Theoretical models of self-conscious emotions indicate that shame is elicited through internal, stable, and global causal attributions of the precipitating event. The current study aimed to investigate whether these negative attributions are related to trauma-related shame and PTSD symptom severity.
A total of 658 participants aged 18 to 89 (M
Higher levels of internal, stable, and global trauma-related attributions were significantly associated with shame and PTSD. Shame mediated the association between trauma-related attributions and PTSD symptom severity, even after controlling for the effects of number of trauma exposures, worst index trauma and depression.
The present results suggest that negative attributions are a critical cognitive component related to shame and in turn, PTSD symptom severity. Future research should aim to replicate these findings in a clinical sample and extend these findings using prospective designs.
Cognitive antecedents of shame were investigated in a large trauma-exposed sample. Internal, stable, and global trauma attributions were associated with shame severity. Trauma-related shame mediated the association between trauma-related attributions and PTSD symptoms. Specific attributions may be an important predictor of trauma-related shame.
The exposure to a potentially traumatic event (PTE) often elicits a myriad of emotional responses that intensify traumatic stress reactions. Moreover, these reactions are thought to contribute to the development and maintenance of current threat characteristic of posttraumatic stress disorder (PTSD). Recently, there has been a growing interest in the role of shame as an important emotional trauma sequalae linked to poorer adjustment and maladaptive coping and predictive of the development of PTSD symptoms (e.g., intrusive recollections, hyperarousal and avoidance) (
The cognitive model of PTSD offers a framework for understanding how shame may emerge following exposure to PTEs (
In line with this, theoretical models of shame classify it as a self-conscious emotion, as it arises when the self is implicated by a negative and aversive event that violates internal and/or external standards and evokes judgement from others (
Indeed, higher levels of internal, stable and global attributions has been associated with higher levels of PTSD. While, these studies have focused on negative attributional style, which is the tendency to attribute events to internal, stable and global causes to common negative and/or hypothetical life events (
Following exposure to a traumatic event, posttraumatic shame may arise through this appraisal process, where the individual erroneously blames themselves for having caused the event. Consequently, the self is implicated in an unwanted event, and the trauma and its effects are appraised as having occurred due to the individual being inadequate or worthless in some way. Even in the absence of an external threat, the individual may still feel a sense of impending threat due to fear of rejection and stigmatisation but also an internal threat due to ongoing negative self-evaluation. Consequently, feelings of trauma related shame are likely to be painful, prompting avoidance that inhibits trauma processing, which impedes recovery (
Although negative attributions are purported to be a cognitive antecedent to shame, there are several trauma characteristics that may impact the severity of posttraumatic cognitions and emotions. Firstly, although trauma exposure is insufficient to elicit trauma related shame, the nature of the traumatic event may function as a diathesis toward making more negative appraisals and higher levels of shame. For example, individuals with interpersonal trauma exposure, defined as an event that involves deliberate perpetration of harm to another individual (e.g., sexual assault, armed robbery, physical threats etc.) (
Secondly, routine self-report PTSD screening measures require a single designated trauma event to be used in assessing the severity of symptoms. However, the exposure to multiple potentially traumatic events can be considered a rule not the exception. There is robust evidence indicating that, with an increased number of PTE exposures, PTSD risk increases in a dose-dependent manner (
Regardless of overall trauma exposure, it is expected that individuals will seek to assign meaning and provide causal attributions to explain their experiences. Thus, the current study sought to extend previous findings in two ways. Firstly, it aimed to investigate the relationships between trauma specific negative attributions (higher internal, stable, and global attributions) shame and PTSD symptom severity in a broad sample of trauma exposed survivors. Based on previous findings, it was hypothesised there would be significant associations between negative attributions, shame, and PTSD symptoms. Secondly, it explored whether trauma-related shame would mediate the relationship between higher levels of internal, stable, and global attributions on the one hand, and PTSD symptoms on the other.
To examine the unique contributions of trauma related attributions and shame in relation to PTSD, the current study controlled for the effects of the various trauma characteristics mentioned. This included cumulative lifetime exposure to PTEs, reference trauma type (interpersonal vs. non-interpersonal) and time elapsed since reference trauma. Symptoms of depression were also controlled for due to depression’s significant comorbidity with PTSD (
Six hundred and sixty-seven participants consented to participate in the study, however nine participants failed the attention checks, and were excluded from the analyses. The final sample consisted of 658 participants between the ages of 18 to 89 (
Participants endorsed exposure to an average of 6.3 (
The LEC (
The PCL-5 (
The EASQ (
The EASQ was adapted by
The TRSI (
The DASS-21 (
Participants were recruited from Australia, Canada, Ireland, The United Kingdom and United States via Prolific Academic (ProA), an online crowdsourcing platform. Only participants over the age of 18 and who endorsed being exposed to at least one potentially traumatic event (PTE) within their lifetime according to the LEC (
Spearman’s rank order correlations were calculated given the non-normal positively skewed distributions of depression, PTSD, and trauma-related shame. Bootstrapping (5,000) iterations were performed to test the indirect effects of shame and negative attributions in relation to PTSD symptom severity using conditional process analysis (
The use of bootstrapping, a non-parametric resampling method offers an advantage over the traditional Sobel Test as it does not require the assumption of normality to be met for the product of co-efficients. Further, the resampling methods minimises bias that arises from non-normal sampling distributions (
Mean, standard deviation and range of all self-reported measures are reported in
Variable | Range | Cronbach’s α | ||
---|---|---|---|---|
Exposure (LEC) | 6.31 | 2.16 | 2-16 | – |
Depression (DASS-21) | 6.67 | 6.26 | 0-21 | .94 |
Internal attributions (EASQ-T Internal) | 2.45 | 1.43 | 1-7 | – |
Stable attributions (EASQ-T Stable) | 3.73 | 1.63 | 1-7 | – |
Global attributions (EASQ-T Global) | 3.34 | 1.56 | 1-7 | – |
Attributions (EASQ-T Total) | 3.17 | 1.07 | 1-6.58 | – |
Shame (TRSI) | 14.33 | 15.94 | 0-70 | .97 |
PTSD (PCL-5) | 27.78 | 19.59 | 0-80 | .95 |
Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
---|---|---|---|---|---|---|---|---|
1. Exposure | – | .16** | .10** | .10** | .08 | .13** | .30** | .19** |
2. Depression | – | .27** | .16** | .14** | .31** | .59** | .56** | |
3. Attributions | – | .54** | .73** | .79** | .27** | .29** | ||
4. Internal | – | .04 | .23** | .25** | .20** | |||
5. Stable | – | .42** | .04 | .08* | ||||
6. Global | – | .35** | .37** | |||||
7. Shame | – | .66** | ||||||
8. PTSD | – |
*
However, when trauma related shame was included in the model, the direct effect of trauma-related attributions remained significant,
As a secondary exploratory analysis, we repeated the mediation analyses for each separate attribution dimension. The results of these are presented in Figures 1-3 in the
To our knowledge, this is the first study that examines the role of internal, stable and global trauma-related attributions in relation to shame and PTSD symptoms in a broad trauma exposed sample. The purpose of the study was two-fold. Firstly, it aimed to investigate the relationship between negative attributions (higher levels of internal, stable, and global attributions), trauma-related shame and PTSD. Secondly, it investigated whether trauma-related shame would mediate the relationship between negative trauma-related attributions and PTSD symptoms.
As predicted, negative attributions, that is, higher levels of internal, stable, and global attributions and trauma-related shame both had significant direct effects on PTSD symptom severity. Interestingly, although cumulative trauma exposure is an important risk factor for PTSD (
The finding that internal, stable and global attributions are significantly associated with higher levels of PTSD is consistent with previous research indicating strong associations between negative causal attributions and PTSD symptoms (
As our findings indicate, negative attributions of the traumatic event were associated with higher levels of trauma-related shame which in turn, were associated with more severe PTSD symptoms. Thus, the appraisal that negative events are due to internal, stable and global attributions may lead to the focus of evaluation being directed inward where the self and its entirety is judged negatively, prompting feelings of intense shame. The cross-sectional nature of our study precludes causal inferences; however, further prospective studies of these variables should seek to confirm this possibility.
The phenomenological experience of shame is painful, motivating the desire to withdraw and hide due to the fear of rejection or stigmatisation. In this way, feelings of shame may increase the intensity of PTSD symptoms through responses such as avoidance (
Although the current results support our second hypothesis, there may be other variables that influence and explain the relationship between shame and PTSD. Following trauma exposure, shame is typically accompanied by other emotional responses such as fear, guilt, alienation, and betrayal that also promote avoidance and intense reliving of trauma memories (
Overall, the findings support the assertion that individual variability in trauma attributions and reactions are linked to not only an increase in PTSD symptom severity, but this relationship can also be explained by emotional and behavioural reactions associated with shame related to one’s traumatic experiences.
Some limitations of the current study should be noted as avenues for future research. First, the use of a cross-sectional design precludes any causal inferences. It is likely that both negative appraisals and trauma related shame have a bi-directional relationship, however the extent to which they reinforce each other remains an empirical question. Thus, longitudinal research is needed to assess the directionality of these constructs. Second, although the use of self-report questionnaires is common in clinical psychology research, responses may be influenced by participants’ introspective ability and other response biases. Third, additional demographic data was not obtained with respect to ethnicity, or employment status which may be important risk factors for PTSD (
Fourth, the construct validity of the “global” dimension of the EASQ may be imperfect in that the global dimension items appeared to assess attributions about the perceived consequences of traumas, rather than attributions about the cause itself (“Is this cause something that affects just this type of situation, or does it also influence other areas of your life”). This may have contributed to the relatively stronger associations observed between global attributions and PTSD symptoms when compared with the internal-external and stable-variable dimensions. Future studies should ideally use interviewer-based approaches to allow careful distinctions between attributions about the causes versus the consequences of trauma events.
Further, although the PCL-5 is widely accepted and utilised within trauma research as a PTSD symptom screening tool, it does not examine trauma relatedness of symptoms and significant overlap between PTSD and other psychiatric symptoms may inadvertently inflate PTSD symptom severity scores (
Although specific attribution dimensions may exert greater influence on shame and PTSD symptoms than others, the results indicate that, together, internal, stable and global attributions for lifetime exposure to PTEs functions as a potential cognitive vulnerability toward trauma related shame. Thus, targeting these cognitions may constitute an important mechanism for trauma recovery. Cognitive based interventions that utilise attribution retraining such as Cognitive Processing Therapy (CPT;
Overall, the present study indicates that following exposure to a PTE, negative attributions are associated with shame, which in turn is associated with higher levels of PTSD symptoms. The findings underscore the potential clinical utility of assessing negative attributions as a potential antecedent of shame. In doing so, clinicians can seek to target these processes and potentially change the trajectory of shame responses and reduce the emotional impact of the trauma and the severity of PTSD symptoms.
The authors have no relevant financial or non-financial interests, and no conflicts or competing interests to disclose.
The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Participants in the present study did not consent for their data to be shared publicly, so supporting data for the present study is not available.
The Supplementary Materials contain the following items (for access see
Figure 1 – The relationship between Internal Attributions and PTSD Symptom Severity mediated by Trauma-Related Shame.
Figure 2 – The relationship between Stable Attributions and PTSD Symptom Severity mediated by Trauma-Related Shame.
Figure 3 – The relationship between Global Attributions and PTSD Symptom Severity mediated by Trauma-Related Shame.
The authors have no additional (i.e., non-financial) support to report.