Shame is an emotion that can lead to feelings of humiliation, embarrassment, unattractiveness, and isolation. People who feel shame often have low feelings of self-worth and have less-than-optimal opinions of their own identities. For people with anxiety, shame may be a particularly debilitating emotion, especially if they also have psychosis. In fact, it is estimated that the majority of comorbidity found among individuals with psychosis is with anxiety and social anxiety in particular. Researchers theorize that people who are susceptible to social anxiety have symptoms of behavioral issues, shyness, and shame long before they develop evidence of anxiety. Because of the high rates of comorbidity in psychosis and anxiety, it would be prudent to explore whether or not shame increases the risk for anxiety in those with psychosis.
Maria Michail of the Division of Nursing at the School of Nursing, Midwifery, and Physiotherapy at the University of Nottingham in the UK recently led a study looking at how shame vulnerability, shame appraisals, and loss of perceived social position affected people with social anxiety (SAD) and a first episode of psychosis (FEP). Michail found that the participants with SAD were most negatively affected by shame proneness and their perceived loss of social position. This was especially true of those with SAD and psychosis; however, even participants with SAD only were affected. For those with both FEP and SAD, stigma associated with mental illness led to increases in shame and feelings of rejection. These findings suggest that shame is the catalyst for negative outcomes in SAD, regardless of whether psychosis is present or not. But Michail believes that these results also demonstrate that those experiencing their first episode of psychosis may be at increased risk for negative outcomes if they also have SAD. Michail hopes that her findings will extend the reach of existing treatments aimed at individuals with psychosis and SAD. Michail said that when therapists are addressing distress in psychosis and SAD symptoms, “Psychological interventions could be enhanced by taking into consideration these idiosyncratic shame appraisals.”
Michail, M., and Birchwood, M. (2013). Social Anxiety Disorder and Shame Cognitions in Psychosis. Psychological Medicine, 43(1), 133-42. doi: http://dx.doi.org/10.1017/S0033291712001146
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