Examining the Effectiveness of Self-Acceptance Group Therapy
Examining the Effectiveness of Self-Acceptance Group Therapy
When people feel shame, they experience negative thoughts about themselves ("I'm a bad
 person") and urges to avoid others. Shame is related to many psychological problems, such as
 depression, social anxiety, and borderline personality disorder (BPD). Because there are
 currently no well-tested treatments for shame, this study will examine the utility of
 Self-Acceptance Group Therapy (SAGT). SAGT is short-term group therapy that addresses shame
 specifically. Changes in shame, mood, and behavior will be examined over the course of
 treatment and a one-month follow-up.

 Based on theory and existing evidence, Hypothesis 1a is that individuals with elevated
 initial levels of shame will report improvements on all outcome measures (e.g., reductions in
 trait shame, increases in self-acceptance) from pre-treatment to post-treatment, and
 Hypothesis 1b is that these gains will be maintained at follow-up one month after treatment
 completion.
Shame is an unpleasant self-conscious emotion that can be experienced following unwanted
 outcomes and events (Lewis, 1971). Cognitively, shame involves the attribution of negative
 outcomes to global, stable characterological flaws (e.g., thinking "That happened because I
 am a bad person;" Tracy & Robins, 2006). Behaviorally, shame involves urges to avoid or
 withdraw from other people in order to hide perceived flaws (e.g., Lindsay-Hartz et al.,
 1995). Shame has been theoretically implicated in the development and maintenance of many
 forms of psychopathology and problematic behaviors, including depression, social anxiety, and
 borderline personality pathology (e.g., Beck & Alford, 2009; Clark & Wells, 1995; Rizvi et
 al., 2011; Schoenleber & Berenbaum, 2012). Indeed, research indicates that shame is
 ubiquitous in psychopathology (see Tangney & Dearing, 2002), resulting in increasing
 recognition that treatments specifically addressing shame are needed (see Dearing & Tangney,
 2011). Although a few promising and potentially shame-relevant treatments have recently been
 described (Brown et al., 2011; Germer & Neff, 2013; Gilbert, 2011), no well-validated
 treatments currently exist and these novel treatments generally do not address both the
 cognitive and the behavioral components of shame.

 Evidence that shame involves both problematic thinking patterns and maladaptive actions
 suggests that effective interventions for shame need to address each of these components.
 Indeed, there is some initial evidence that cognitive and behavioral therapy techniques can
 reduce shame, at least in response to specific triggers. For example, cognitive restructuring
 in the context of cognitive processing therapy has been found to reduce trauma-related
 self-blaming thoughts (Resick et al., 2002), and women instructed in how to use the
 dialectical behavior therapy opposite-action skill to address a specified shame trigger
 reported reductions in shame about the given trigger (Rizvi & Linehan, 2005).

 Drawing from this literature, a shame-focused intervention, Self-Acceptance Group Therapy
 (SAGT), was developed to target both the cognitive and behavioral components of shame from a
 cognitive-behavior therapy framework. SAGT is an 8-week group treatment that involves
 psychoeducation and training in cognitive and behavioral shame-coping skills in order to
 promote improvements in self-acceptance, which is the conceptual opposite of shame. For
 example, group members are taught how to recognize and challenge shame-eliciting thoughts, as
 well as how to effectively discuss shame-eliciting topics with others in order to alleviate
 shame, foster adaptive social support, and enhance their ability to demonstrate
 self-kindness/compassion. As in other cognitive-behavior therapies, group members complete
 weekly homework assignments that allow them to practice their new skills. In addition,
 in-session activities are used to promote further skills practice and target the social
 disconnection created by shame. An initial version of SAGT was provided to 8 women Veterans
 at the G.V. (Sonny) Montgomery VA Medical Center by one of the researchers (Dr. Schoenleber).
 Preliminary data indicate that group members reported large reductions in trait shame (d =
 1.55) and improvements in self-acceptance (d = 2.15). Based on feedback provided by these
 group members, an updated version of the SAGT protocol has been prepared. The primary aim of
 the present study is to examine whether the current version of Self-Acceptance Group Therapy
 is effective in improving shame, as well as emotional and interpersonal functioning among
 individuals with elevated shame.

 Based on theory and existing evidence, Hypothesis 1a is that individuals with elevated
 initial levels of shame will report improvements on all outcome measures (e.g., trait shame,
 self-acceptance, psychiatric symptoms) from pre-treatment to post-treatment, and Hypothesis
 1b is that these gains will be maintained at follow-up one month after treatment completion.
Inclusion Criteria:

 -  Eligible participants will be adults (age 18 or older) who are fluent in English (as
 all materials will be presented in English) and report elevated levels of trait shame
 on the Experience of Shame Scale (ESS) at screening. Specifically, based on past
 research, individuals must score at least 55 on the ESS screening items, which is
 consistent with levels of shame often reported by clinical samples. In addition, all
 interested individuals must have a therapist/case manager/psychiatrist who provides
 them with individual psychotherapy on a regular basis and for whom the participant is
 willing to sign an Authorization for Release of Health Information.

 Exclusion Criteria:

 -  Individuals will be excluded from the present study if they do not report significant
 difficulties with shame (i.e. ESS screening item scores less than 55), do not have an
 individual therapist/case manager/psychiatrist who monitors and addresses their
 broader mental health concerns, are experiencing active psychosis (i.e. delusions
 and/or hallucinations), or are experiencing an episode of mania.