Proneness for and Aversion to Self-Conscious Emotion in Posttraumatic Stress

Clinical Impact Statement For individuals with a history of trauma, shame-proneness and shame aversion may increase risk of lasting posttraumatic stress. Assessing shame and these shame-related traits would inform treatment decision-making before and during the course of intervention. Addressing shame and helping patients learn effective skills for regulating shame may be helpful as part of or prior to engaging in empirically supported treatments for posttraumatic stress. Our findings should be generalized to clinical contexts with caution, as shame-proneness, shame aversion, and their interaction accounted for small proportions of the variance in posttraumatic stress, and severity of posttraumatic stress in our sample was mild to moderate. Objective: Theory suggests that self-conscious emotions (guilt and shame) may play a role in the development/maintenance of posttraumatic stress. Propensities to experience these emotions (i.e., proneness) may confer risk for posttraumatic stress, while difficulties tolerating or coping with them (i.e., aversion) may maintain or exacerbate symptoms. However, no research to date has examined the importance of guilt aversion or shame aversion in posttraumatic stress. Method: A total of 336 participants provided open-ended information on their experience of potentially traumatic events; a team of trained raters determined that a final sample of 186 participants had a clinically significant history of trauma. These participants completed measures of posttraumatic stress, along with measures of proneness for and aversion to both guilt and shame. Negative affect and experiential avoidance were assessed as covariates. Results: Zero-order correlations indicated that guilt-proneness and guilt aversion were not associated with posttraumatic stress. By contrast, shame-proneness was associated with posttraumatic stress over and above trait negative affect and experiential avoidance. Moreover, a significant interaction revealed that shame-proneness was only associated with posttraumatic stress when shame aversion was high. Conclusions: Results suggest that people high in shame-proneness, and therefore likely to experience shame in response to traumatic events, may experience greater posttraumatic stress if they are shame averse. If this is the case, addressing shame directly and teaching better skills for regulating it may be an important treatment goal for some individuals with posttraumatic stress.