Developing and evaluating a compassion-based therapy for trauma-related shame and posttraumatic stress

Abstract

Posttraumatic Stress Disorder (PTSD) has been primarily conceptualized as a fear-based disorder, but accumulating research indicates that shame can also strongly contribute to the development and maintenance of PTSD. Existing evidence-based treatments for PTSD typically focus on dysregulated fear responding and do not directly target the affective experience of shame. Interventions that promote self-compassion have shown promise for reducing shame related to various clinical problems, but this approach has not been systematically evaluated in traumatized individuals. The aim of this study was to develop and evaluate a brief compassion-based therapy, with the hypothesis that it would reduce trauma-related shame and PTSD symptoms. The intervention consisted of six weekly individual therapy sessions focused on promoting self-compassion in response to a traumatic event and its sequelae. Using a multiple baseline design, the intervention was evaluated in a community sample of trauma-exposed adults (N = 10) with elevated shame and PTSD symptoms. Participants completed assessments on a weekly basis during a 2-, 4-, or 6-week baseline phase and 6-week treatment phase, and at 2- and 4-weeks after the intervention. By the end of treatment, 90% of participants demonstrated reliable decreases in PTSD symptom severity (p < .05), while 80% of participants showed reliable reductions in shame (p < .05), relative to their respective scores at baseline. These improvements were maintained at 2- and 4-week follow-up, with large effect sizes for PTSD symptom severity (d = 2.26) and shame (d = 2.12), compared to scores at baseline. The intervention was also associated with improvements in self-blame (d = 2.61), self-compassion (d = 2.28), mindfulness (d = 2.21), positive affect (d = 1.07), and negative affect (d = 2.14). Greater increases in self-compassion from baseline to follow-up were correlated with greater reductions in PTSD symptom severity (r = -.76, p < .05) and in shame (r = -.79, p < .01). Participants reported high levels of satisfaction with the intervention. The results from the present study support the hypothesis that compassion-based therapy is associated with reductions in trauma-related shame and PTSD symptoms. The marked improvements observed during the relatively brief intervention suggest that the intervention may be useful as either a stand-alone treatment or as a supplement to other treatments.