Managing shame and guilt in addiction: A pathway to recovery. (September 2021)

• Record Type: Journal Article
• Authors: Snoek, Anke; McGeer, Victoria; Brandenburg, Daphne; Kennett, Jeanette
• Is Part Of: Addictive behaviors. Volume 120(2021)
• Publication Date: 2021-09
• Subjects: Addiction -- Shame -- Guilt -- Empathy -- Treatment -- Agency -- Self-blame -- Reproach; Substance abuse -- Periodicals; Alcoholism -- Periodicals; Drug addiction -- Periodicals; Nicotine addiction -- Periodicals; Smoking -- Periodicals; Gambling -- Psychological aspects -- Periodicals; Electronic journals; 362.29
• DOI: 10.1016/j.addbeh.2021.106954
• Languages: English
• ISSNs: 0306-4603

Abstract

Highlights: People with substance dependency often report feelings of guilt and shame. Researchers suggest guilt may help overcome addictive behaviour, but shame does not. If so, therapeutic intervention should aim to up-regulate guilt and down-regulate shame. This view is too simplistic: guilt and shame can be equally counterproductive – or productive. The difference lies in how these feelings are managed. Such management depends on a person's quality of self-blame (retributive or 'scaffolding'). Retributive self-blamers see themselves as fixed and unchanging (shame and guilt destructive). Scaffolding self-blamers see themselves as capable of self-change (shame and guilt constructive). Recommended therapy is to facilitate a shift in self-attitude, focussing especially on blame. Self-empathy and narratively reshaping the past can be important aspects of this shift. Abstract: A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people's degree of guilt-proneness versus shame-proneness. In this paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person's quality of self-blame (retributive or 'scaffolding'), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding 'reproach', thereby enabling them to manage their experiences of both shame and guilt in a more generative way.