A Case Study on Transforming Shame: The Role of Acceptance and Commitment Therapy in Fostering Psychological Flexibility and Self-Compassion.

Shame is related to a host of social and psychological problems including depression, PTSD, social anxiety, substance misuse, borderline personality disorder, eating disorders, and self-directed violence. Shame is an acutely painful emotion that motivates humans to protect the "flawed" or "fragile" self, often through withdrawal or avoidance. Consequently, many clients who frequently and intensely experience shame persistently avoid life situations where shame could be triggered and engage in frequent self-criticism geared toward self-improvement. Though well-intentioned, these repeated attempts to reduce or avoid shame can exacerbate the sense of being defective, other, or unworthy already associated with shame and prevent people from living out their values in relationship with themselves and important others. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to promote psychological and behavioral flexibility in response to painful internal experiences, like shame. This case illustration depicts how ACT can be applied to target shame by incorporating a collaborative case conceptualization process and principles from affective science to help the client respond more flexibly to shame when it is cued, and take steps to cultivate a more compassionate, values-driven relationship with self and others. The client, Courtney, was an adult heterosexual cisgender white woman working in secondary education. She presented to therapy with symptoms of anxiety, depression, and self-esteem issues and underwent 20 sessions of ACT for shame. By the final session, Courtney reported significantly reduced shame and self-criticism and increased self-compassion.