Table 1.
Characteristics and key findings of reviewed studies.
| Author (Year) | Sample Type (n) | Design | PTSS/PTSD Measure 2 | Shame Measure 2 | Findings |
|---|---|---|---|---|---|
| Aakvaag et al. (2014) | Adolescent and adult survivors of terrorism (n = 325) | Cross-sectional | PTSD-RI | PTSD-RI (2 items) | Past month trauma-related shame and guilt associated with PTS 1 in mass-trauma survivors. Greater severity of trauma-related shame or guilt associated with greater PTS severity. |
| Andrews et al. (2000) | Adult victims of violent crime (n = 157) | Longitudinal | PSS-SR | Study-designed semi-structured interview (single item) | Post-traumatic shame and anger predicted PTS at 1-month after crime victimization. Post-traumatic shame and 1-month PTS predicted 6-months PTS. Post-traumatic shame mediated childhood abuse and 6-months PTS. |
| Badour et al. (2015) | Adult survivors of interpersonal trauma (n = 1522) | Cross-sectional | NSES | NSES | Peritraumatic anger, shame, and fear, in order, predicted assault related-PTSD (AR-PTSD). Peritraumatic shame was more associated with AR-PTSD in women; peritraumatic fear was more associated with AR-PTSD in men. |
| Barr (2011) | Couples with sick newborn infants (n = 67) | Cross-sectional | PCL-S | TOSCA | Shame-proneness predicted depression, but not PTS or anxiety. Guilt was a significant predictor of PTS symptoms, depression, and anxiety. |
| Beck et al. (2011) | Female IPV 1 survivors (n = 63) | Cross-sectional | CAPS | ISS | Trait shame, guilt-related distress, and guilt cognitions positively correlated with PTSD. Shame was positively correlated with higher levels of emotional and verbal abuse. Women with IPV marked by high dominance/isolation or emotional/verbal abuse and high shame had higher PTSD severity. Guilt was not a significant moderator. |
| Beck et al. (2015) | Female IPV survivors (n = 109) | Cross-sectional | CAPS | ISS | Trait shame and depression predicted negative thoughts of the self; shame had a larger effect size. Higher guilt associated with negative thoughts of the world. Higher levels of trait shame and guilt but lower levels of depression associated with greater self-blame. |
| Bennett et al. (2016) | Adolescent and young adults living with HIV (n = 88) | Cross-sectional | CPSS | TOSCA-A | Shame-proneness was positively associated with higher levels of PTSD and depression symptoms. Depression was predicted by shame-proneness and HIV-related stigma whereas PTSD was predicted by HIV-related stigma and avoidant coping. |
| Bockers et al. (2015) | Inpatient sample of female survivors of interpersonal trauma: with PTSD (n = 28), without PTSD (n = 32), non-traumatized (n = 92) | Cross-sectional | MINI | TOSCA and IAT (implicit) | Explicit shame and guilt were significantly different across groups; PTSD group had the highest and the non-traumatized group had the lowest. No differences in implicit shame between PTSD group and traumatized/no PTSD group. |
| Brewin et al. (2000) | Adult victims of violent crime (n = 138) | Longitudinal | PSS-SR | Semi-structured interview (single item) | Trauma-related shame experienced by a subset of participants and significant predictor of PTSD. |
| Bryan et al. (2013) | Active duty military personnel (n = 69) | Cross-sectional | PCL | PFQ2 | Guilt and trait shame are higher in military personnel with history of suicidal ideation. Both guilt and trait shame mediated the relationship between PTSD or depression and suicidal ideation; guilt had a stronger relationship with suicidal ideation. |
| Cohen et al. (2004) | Sexually abused children (n = 203) | Longitudinal; RCT 1 | K-SADS-PL | CAPS | Children randomized to TF-CBT showed greater reductions in shame attributions and PTSD from baseline to post-treatment in comparison to children in CCT 1. |
| Crocker et al. (2016) | Returning veterans, primarily male (n = 127) | Cross-sectional | PCL-S | ISS | PTSD predicted trait shame and global guilt. When controlling for global guilt, shame partially mediated PTSD symptoms and verbal aggression. |
| Dahl (1989) | Young adult and adult survivors of rape and attempted rape, primarily female (n = 55) | Cross-sectional | IES and semi-structured interview | CPRS (single item) | Assault-related shame, guilt, and suicidal ideation present in the majority of rape survivors. |
| Deblinger et al. (2006) | Child survivors of sexual abuse (n = 183) | Longitudinal; RCT | K-SADS-PL | TSQ and CAPS | Children in TF-CBT 1 showed significant decrease in trauma-related shame during post-treatment, 6-month, and 12-month follow ups in comparison to children in Child-Centered Therapy. |
| DePrince et al. (2011) | College students with at least one traumatic event (n = 98); Adult female survivors of child abuse/interpersonal crime (n = 94); Adult female survivors of nonsexual IPV (n = 236) | Cross-sectional | RCMS and PDS | TAQ | Posttraumatic shameful appraisals predicted PTSD in college students and female survivors of child abuse or interpersonal crime. Posttraumatic shameful appraisals did not predict PTSD in the nonsexual IPV sample. |
| Dewey et al. (2014) | College students (n = 144) | Cross-sectional | PCL-S | TEQ (subscales: anger, fear, guilt, shame, disgust) | In order, peritraumatic fear, anger, and shame were the top three predictors of avoidance and numbing symptoms. Peritraumatic guilt, fear, and anger predicted re-experiencing; shame did not. Peritraumatic guilt and shame were the strongest predictors of hyperarousal symptoms. |
| Dorahy et al. (2013) | Treatment-receiving adult survivors of Northern Irish conflict exposure with PTSD (n = 65) | Cross-sectional | SRC and clinical interview | CoSS, SSGS, and PFQ-2 | Clinical dissociation group had significantly higher levels of (a) trait shame and guilt and (b) state shame, guilt, and pride than the subclinical dissociation group. Dissociation, trait/state shame, and trait/state guilt significantly predicted complex PTSD. |
| Dorahy et al. (2016) | Adults with Dissociative Disorders (n = 39); Two comparison groups: adults with child abuse-related chronic PTSD (n = 13) & adults with mixed psychiatric diagnoses and child abuse histories (n = 21) | Cross-sectional | CTQ and clinical interview | PFQ-2 | Child maltreatment significantly contributed to trait shame and child abuse and neglect significantly contributed to trait guilt. Emotional abuse was the strongest predictor of both trait shame and trait guilt. |
| Dyer et al. (2015) | Adult female German inpatients/outpatients with PTSD from CSA 1 (n = 23), BPD (n = 25), BPD and PTSD after CSA (n = 22), and healthy controls (n = 27) | Cross-sectional | SCID-I | SBA and BIGSS | Participants with child sexual abuse identified more body areas as associated with traumatic experiences. Psychiatrically diagnosed groups rated trauma-related body areas to have more body-related shame, guilt, and disgust compared to the healthy controls. |
| Feiring et al. (2002) | Child and adolescent survivors of CSA (n = 137) | Longitudinal | IAE and CITES-R | Study-designed measure | Trauma-related shame was a significant mediator between abuse attributions both after the traumatic event and one year later with both PTSD and depression symptoms. |
| Feiring et al. (2002) | Child and adolescent survivors of CSA (n = 147) | Longitudinal | CITES-R and TSI | Study-designed measure | Trauma-related shame at abuse discovery was a small predictor of PTSD, depression, and self-esteem, but trauma-related shame one year after abuse was a strong predictor of PTSD, depression, and low self-esteem. Girls showed more shame than boys at the time of abuse, but decreased in shame over a year. Boys did not show a significant decrease in shame from abuse discovery to one year later. |
| Feiring and Taska (2005) | Adolescent survivors of CSA (n = 118) | Longitudinal | CITES-R and TSI | TOSCA and study-designed measure | Trauma-related shame experienced one year after CSA predicted high trauma-related shame six years after CSA and symptoms of hyperarousal, intrusive recollections, and avoidance. Children low in trauma-related shame have better treatment prognosis. |
| Freed and D’Andrea (2015) | Adult female survivors of interpersonal violence with PTSD (n = 27) | Cross-sectional | PCL-IV | PANAS (single-item) and study-designed adjective list | Shame-proneness was the only predictor of autonomic arousal in a trauma reminder task. Inactivation of the peripheral nervous system in PTSD patients was associated with fear and shame at baseline, anxiety and shame during the task, and shame during recovery period. Trait shame predicted lower respiratory sinus arrhythmia during recovery suggesting difficulty regulating affect after trauma reminders. State shame was the only predictor of lower RSA during the task, more than fear and anxiety. |
| Ginzburg et al. (2009) | Adult female CSA survivors (n = 166) | Longitudinal; RCT | PCL-S | ARBQ (Shame subscale) | Both treatment conditions demonstrated reductions in PTSD, abuse-related shame, and guilt. Improvement in shame mediated treatment effect on PTSD. No mediating effect found for guilt. |
| Hagenaars et al. (2011) | Treatment-seeking adults (n = 110) | Cross-sectional | CAPS | Study-designed single item | Multiple trauma group reported more recent shame experiences than single trauma group, independent of PTSD severity. Association between shame and childhood versus adult trauma group did not hold after controlling for PTSD severity. |
| Harman and Lee (2010) | Treatment-seeking adults (n = 49) | Cross-sectional | PDS | ESS | Shame-proneness positively correlated with self-criticizing thinking style, above and beyond contributions of PTSD and depressive symptoms. |
| Harned et al. (2014) | Adult females with comorbid BPD 1 (n = 26) | Longitudinal; RCT | PSS-I | ESS | Clinically significant and reliable improvement in shame-proneness and PTSD after one year of both tested therapies, DBT and DBT + DBT PE 1. |
| Held et al. (2015) | Treatment-seeking substance users (n = 72) | Cross-sectional | PCL-S | SSGS | Trauma-related shame provided direct and indirect (through avoidant coping) pathways for the relationship between trauma-related guilt and PTSD severity. |
| Hundt and Holohan (2012) | Treatment-seeking adult male veterans (n = 264) | Cross-sectional | PCL-C | ISS | Trait shame mediation of PTSD and IPV perpetration relationship not significant when depression taken into account. |
| La Bash and Papa (2014) | College students (n = 99) | Cross-sectional | PCL | Modified TLEQ | Peritraumatic shame mediated relationship between risk factors (trauma type and number of potentially traumatic events) and PTSD symptoms. |
| Layer et al. (2004) | Adult females (n = 35) | Longitudinal | IES-R | ISS | Spiritually-based group intervention associated with improvement in trait shame and PTSD symptoms in women suffering from post-abortion grief. |
| Leskela et al. (2002) | Adult male veterans (n = 107) | Cross-sectional | PCL-M and CES | TOSCA | Shame-proneness, not guilt-proneness, positively correlated with PTSD severity. |
| Lowinger and Solomon (2004) | Adult males convicted of reckless driving (n = 75) | Cross-sectional | PTSD-I | TOSCA | Trait shame did not significantly differ between reckless drivers who had caused an accidental death and control group. |
| Negrao II et al. (2005) | Female children and adults (n = 137) | Cross-sectional | PSS | EMFACS (nonverbal) and narrative coding | Coherence between facial and verbal shame expression correlated with PTSD severity in non-disclosing group of CSA survivors. |
| Ojserkis et al. (2014) | College students (n = 45) | Cross-sectional | LEC, PCL-C, IES-R, and PCI | TOSCA and visual analogue scale | State shame, but not trait shame, correlated with PTSS. |
| Øktedalen et al. (2015) | Norwegian adults in an inpatient setting (n = 65) | Longitudinal; RCT | PSS-I and PSS-SR | Study-designed self-report measure | Within-person improvements in trauma-related shame and trauma-related guilt predicted subsequent reductions in PTSD during both interventions, PE1 and modified PE. |
| Pineles et al. (2006) | College females (n = 156) | Cross-sectional | PCL | TOSCA | Shame-proneness, independent of guilt-proneness, predicted PTSD symptoms whereas guilt independent of shame did not. |
| Resick et al. (2008) | Adult female victims of interpersonal violence (n = 150) | Longitudinal; RCT | CAPS and PDS | ESS | PTSD and trait shame improved over time in all three conditions (components of CPT 1). |
| Robinaugh and McNally (2010) | Adults (n = 140) | Cross-sectional | PCL | SSGI | Event-related shame predicted PTSD symptoms. |
| Schoenleber et al. (2015) | Adult male survivors of interpersonal trauma (n = 103) | Cross-sectional | LEC and PCL-C | PANAS (single-item) | Trait shame accounted for the association between posttraumatic symptoms and aggressive behavior whereas trait guilt did not. |
| Semb et al. (2011) | Adult victims of single violent crime (n = 35) | Cross-sectional | HTQ | TOSCA and visual analogue scale | Both shame-proneness and event-related shame positively correlated with severity of posttraumatic distress. Level of event-related shame mediated the effect of shame-proneness on posttraumatic symptoms. |
| Shin et al. (2014) | Treatment-seeking Korean adult female survivors of sexual violence (n = 38) | Longitudinal; prospective | CAPS, PSS-SR, and PCI | PFQ | No correlation between shame-proneness and PTSD severity once depression severity was controlled. Similar findings for guilt-proneness. |
| Sippel and Marshall (2011) | Adult civilians (n = 47) | Cross-sectional | CAPS | Emotional Stroop task (implicit) and self-referential encoding task (implicit) | Speed of implicit shame processing and PTSD severity inversely correlated. Shame processing mediated relationship between PTSD severity and frequency of IPV perpetration. |
| Stotz et al. (2015) | Male refugee youth in Germany (age 11–20) (n = 32) | Cross-sectional | UCLA PTSD | SVQ | Both trauma-related shame and guilt positively correlated with PTSD severity. |
| Street and Arias (2001) | Adult female IPV survivors in domestic violence shelters (n = 63) | Cross-sectional | MS-Civilian | TOSCA | Shame-proneness significantly predicted of PTSD symptoms, guilt-proneness did not. |
| Uji et al. (2007) | Japanese college females (n = 172) | Cross-sectional | IES-R | ASSQ and AAI | Event-related shame directly predicted PTSD, whereas attribution style did not. |
| Vidal and Petrak (2007) | Adult female survivors of adult sexual assault (n = 25) | Cross-sectional | IES-R | ESS and study-designed measure | Shame positively correlated with traumatic stress. |
1 BPD = Borderline Personality Disorder; CCT = Child Centered Therapy; CPT = Cognitive Processing Therapy; CSA = Child Sexual Abuse; DBT = Dialectical Behavior Therapy; DBT PE = DBT Prolonged Exposure; IPV = Intimate Partner Violence; PE = Prolonged Exposure; PTS = Posttraumatic Stress; PTSS = Posttraumatic stress symptoms; RCT = Randomized Clinical Trial; TF-CBT = Trauma-Focused Cognitive Behavioral Therapy. 2 AAI = Abuse Attribution Inventory; ARBQ = Abuse-Related Beliefs Questionnaire; ASSQ = Abuse Specific Shame Questionnaire; BIGSS = Body Image Guilt and Shame Scale; CAPS = Children’s Attributions and Perceptions Scale; CES = Combat Exposure Scale; CITES-R = Children’s Impact of Traumatic Events Scale-Revised; CoSS = Compass of Shame Scale; CPSS = Child PTSD Symptom Scale; EMFACS = Emotion Facial Action Coding System; ESS = Experience of Shame Scale; FSCRS = Forms of Self-Criticizing/Attacking and Self-Reassuring Scale; HTQ = Harvard Trauma Questionnaire; IAE = Impact of Abuse Events; ISS = Internalized Shame Scale; K-SADS-PL = Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version; MS-Civilian = Civilian Mississippi Scale for PTSD; NSES = National Stressful Events Survey; OAS = Other as Shamer Scale; PCL-M = PTSD Checklist-Military; PCL-S = PTSD Checklist-Specific; PCI = Post-traumatic Cognitions Inventory; PDS = Posttraumatic Diagnostic Scale; PFQ2 = Harder Personal Feelings Questionnaire; PFQ-2 = The Personal Feelings Questionnaire-2; PSS-I = PTSD Symptom Scale-Interview; PSS-SR = PTSD Symptom Scale-Self Rating; PTSD-I = Posttraumatic Stress Disorder Inventory; PTSD-RI = Posttraumatic Stress Disorder Reaction Index; RCMS = Revised Civilian Mississippi Scale; SBA = Survey of Body Areas; SPTSS = Screen for Posttraumatic Stress Symptoms; SSGI = State Shame and Guilt Inventory; SSGS = State Shame and Guilt Scale; SRC = Stress Reactions Checklist for Disorders of Extreme Stress; SVQ = Shame Vulnerability Questionnaire; TAQ = Trauma Appraisal Questionnaire; TEQ = Trauma Emotion Questionnaire; TSI = Trauma Symptom Inventory; TSQ = The Shame Questionnaire; UCLA PTSD = UCLA PTSD Reaction Index.