Exploring Trauma-Related Shame, Early Experiences & Self-Compassion
Research type
Research Study
Full title
Exploring the effects of childhood memories of warmth & safeness and self-compassion on trauma-related shame in adults with Complex Post Traumatic Stress Disorder (CPTSD).
IRAS ID
327850
Contact name
Frances Ryan
Contact email
Sponsor organisation
Berkshire Healthcare NHS Foundation Trust
Duration of Study in the UK
1 years, 1 months, 8 days
Research summary
There is a growing body of research that suggests trauma-related shame can predict symptom severity in Post-Traumatic Stress Disorder (PTSD) & Complex Post Traumatic Stress Disorder (CPTSD). However, we do not fully understand why some people experience more trauma-related shame than others. Shame can make people feel as though they are to blame or at fault. This can make accessing trauma-focussed psychological therapies difficult as shame can be a barrier to disclosure and help-seeking. Psychological theories underline childhood experiences of warmth and safeness (which influence our ability to feel soothed and safe in adult relationships) and how compassionate we are (towards ourselves in times of distress) as factors that can potentially buffer against shame.
This study aims to understand:
(1) Whether self-compassion and childhood memories of warmth and safeness account for levels of trauma-related shame experienced by adults with Complex PTSD.
(2) Whether there are significant differences in trauma-related shame in adults with Complex PTSD who have higher and lower levels of self-compassion.
The International Trauma Questionnaire (ITQ), that measures Complex PTSD symptoms, will be used to screen for eligible participants. If eligible, participants will be invited to complete measures of trauma-related shame, childhood memories of warmth and safeness, self-compassion and symptoms of depression.
Clinical Sample
Patients at Berkshire Traumatic Stress Service (main research site) complete these measures as part of routine clinical care.
Participant Identification Centre (PIC)
Clinicians from Southwest London and St George's Traumatic Stress Service will identify potential participants and signpost to the study materials online. The ITQ will act as a screener for eligible participants.
Community Sample
The study recruitment poster and links will be advertised on media channels and through charities. Participants will access measures online. The ITQ will act as a screener for eligible participants.
Power analyses suggest data from 128 participants (minimum) is needed to confidently interpret the findings using a robust scientific method.
Lay summary of study results: Study Lay Summary
Study Title
Exploring the effects of childhood memories of warmth & safeness and self-compassion on trauma-related shame in adults with Complex Post Traumatic Stress Disorder (CPTSD).
Study Details
This study was carried out in conjunction with Berkshire Traumatic Stress Service as part of the first author’s clinical psychology doctorate. It was sponsored by Berkshire NHS Foundation Trust and supervised by Dr Dorothy King, Dr Deborah Lee, and Dr Emily Reeves and supported by Devanshi Sharma. The project team would like to extend a huge thank you to the three experts by experience with lived experience of CPTSD and shame who supported this project with valued guidance and interesting conversation from inception to dissemination, as well as all our participants who so kindly took part.
Why did we do this study?
Around 70% of people will encounter a traumatic experience in their lives. Our experiences in childhood are thought to shape our responses to traumatic events; helping us feel safe, respond to ourselves with kindness, and reach to others for support during times of difficulty. However, some people have not had the opportunity to experience relational safeness or develop self-compassionate abilities. If you experience multiple traumatic experiences over a long period of time (especially interpersonal trauma) the risk of experiencing trauma-related shame and developing a traumatic stress condition called Complex Post Traumatic Stress Disorder (CPTSD) can rise.
Trauma-related shame is a social state of threat that can involve beliefs (e.g. ‘I am defective’ or ‘I am to blame for what happened to me’), emotions (e.g. fear, embarrassment, dysregulation, worthlessness), body sensations (e.g. fight-flight-freeze, dissociation or numbness) and behaviours (e.g. avoidance, concealment, or blame). It is thought that experiencing high shame might make it harder to access support for CPTSD. Theories and research suggest shame can make accessing trauma-focussed treatments harder, such as building a strong therapeutic alliance with a therapist or accessing emotions to process trauma memories. So far, there is not a huge amount of research exploring trauma-related shame, what we can do to reduce trauma-related shame, or how these ideas relate to one another beyond theories. We set out to investigate trauma-related shame in adults with CPTSD.
How was the study carried out?
A sample of adults (aged 18 years and older) with CPTSD were recruited in partnership with an NHS traumatic stress service and online (through social media and peer support charities). Participants either completed a one-off online questionnaire or gave us consent for us to use their scores from questionnaires completed within the service. This was combined with data the service had already collected using the same questionnaires. The questionnaires asked about experiences of trauma symptoms and impairment, trauma-related shame, self-compassionate abilities, childhood memories of warmth and safeness, and depression.
Analyses were taken to consider whether self-compassionate abilities and childhood memories of warmth and safeness could predict trauma-related shame when we controlled for CPTSD symptoms, depression, and demographics such as age, gender, and ethnicity. For our exploratory analyses, we used a study that looked at self-compassion in the UK general population to divide participants into two groups: (1) above average self-compassionate abilities and (2) lower than average self-compassionate abilities. We compared trauma-related shame between these groups and controlled for depression and CPTSD symptoms.
What did we find?
We found that our full model (age, gender, ethnicity, CPTSD symptoms, depression, early memories of warmth and safeness and self-compassionate abilities) predicted trauma-related shame. Low self-compassion and CPTSD symptoms were significant predictors of trauma-related shame. We found that early memories of warmth and safeness did not predict trauma-related shame. We found there were very few memories of warmth and safeness reported by participants in this study (e.g. almost all values were clustered in the bottom quartile). We found significant differences in trauma-related shame between our higher and lower than average groups in respect of self-compassionate abilities.
What did we conclude?
We concluded that our findings suggest self-compassion is a worthwhile therapeutic target in helping people experiencing trauma-related shame in CPTSD; but this finding should be replicated in larger samples and in a controlled experimental design to feel more confident in its reliability and accuracy. We concluded there is value in screening for self-compassionate abilities within NHS traumatic stress services; those who fall below average might experience higher trauma-related shame. We also wondered about other factors that might influence trauma-related shame, such as social support or other types of compassion (such as receiving compassion from others or giving compassion) in explaining more about trauma-related shame in adults with CPTSD.
We had a few hypotheses about why childhood memories of warmth and safeness did not predict trauma-related shame in our study. Most people in our study reported few childhood memories of warmth and safeness. While this aligned with our theoretical ideas, it meant the scores were clustered at the lower end of values. This meant there was little comparison or range within the sample (e.g. people with higher memories of warmth and safeness). We wondered if childhood memories of warmth and safeness might be protective in the development of CPTSD and subsequent trauma-related shame. It is possible that perhaps people who have increased experiences of childhood warmth and safeness might be less likely to develop CPTSD and therefore maybe did not meet our study criteria. Therefore, it was not possible to rule in or completely rule out the role of childhood memories of warmth and safeness in predicting trauma-related shame.
What next?
We wondered about exploring this idea further in future research with people who do not meet the diagnostic criteria for CPTSD (or whose scores fall just below). Moving forward, we concluded that future research should try and replicate our results (with larger samples and in experimental designs). We concluded that it would be helpful to test the other types of compassion (such as receiving compassion from others or giving compassion) to build up a broader picture of the role of compassion and trauma-related shame in CPTSD.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
24/NE/0166
Date of REC Opinion
6 Sep 2024
REC opinion
Favourable Opinion