (Hofmann et al., 2012).
- Compassion-Focused Therapy (CFT): Developed by Paul Gilbert, CFT targets shame and self-criticism, emphasizing the cultivation of compassion both toward oneself and others (Gilbert, 2009).
- Shame Resilience Theory: As proposed by Brené Brown, this approach involves recognizing shame, understanding cultural and personal triggers, practicing critical awareness, reaching out to others, and expressing how you feel about shame through speech, song, or writing (Brown, 2006).
- Psychodynamic Therapy: This therapy often delves into past experiences, early attachments, and the unconscious mind to uncover the roots of shame (Gabbard, 2014).
- Gestalt Therapy: Using an experiential approach, Gestalt therapy helps individuals understand and process feelings of shame in the 'here and now' (Perls et al., 1951).
- Narrative Therapy: This approach involves reshaping one's narrative or story. People burdened by shame often have internalized negative stories about themselves. Narrative therapy helps them deconstruct these harmful narratives and build more positive, empowering stories (White & Epston, 1990).
- Group Therapy: Sharing experiences of shame in a safe group environment can help individuals realize they are not alone in their feelings (Yalom & Leszcz, 2005).
Summary
Shame is an intensely painful emotion tied to the perception of oneself as fundamentally flawed or unworthy. Rooted in one's self-concept reflects an internalized sense of being inadequate or inferior, often compared to societal or personal standards.
Shame is multifaceted and profoundly affects mental health. It is an emotional response that drives behaviors, cognitions, and even physiological reactions. Shame is intertwined with an individual's sense of self-worth, often leading to feelings of isolation, self-blame, and an overwhelming sense of defectiveness.
Shame can detrimentally affect mental health in various ways:
- It can magnify feelings of worthlessness.
- Encourage isolation due to fear of judgment.
- Enhance susceptibility to other mental health issues like depression and anxiety.
- Contribute to maladaptive coping mechanisms, such as substance abuse.
Shame and anxiety often coexist and influence one another. For example, shame can lead to heightened anxiety, especially in social situations. Conversely, chronic anxiety can intensify feelings of shame, creating a vicious cycle of self-deprecation and worry.
Shame is intrinsically linked with trauma. Traumatic events can instill intense shame, especially if the individual perceives themselves as responsible or societal stigma surrounds the trauma. Conversely, entrenched shame can increase vulnerability to trauma or hinder recovery.
Persistently experiencing shame can lead to chronic mental health issues. Apart from the immediate emotional distress, it can:
- Weaken self-esteem over time.
- Strain interpersonal relationships due to withdrawal or over-compensatory behaviors.
- Increase vulnerability to other psychological disorders.
- Elevate the risk of harmful behaviors, including self-harm.
Contemporary research on shame seeks to understand its roots, triggers, and multifaceted impacts on well-being. This research's core drivers revolve around shame's interconnectedness with other emotions and conditions, its societal implications, and its neurophysiological bases. Such research is pivotal for a comprehensive psychological understanding of shame.
Given shame's profound impact on mental health, various psychotherapy methods target its alleviation:
- Cognitive-behavioral therapy (CBT) for altering negative thought patterns.
- Compassion-Focused Therapy (CFT) to foster self-kindness.
- Shame Resilience Theory, promoting recognition and expression of shame.
- Psychodynamic Therapy to explore deep-seated sources of shame.
- Gestalt and Narrative Therapies for present-moment awareness and reshaping self-narratives, respectively.
- Group Therapy for shared experiences and mutual support.
With its oppressive weight, the powerful emotion of shame can seem like an impenetrable cloud. However, it is essential to understand that clouds can dissipate, revealing a sky full of potential and beauty. Emerging from the throes of shame signals recovery and an opportunity for unparalleled growth, resilience, and self-awareness.
While the scars of shame might linger, they serve as a testament to an individual's ability to endure, heal, and transform. In overcoming shame, one gains a deeper understanding of oneself and the complexities of human emotion. This nuanced awareness breeds compassion—not just for oneself, but for others who are on their journey battling internal demons.
The pathway out of shame is strewn with valuable lessons. Each step away from the stifling grips of this emotion is a step towards authenticity, self-acceptance, and the genuine freedom that comes with self-forgiveness. As Brené Brown often emphasizes, embracing vulnerability becomes not a sign of weakness but a hallmark of strength and courage.
Moreover, the journey away from shame underscores the impermanent nature of our feelings and states. Just as seasons change, so too can our internal landscapes. The winter of shame can give way to the spring of renewal, where new perspectives bloom and self-worth flourishes.
For those who have traveled this challenging road, there is an inherent potential to be torchbearers. By sharing their stories and insights, they light the path for others, turning their once painful experiences into sources of hope and guidance. In this way, the recovery from shame can ripple outwards, transforming not just one life but many.
Ultimately, the narrative is not about the darkness of shame but the luminosity of the human spirit and its unyielding capacity to recover, reimagine, and rebuild. The journey beyond shame is not just about returning to where one started but soaring to heights previously unimaginable.
References
Beck, A. T. (1976). Cognitive therapies and emotional disorders. New York: New American Library.
Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services, 87(1), 43-52.
Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services, 87(1), 43-52.
Dearing, R. L., & Tangney, J. P. (Eds.). (2011). Shame in the therapy hour. Washington, DC: American Psychological Association.
Dearing, R. L., Stuewig, J., & Tangney, J. P. (2005). On the importance of distinguishing shame from guilt: Relations to problematic alcohol and drug use. Addictive Behaviors, 30(7), 1392-1404.
Deblinger, E., Pollio, E., & Dorsey, S. (2016). Applying trauma-focused cognitive-behavioral therapy in group format. Child Maltreatment, 21(1), 59-73.
Dickerson, S. S., Gruenewald, T. L., & Kemeny, M. E. (2004). When the social self is threatened: Shame, physiology, and health. Journal of Personality, 72(6), 1191-1216.
Dorahy, M. J., & Clearwater, K. (2012). Shame and guilt in men exposed to childhood sexual abuse: A qualitative investigation. Journal of Child Sexual Abuse, 21(2), 155-175.
Feiring, C., Taska, L., & Lewis, M. (2002). Adjustment following sexual abuse discovery: The role of shame and attributional style. Developmental Psychology, 38(1), 79-92.
Fessler, D. M. T. (2004). Shame in two cultures: Implications for evolutionary approaches. Journal of Cognition and Culture, 4(2), 207-262.
Gilbert, P. (2003). Evolution, social roles, and the differences in shame and guilt. Social Research, 70(4), 1205-1230.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353-379.
Gruenewald, T. L., Kemeny, M. E., Aziz, N., & Fahey, J. L. (2004). Acute threat to the social self: Shame, social self-esteem, and cortisol activity. Psychosomatic Medicine, 66(6), 915-924.
Hartling, L. M., Rosen, W., Walker, M., & Jordan, J. V. (2000). Shame and humiliation: From isolation to relational understanding. Work in Progress, 88(3), 1-17.
Hedman, E., Ström, P., Stünkel, A., & Mörtberg, E. (2013). Shame and guilt in social anxiety disorder: Effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PLoS ONE, 8(4), e61713.
Lanius, U. F., Vermetten, E., & Pain, C. (2010). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.
Lewis, H. B. (1971). Shame and guilt in neurosis. Psychoanalytic Review, 58(3), 419.
Orth, U., Berking, M., & Burkhardt, S. (2006). Self-conscious emotions and depression: Rumination explains why shame but not guilt is maladaptive. Personality and Social Psychology Bulletin, 32(12), 1608-1619.
Patchin, J. W., & Hinduja, S. (2010). Cyberbullying and self‐esteem. Journal of school health, 80(12), 614-621.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour research and therapy, 35(8), 741-756.
Scheff, T. J. (2003). Shame in self and society. Symbolic Interaction, 26(2), 239-262.
Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. Guilford Press.
Tangney, J. P., Miller, R. S., Flicker, L., & Barlow, D. H. (1996). Are shame, guilt, and embarrassment distinct emotions? Journal of Personality and Social Psychology, 70(6), 1256-1269.
Tangney, J. P., Wagner, P., & Gramzow, R. (1989). The Test of Self-Conscious Affect (TOSCA). George Mason University.
Tangney, J. P., Wagner, P., Fletcher, C., & Gramzow, R. (1992). Shamed into anger? The relation of shame and guilt to anger and self-reported aggression. Journal of Personality and Social Psychology, 62(4), 669-675.
Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Wagner, U., N'Diaye, K., Ethofer, T., & Vuilleumier, P. (2011). Guilt and shame in social and personal contexts: consistent evidence for domain specificity in the anterior paracingulate. Social neuroscience, 6(5), 464-475.