Many therapy clients experience difficulty managing guilt and/or shame.
These painful emotions both involve a self-conscious or self-critical focus. They can worsen other forms of distress, including anxiety and depression. Guilt and shame tend to strongly draw our attention as they point to some threat. Evolution has taught us to pay more attention to painful, threat-based emotions than positive emotions as they have the most direct survival value.
There are some important differences between guilt and shame.
Guilt can have a constructive social purpose. Guilt is based on empathy for others as it arises from perceiving one’s behaviour as having been harmful to others in some way. This can uphold moral values and motivate a person to try to repair the harm. For example, they might apologise and atone in some way, or at least make an effort to not repeat the harmful behaviour. In the long run this might help minimise harm to others. However, as described later, many people can suffer from unwarranted or excessive guilt. This can compound such difficulties as depression, trauma reactions or any other mental health problem.
Shame tends to have an undermining impact with less potential benefit. The experience of shame is typically associated with the person having a more global view of themselves as unworthy, inadequate or unlovable. It can prompt a person to withdraw or hide rather than to constructively engage with others, including to repair harm. External shame is associated with concern about others perceiving you more negatively. Internal shame relates to adopting a negative view of oneself, reflected in rejecting self-talk.
Three core systems that influence our behaviour
Paul Gilbert, who founded Self-compassion therapy, described how guilt and shame relate to three evolutionary systems that strongly influence human behaviour.
These are the drive system, the threat system and the soothing system. The drive system relates to our pursuit of goals and everyday activities to seek reward. It is mediated by the neurotransmitter, dopamine. Our threat system relates to the activation of our fight-flight-freeze responses to respond to threat or danger. It is mediated by the release of the stress hormones, cortisol and adrenaline. The soothing system is associated with ways of reaching and remaining in a calm state. This includes engaging in warm or nurturing behaviours toward ourselves and others, or giving or receiving social support. It is mediated by oxytocin, the “cuddle hormone”, and endorphins which help relieve pain. Oxytocin can also increase serotonin levels, which helps regulate and boost mood.
Our relative happiness and stability are largely influenced by the interaction of these three systems.
If we drive ourselves too hard, we will likely become stressed and over-activate our threat system. When our threat system is excessively activated, it will interfere with our performance and wellbeing. If we focus too much on soothing behaviours or avoiding discomfort, we might be much less likely to achieve our goals.
Guilt and shame involve a different balance of these three systems. Shame can strongly activate the threat system, and especially the sense of threat associated with being perceived as less worthy by others, and therefore reducing one’s social standing. If shame is accompanied by feelings of humiliation it may prompt aggressive or other destructive or defensive behaviours. Not only is shame painful for the person experiencing it, it is also generally unhelpful for one’s relationships.
Guilt may also activate the limbic system in the brain, associated with perceived threat.
However, it can also activate frontal lobe activity to promote a constructive response. This may involve thinking about the situation and making amends in some way. Guilt can then be healthy and have positive social value in reflecting our empathic awareness and taking responsibility for our actions. The problem arises when our guilt is unwarranted and our perceived responsibility is distorted or excessive. This is especially the case if our excessive guilt provides no benefit to others.
Self-compassion therapy draws on the understanding that we can soothe ourselves as well as others.
We can do this by showing ourselves empathy and acting in ways to improve our situation or to calm our feelings. Showing self-understanding and care can reduce our sense of threat, improving our everyday functioning and wellbeing.
Sometimes an initial goal is to shift one’s shame more to a sense of guilt, considering what we might do to help address any wrongdoing. We might then promote self-compassion by acknowledging our distress, recognizing that our behaviour and reactions are associated with us being human, and then considering more broadly what we can do to improve the situation for ourselves and others in future.
Guilt and shame in therapy settings
Excessive guilt and shame are often powerfully disruptive emotions from which little benefit results.
It can therefore help to address these emotions directly in the therapy setting. This includes the therapist adopting an accepting stance toward the client, sometimes referred to as unconditional positive regard. The therapist might still challenge the client in relation to self-defeating behaviours, of which self-criticism based on shame is a striking example. Most importantly, it can make a great difference when those suffering from excessive guilt and shame learn to show greater empathy and compassion for themselves.
Self-criticism about having mental health problems
Many clients experience excessive guilt and shame about having a mental health problem, such as depression.
This may compound the person’s distress and helplessness, potentially increasing suicidal thoughts. It is understandable that a person will be concerned about the impact of their mental health problem on others they care about, including family members. However, people suffering difficulties may then be more at risk of withdrawing and might underestimate and underuse the supports around them. The best thing the person can do for those around them is to improve their situation, often by drawing on supports.
There is much less stigma from having mental health problems these days. Most people understand that it takes courage for someone to seek help and that this is often a very important step in recovery. Most people will relate to the feeling of being stuck or overwhelmed in a challenging situation, at least for a period of time.
When seeing clients who are struggling with this, I often highlight that when people seek therapy, they often have two main problems.
One is the original problem for which they are seeking help, such as depression or a trauma reaction. The second problem and often the most disruptive one, is experiencing a degree of non-acceptance or shame for having the problem in the first place. People generally handle situations the best way they know how given their disposition, history and current circumstances. Little is likely to be gained by damning yourself for experiencing your current challenges.
As people show greater acceptance for themselves with their current difficulties, they typically are much more ready to explore strategies that may help.
Most people then make significant progress on even the most challenging problems. Even when progress is slow and gradual, people are usually bolstered by the feeling that they are heading in the right direction.
For those struggling with these issues, I recommend they read the blog, Turning a Larger problem into a lesser one
Especially when combined with more general tendencies to be self-critical, developing further self-compassion may be an additional worthwhile goal in therapy.
Guilt, shame and perfectionism
Perfectionism is a personality attribute that can strongly predispose people to depression.
It also increases the likelihood of people experiencing guilt or shame if they fall short of expectations. Those who are perfectionistic may become especially self-damning if they think they have let down themselves or others. This is compounded if people do become depressed, which distorts people’s thinking toward unrealistically negative views of themselves, their current situation and the future.
Sometimes people’s perfectionism is based on rigidly high expectations based on their desire for improvement or to perform at their highest level at all times. This kind of striving may lead to internal shame. People may then benefit from reflecting on whether harsh self-criticism is truly a better motivator than genuine self-encouragement. For example, did they gain more from past teachers or coaches who encouraged them by recognising their strengths and positive attributes than from their more harsh or critical teachers?
Perfectionism can be even more problematic if it is based on the desire to gain approval or to be valued more by others.
This may readily lead to external shame, and perhaps even feelings of humiliation if the person is not able to perform or function as they wish. People are more at risk of this problem if they were raised in emotionally deprived environments or if the love or acceptance they received in childhood was conditional on them performing to other people’s expectations. Their threat system may be much more readily activated in performance situations.
Perfectionism can also contribute to developing conditions like obsessive-compulsive disorder (OCD).
People with OCD are typically oversensitive to feelings of guilt, which strongly activate their threat system. They may feel unwarranted guilt from not performing certain rituals “properly”, like repeatedly washing their hands to avoid unlikely contamination of others, or engaging in counting rituals to neutralizing unacceptable thoughts. Apart from other therapy techniques specific for OCD, sufferers typically need to learn to accept some uncertainty in their minds about whether they have caused harm to others and to tolerate a degree of guilt.
In general, people can learn to curb their perfectionism by allowing themselves to be more vulnerable, challenging rigid expectations, and learning to accept the extent to which situations are beyond their control.
They can benefit from developing a “growth mindset”, which focuses on one’s gradual development of skills and attributes through ongoing efforts. By contrast, a “fixed mindset” overly focuses on judging oneself or others in terms of innate characteristics. A growth mindset mantra is “learn to fail or fail to learn”, emphasizing effort and development of skills rather than just results of performance. It helps to adopt a growth mindset when developing further self-compassion.
Guilt and shame in trauma reactions
A common source of excessive guilt and shame in therapy settings is when people have experienced past trauma.
One example is survivor guilt if others connected with you have suffered severe loss or injury. Guilt can be especially pronounced if the person feels they did something that unexpectedly influenced a tragic event, albeit through no fault of their own.
For example, one client’s post-traumatic stress disorder (PTSD) was compounded by guilt of having asked her mother to pick her up from a train station and then learning that her mother was killed on the way. In another example, a soldier who went on scheduled leave felt marked guilt after being replaced by a friend who was subsequently killed. He felt that it should have been him and not his friend who should have been killed by performing his usual role. People might benefit from cognitive therapy strategies to challenge their harsh self-judgment in these situations, including recognizing that they would not judge others harshly in the same circumstances.
Such problems relate to difficulty adjusting to terrible circumstances where we were confronted with having little control.
However, it also helps to acknowledge that such reactions are influenced by a person’s positive qualities, including their genuine empathy and concern for others and their earnest wish they could have done something to prevent the traumatic event from occurring. Self-compassion strategies may then help ease some of the harshness of such self-judgment. The goal is not so much to eradicate once distressing thoughts and recollections but to have a different reaction to such thoughts.
Trauma, abuse and neglect
One of the most serious problems with unwarranted guilt can occur in situations of severe abuse.
Many of those who have been repeatedly sexually abused in childhood or experiencing domestic violence can feel unwarranted guilt and shame in relation to the abuse. They might wonder what they did to have been targeted by the abuser. They may feel guilty that they were complicit in some way, even if they were in a helpless situation.
Sometimes it seems that the person’s sense of guilt is predisposed by the perpetrator taking no responsibility themselves, leaving the sense of responsibility to be taken by others. The perpetrator might have threatened the child with harm to themselves or others if the secret of abuse were exposed, potentially leaving the person abused with a sense of responsibility for other negative consequences that may follow. A perpetrator of domestic violence may even directly blame their partner, such as by saying, “See what you made me do.” Such blaming statements might be blatantly wrong, yet may still have a strong negative impact.
Guilt or shame reactions might even have some survival value in dangerously abusive situations.
The person may adopt a more submissive stance, consciously or not, in the understandable hope of reducing the likelihood of attack. Sometimes people blame themselves for not identifying the risk or taking some other action, such as appeasing their abuser to avert the attack. When facing threat of aggression, it may be or feel unsafe for the person to stand up to the abuser or to leave. It is important that there are wider supports and community supports available in such situations, including services for those suffering from domestic violence. There need to be sanctions for those who perpetrate abuse so that it is unmistakably clear who the wider community considers to be responsible for the abuse.
Perhaps the most disruptive impact of shame occurs when people have experienced repeated abuse and neglect in childhood.
They may have internalised abusive messages. This can predispose a person to feel unworthy of others’ ongoing love. This experience can also be especially harmful as it would likely disrupt the person’s attachment systems, associating caregivers and intimate others with a sense of threat. If they have felt abandoned, emotionally deprived or neglected they may be especially sensitive to a repeat of such experiences. On the one hand they might be more dependent and clingy, or otherwise may be more avoidant of intimacy and inclined to disconnect from others.
This means that when others display empathy, warmth or caring, it can activate the person’s threat system as opposed to their soothing system. This can also occur in the therapy setting. In more extreme situations, a person may experience the pain of feeling repeatedly rejected in promising relationships, sometimes unaware of how they may have acted in ways to sabotage the relationship owing to fear of becoming even more close to someone and then being rejected. It can then be especially important for people to recognise how their self-defeating behaviours are strongly related to past experiences beyond their control, rather than mainly criticising themselves and judgmentally focusing on their personality failings.
It is most understandable that people who have been repeatedly abused or neglected would have more difficulty showing care and compassion toward themselves.
How we see ourselves is strongly influenced by how others interact with us. By contrast, those who have been raised in secure and loving families are likely to experience self-compassion more easily. They have long benefited from the experience of being lovable and acceptable as they are, regardless of occasional imperfect behaviour or performance. It can be easier to develop further self-compassion strategies, including ways of soothing or calming themselves.
Fortunately, regardless of one’s background, people can still learn to develop and strengthen their capacity for self-compassion, including developing their distress tolerance and self-soothing strategies. It may take time and patience.
How to strengthen self-compassion
As highlighted by Kristen Neff, exercising self-compassion is based on the same principles as showing compassion toward another person.
This firstly involves recognising and being open to another person’s suffering. We appreciate that the person’s suffering is associated with our common humanity. We might then respond to the person’s suffering in a kind, caring and non-judgmental way. The person is not left to suffer on their own. This is how you would treat a good friend.
Self-compassion, therefore, comes down to treating yourself in a similar fashion.
It means being open to acknowledging your suffering or pain in a non-judgmental way. It means recognising that the suffering you feel is understandable given your common humanity with others. Others in similar circumstances with similar histories and experiences would also likely suffer in a similar way. Then it involves doing something caring or kind for yourself.
Paul Gilbert and others have developed self-compassion therapy to apply these principles in a practical way. These strategies are aimed at helping people shift their self-talk from a more critical or rejecting tone to a more accepting and supportive stance. If people show warmth and understanding towards themselves as opposed to being very self-critical and judgmental, this can activate the soothing system as opposed to the threat systems. It can mimic the effects of someone else responding to us in a kind rather than a punitive manner.
Developing and practising self-compassion would also be helped by having or developing supportive relationships where you frequently experience yourself as being on the receiving end of others’ kindness.
It helps to be discerning in our relationships, noticing how we feel after interacting with others. Does our contact with that person leave us feeling positive and uplifted or downtrodden?
Sometimes developing self-compassion involves setting more boundaries with others who may act in an exploitive or abusive way towards us. However, the main thing is limiting the ways in which we might act meanly or abusively toward ourselves. That typically involves developing our self-acceptance, understanding and responsible self-care.
These practices can include anything that involves calming the threat system or activating the soothing system.
You may want to listen to our podcast episode Drive, Soothing and Threat – Seeking a Synergy of Systems for a more detailed overview of these systems.
You can experiment with ways of touching yourself in a soothing manner. This might include gently stroking your forearm, putting your hand over your heart, cradling your face in your hands, or hugging your shoulders with arms crossed in front of you. As with all the other exercises, it especially helps to allow yourself to experience the feeling of warmth and self-care as you do this. The more you allow yourself to experience a feeling of warmth for self-care, the more benefit you get from the exercise.
One of the best ways to slow and regulate our heart rate is to engage in slow, deep breathing. As you develop a soothing breathing rhythm it helps to notice sensations in your body. Slow breathing is built into practices such as relaxation, meditation, yoga or mindfulness techniques, which are all disciplines that aid distress tolerance and self-soothing.
This can include imagining yourself in a safe place that you find especially calming and peaceful. It might be on a secluded beach or remembering the place where you previously felt very calm and safe. When we focus on a visual image as if we were there, drawing on all the senses, our body can react in a similar way to if we were there.
This can involve getting in a comfortable position, closing your eyes, adopting a soothing breathing rhythm, and repeating a few calming phrases to yourself. For example, a popular loving-kindness meditation might include repeating the phrases, “May you be well, may you be happy, may you be free of suffering”. This can be repeated with yourself in mind, someone else such as a family member or friend, or even someone less close to you to further develop a compassionate orientation to others.
A core goal of practising self-compassion is to help recognise negative self-talk, especially when judgmental or punitive, and shifting it toward more positive or encouraging self-talk. Sometimes this can include developing supportive self-statements for anxiety, such as “I’ll be okay”, Or “just breathe”. To challenge negative thoughts with depression you can encourage yourself after performing any activity by saying, “At least I’m having a go”, or “At least I did that”. Otherwise, it helps to counter negative self-talk by focusing your attention outwardly rather than allowing an inner focus on negative thoughts.
Practise feeling cared for
This can include developing one’s own image that embodies the attributes of compassion. These attributes include sensitivity, acceptance, empathy and caring. It could be a human-like figure or some other image that embodies these qualities to you. Imagine compassion flowing into you from that image. It also helps to notice the even small kindnesses the people extend to you.
There is a particularly powerful therapy technique that can help address especially harsh and critical self-talk. It involves developing an image of one’s inner critic that you imagine sitting in one chair. You then respond to that critic whilst sitting in another chair. This can best be done with a therapist to help identify the feelings and reactions you have in response to the critic. It then helps to interact with the critical voice in a different manner than usual.
The emphasis is helping develop a greater understanding of the impact of such self-talk, what fears or other motivations might lie behind it, and developing a more self-compassionate response to such an internal threat. This might then defuse the critic’s impact, include being more ready to short-circuit the previous ways of responding to it.
Finally, anything else that promotes self-understanding and acceptance and that promotes a compassionate response to oneself or others is likely to help. Ultimately, people’s happiness is strongly influenced by the quality of connection to oneself and others. Anything that encourages the compassionate qualities of sensitivity, sympathy, distress tolerance, empathy, being non-judgemental and caring for yourself and others is likely to enhance those positive connections. The more difficult this is to learn, the more important it is to allow for slow and gradual progress. That in itself is a very practical form of self-compassion.
You can access our Psych Spiels and Silver Linings podcast episode, Strengthening-self-compassion, at https://www.chrismackey.com.au/strengthening-self-compassion/