Treatment of shame in borderline personality disorder
Research on the emotion of shame has increased dramatically in recent years. Shame has been found to be associated with suicidal behavior, interpersonal difficulties, deficits in problem solving, and problems with other negative affect such as anger and depression. However, despite empirical evidence that the experience of shame is linked to psychopathology, a focus on shame has been largely absent in clinical approaches. Nowhere is this more apparent than in the field of borderline personality disorder (BPD), a disorder proposed to be associated with the presence of intense and chronic levels of shame. This study sought to develop and test a short-term intervention for shame in BPD, using the skill of "Opposite Action," from Dialectical Behavior Therapy. This skill was expanded upon and developed into a 8--10 week intervention during which clients were exposed to cues that evoked shame, maladaptive responses were blocked, and adaptive, opposite responses were elicited and strengthened. A pilot case was used to further refine the treatment manual and consequently, five clients were treated with the intervention using a single-subject, multiple baseline design. There were several noteworthy results. First, repeated measurement led to the finding that state ratings of shame are highly variable, independent of any treatment effect. Second, within-session changes in shame indicate that it is possible to reduce shame about a specific event over a short period of time using the technique of opposite action. A shame checklist that was created for this study verified this finding. Scores on the checklist showed a significant reduction in shame intensity by the end of treatment, suggesting that this intervention was successful at reducing shame about specific events that was not necessarily accounted for in the weekly, unstable ratings. Finally, the method for developing the treatment manual was successful in that it produced a short-term intervention, based on empirical principles of behavior change, that was highly acceptable to participants. There were no dropouts during the intervention and rates of overall compliance were extremely high. These findings have several implications for the treatment of shame in BPD and other clinical populations.
- Psychology