A Compassion-based Intervention for Internal and External Shame

NCT ID: NCT04600557

Last Updated: 2021-12-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

439 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-12

Study Completion Date

2021-11-18

Brief Summary

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This is a four-arm randomized pilot study aimed at reducing internal and/or external shame using self-compassion and/or compassion from others. The study is designed to test the theory that trait shame is comprised of both internal and external shame and to test compassion for others as an intervention for external shame.

Detailed Description

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Shame is a common, painful emotion involving negative evaluations of the self. It has been theorized that trait shame involves both internal shame (i.e., evaluating oneself negatively) and external shame (i.e., perceiving that others evaluate the self negatively). Shame is experienced across a variety of psychiatric illnesses, yet it has been highly understudied.

Self-compassion has been used as an intervention for reducing shame in a variety of research studies, often in the context of a specific psychiatric disorder. However, self-compassion interventions, which aim to change the way one thinks and feels about oneself, may specifically target internal shame but not external shame. It is proposed that receiving compassion from others is an analogous and plausible intervention for external shame. In order to test the theory that trait shame is comprised of both internal and external shame and to test compassion for others as an intervention for external shame, a four-arm randomized pilot study aimed at reducing internal and/or external shame using self-compassion and/or compassion from others is proposed here.

Participants (N=180) scoring high on both internal and external shame on self-report measures will be assessed at baseline using both questionnaires and a shame-memory recall. Participants will be randomized to one of four conditions: a) describing a shameful experience using a self-compassionate prompt and receiving no verbal responses from confederates (self-compassion only), b) describing a shameful experience using a neutral prompt and receiving compassionate responses from confederates (compassion from others only), c) both describing a shameful experience using a self-compassionate prompt and receiving compassionate responses from confederates (self-compassion plus compassion from others), or d) describing a shameful experience using a neutral prompt and receiving no verbal responses from confederates (sharing-only control). Participants will complete questionnaires and shame-memory recalls again immediately following the sharing intervention and at a one-week post-intervention follow-up.

The two primary outcome measures will be state internal shame, as measured by the Internalized Shame Sclae, and state external shame, as measured by the Other As a Shamer scale. Both the Internalized Shame Scale and Other As a Shamer scale will be administered at baseline (immediately pre-treatment), immediately post-treatment, and a one-week post-intervention follow-up. Secondary outcome measures will include the Positive and Negative Affect Scale, and a real-time assessment of state shame.

It is expected that (a) participants assigned to describe a shameful experience using self-compassionate instructions will display larger reductions in internal shame relative to those assigned to describe a shameful experience using neutral instructions; (b) participants who receive compassionate responses from others after sharing a shameful experience will display larger reductions in external shame relative to those assigned to a listening-only control; and (c) participants assigned to describe a shameful experience using self-compassionate instructions combined with receiving compassionate responses from others will display larger reductions in both internal and external shame relative to participants who receive either component alone.

Conditions

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Shame Compassion

Keywords

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compassion self-compassion shame

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants are randomly assigned to one of four conditions throughout the study.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Participants are not told which arm they are assigned to

Study Groups

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Self-compassion only

Describing a shameful experience using a self-compassionate prompt and receiving no verbal responses from confederates

Group Type EXPERIMENTAL

Describing a shameful experience using a self-compassionate prompt

Intervention Type BEHAVIORAL

Participants will be instructed to describe a shameful experience to two confederates using a self-compassionate prompt

Receiving no response from confederates

Intervention Type BEHAVIORAL

Following the participant's description of a shameful experience, two confederates will not be allowed to provide any verbal response

Compassion from others only

Describing a shameful experience using a neutral prompt and receiving compassionate responses from confederates

Group Type EXPERIMENTAL

Receiving compassionate responses from confederates

Intervention Type BEHAVIORAL

Following the participant's description of a shameful experience, two confederates will respond with compassionate responses

Describing a shameful experience using a neutral prompt

Intervention Type BEHAVIORAL

Participants will be instructed to describe a shameful experience to two confederates using a neutral (i.e., not self-compassionate) prompt

Self-compassion plus compassion from others

Both describing a shameful experience using a self-compassionate prompt and receiving compassionate responses from confederates

Group Type EXPERIMENTAL

Describing a shameful experience using a self-compassionate prompt

Intervention Type BEHAVIORAL

Participants will be instructed to describe a shameful experience to two confederates using a self-compassionate prompt

Receiving compassionate responses from confederates

Intervention Type BEHAVIORAL

Following the participant's description of a shameful experience, two confederates will respond with compassionate responses

Sharing-only control

Describing a shameful experience using a neutral prompt and receiving no verbal responses from confederates

Group Type ACTIVE_COMPARATOR

Describing a shameful experience using a neutral prompt

Intervention Type BEHAVIORAL

Participants will be instructed to describe a shameful experience to two confederates using a neutral (i.e., not self-compassionate) prompt

Receiving no response from confederates

Intervention Type BEHAVIORAL

Following the participant's description of a shameful experience, two confederates will not be allowed to provide any verbal response

Interventions

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Describing a shameful experience using a self-compassionate prompt

Participants will be instructed to describe a shameful experience to two confederates using a self-compassionate prompt

Intervention Type BEHAVIORAL

Receiving compassionate responses from confederates

Following the participant's description of a shameful experience, two confederates will respond with compassionate responses

Intervention Type BEHAVIORAL

Describing a shameful experience using a neutral prompt

Participants will be instructed to describe a shameful experience to two confederates using a neutral (i.e., not self-compassionate) prompt

Intervention Type BEHAVIORAL

Receiving no response from confederates

Following the participant's description of a shameful experience, two confederates will not be allowed to provide any verbal response

Intervention Type BEHAVIORAL

Other Intervention Names

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Self-compassionate prompt Compassionate confederates Neutral prompt Neutral confederates

Eligibility Criteria

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Inclusion Criteria

* Elevated levels of internal and external shame
* Can recall two shameful experiences

Exclusion Criteria

* Active suicidal ideation as measured by endorsement of 2 (I would like to kill myself) or 3 (I would kill myself if I had the chance) on BDI-II item 9
* Endorses intent to harm or kill others
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Texas at Austin

OTHER

Sponsor Role lead

Responsible Party

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Michael J. Telch

Professor of Psychology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Michael J Telch, PhD

Role: PRINCIPAL_INVESTIGATOR

Professor of Psychology

Locations

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The University of Texas at Austin

Austin, Texas, United States

Site Status

Countries

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United States

References

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Cook, D. R. Measuring shame: the internalized shame scale. Alcoholism Treatment Quarterly, 1987; 4, 197- 215.

Reference Type BACKGROUND

del Rosario, P.M., & White, R.M. The Internalized Shame Scale: Temporal stability, internal consistency, and principal components analysis. Personality and Individual Differences. 2006; 41, 95-103.

Reference Type BACKGROUND

Goss, K., Gilbert, P., & Allen, S. An exploration of shame measures-I: The Other As Shamer scale. Person. Individ. Diff.,1994; 17(5), 713-717.

Reference Type BACKGROUND

Andrews B, Qian M, Valentine JD. Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. Br J Clin Psychol. 2002 Mar;41(Pt 1):29-42. doi: 10.1348/014466502163778.

Reference Type BACKGROUND
PMID: 11931676 (View on PubMed)

Neff, K.D. The development and validation of a scale to measure self-compassion. Self and Identity. 2003; 2, 223-250.

Reference Type BACKGROUND

Rybak, C.J. & Brown, B. Assessment of internalized shame: Validity and reliability of the Internalized Shame Scale. Alcoholism Treatment Quarterly. 1996; 14:1.

Reference Type BACKGROUND

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 2013.

Reference Type BACKGROUND

Au TM, Sauer-Zavala S, King MW, Petrocchi N, Barlow DH, Litz BT. Compassion-Based Therapy for Trauma-Related Shame and Posttraumatic Stress: Initial Evaluation Using a Multiple Baseline Design. Behav Ther. 2017 Mar;48(2):207-221. doi: 10.1016/j.beth.2016.11.012. Epub 2016 Nov 29.

Reference Type BACKGROUND
PMID: 28270331 (View on PubMed)

Gilbert P. The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy. Br J Med Psychol. 1997 Jun;70(2):113-47. doi: 10.1111/j.2044-8341.1997.tb01893.x.

Reference Type BACKGROUND
PMID: 9210990 (View on PubMed)

Gilbert, P. What Is shame? Some core issues and controversies. In Shame: Interpersonal behavior, psychopathology, and culture. 1998.

Reference Type BACKGROUND

Gilbert, P., & Procter, S. Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. In Clinical Psychology and Psychotherapy. 2006; 13(6): 353-379. https://doi.org/10.1002/cpp.507

Reference Type BACKGROUND

Johnson, E. A., & O'Brien, K. A. Self-Compassion Soothes the Savage EGO-Threat System: Effects on Negative Affect, Shame, Rumination, and Depressive Symptoms. Journal of Social and Clinical Psychology. 2013; 32(9), 939-963. https://doi.org/10.1521/jscp.2013.32.9.939

Reference Type BACKGROUND

Judge, L., Cleghorn, A., McEwan, K., & Gilbert, P. An exploration of group-based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy. 2012. https://doi.org/10.1521/ijct.2012.5.4.420

Reference Type BACKGROUND

Kim S, Thibodeau R, Jorgensen RS. Shame, guilt, and depressive symptoms: a meta-analytic review. Psychol Bull. 2011 Jan;137(1):68-96. doi: 10.1037/a0021466.

Reference Type BACKGROUND
PMID: 21219057 (View on PubMed)

Lewis, M. Shame: The exposed self. New York: Free Press. 1992.

Reference Type BACKGROUND

Lewis, M. The role of the self in shame. Social Research, 70, 1181-1204. 2003.

Reference Type BACKGROUND

Luoma JB, Kohlenberg BS, Hayes SC, Fletcher L. Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. J Consult Clin Psychol. 2012 Feb;80(1):43-53. doi: 10.1037/a0026070. Epub 2011 Oct 31.

Reference Type BACKGROUND
PMID: 22040285 (View on PubMed)

Skinta, M. D., Lezama, M., Wells, G., & Dilley, J. W. Acceptance and Compassion-Based Group Therapy to Reduce HIV Stigma. Cognitive and Behavioral Practice. 2015. https://doi.org/10.1016/j.cbpra.2014.05.006

Reference Type BACKGROUND

Other Identifiers

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2018-07-0058

Identifier Type: -

Identifier Source: org_study_id