Elsevier

Current Opinion in Psychology

Volume 2, April 2015, Pages 97-101
Current Opinion in Psychology

Shame, self-criticism, self-stigma, and compassion in Acceptance and Commitment Therapy

https://doi.org/10.1016/j.copsyc.2014.12.016Get rights and content

Highlights

  • Acceptance and Commitment Therapy appears to effectively address shame and self-stigma.

  • Self-compassion is a potential process variable in ACT.

  • Compassion-based techniques have the potential to enhance ACT for shame and self-stigma.

Within the past decade, empirical evidence has emerged supporting the use of Acceptance and Commitment Therapy (ACT) targeting shame and self-stigma. Little is known about the role of self-compassion in ACT, but evidence from other approaches indicates that self-compassion is a promising means of reducing shame and self-criticism. The ACT processes of defusion, acceptance, present moment, values, committed action, and self-as-context are to some degree inherently self-compassionate. However, it is not yet known whether the self-compassion inherent in the ACT approach explains ACT's effectiveness in reducing shame and stigma, and/or whether focused self-compassion work may improve ACT outcomes for highly self-critical, shame-prone people. We discuss how ACT for shame and stigma may be enhanced by existing approaches specifically targeting self-compassion.

Introduction

Empirical evidence continues to mount demonstrating the effectiveness of Acceptance and Commitment Therapy (ACT) across a wide range of conditions 1, 2, 3. In many head-to-head trials, ACT outcomes are comparable to those in more established gold-standard treatments for a particular difficulty, but only sometimes outperform those treatments 4, 5•. Thus, efforts need to shift from ‘Is ACT effective?’ to researching processes of change that may provide guidance for how to further improve outcomes. One way to improve outcomes would be to focus on new transdiagnostic processes, such as self-criticism and shame, which have been shown to play important roles in a variety of psychological disorders and issues, including depression [6], post-traumatic stress disorder [7], borderline personality disorder [8], eating disorders [9••], schizophrenia [10], addiction [11••], paranoid ideation and social anxiety, and [12] narcissistic personality disorder [13].

An important contributor to self-criticism and shame is the societal devaluation of stigmatized identities. Shame is the emotional core of the experience of stigma [11••] and tends to involve fusion with beliefs of being flawed or unlovable [14]. Self-stigma involves the internalization of a socially devalued status. Shame, the main emotional component of stigma, impedes social engagement [15], promotes interpersonal disconnection [16], and interferes with interpersonal problem solving [17]. The ashamed person's perspective is narrow, focused inward toward thoughts of a ‘bad self’ [14]. In contrast to the socially-distancing and isolating effects of shame, compassion tends to evoke more flexible ways of responding and includes behavioral repertoires around caring for and relating to self and others that are associated with affilliative emotions such as warmth, interest, sympathetic joy, and pride [18]. As such, clinical interventions targeting shame and self-criticism often focus on fostering self-compassion 19, 20, 21.

Self-compassion is fundamentally about self-to-self relating, wherein a person responds to their own behavior with the same sort of caregiving repertoire that one might apply to a friend, loved one, or other beloved person. This is a fairly complex cognitive task that requires the person to be able to observe their own behavior and respond to it in a manner that evokes these evolved caregiving repertoires. A central task of working with high self-critics is activating and cultivating these caretaking repertoires as they apply to oneself.

To date there have been a number of ACT studies looking at issues of self-criticism, shame, and self-stigma. However, with the exception of one pilot study [22••], none of this work has focused on self-compassion as a potential process variable. Below is a brief review of the existing research on ACT for shame and stigma, followed by considerations for the important role self-compassion may have in this work. Figure 1 also summarizes research examining ACT for shame and stigma, as well as research relevant to compassion in ACT.

Section snippets

Evidence supporting ACT for stigma and shame

In the past decade, several studies have examined ACT interventions for stigma and shame. Of particular relevance to treatment are several studies focused on self-stigma, or the devaluation of oneself and related fears of being stigmatized due to identification with a stigmatized group. Two studies provide support for the application of ACT for self-stigma and shame related to substance addiction. The first study [23] was an open trial that supplemented treatment as usual with a six-hour group

ACT and self-compassion

While there is growing discussion of the role of self-compassion in ACT 22••, 27 only one published study of ACT has examined compassion as a mediator of outcomes, to our knowledge. Vowles and colleagues [28••] found self-compassion to be a robust mediator of outcomes in an open trial of ACT for chronic pain. This finding is particularly interesting because the treatment did not emphasize self-compassion, raising the possibility that self-compassion may be an under-recognized mechanism of

Conclusion

Acceptance and commitment therapy successfully improves lives in a wide variety of ways. One fruitful domain for the application of ACT is in addressing self-criticism, self-stigma and shame, which are issues relevant to many people seeking treatment across a range of diagnostic categories. While self-compassion is inherent in the ACT model, there may be important ways to strengthen this process, a process which appears to be particularly important to highly self-critical and shame prone

Conflict of interest

None declared.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

  • •• of outstanding interest

Acknowledgement

The authors wish to acknowledge Dr. Jenna LeJeune for her valuable input on this manuscript.

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