Role of illness-related shame and compassion in long-term health conditions

Abstract

OBJECTIVE: Compassion Focussed Therapy (CFT) was initially developed to treat people with high levels of shame proneness and self-criticism. In CFT, shame is conceptualised as transdiagnostic in psychological distress. The prevalence of psychological distress (including shame) in people living with long-term physical health conditions (LTCs) is well evidenced. There is interest in the use of compassion-focussed interventions for people with LTC’s and initial evidence that they can reduce distress and increase self-management behaviours. The presented systematic review explores the current evidence for illness-related shame (IRS) across physical health populations and identifies associated psychosocial factors. The empirical paper investigates the process of change for individuals with various LTCs during a CFT group intervention.

METHODS: Three key databases were searched to identify studies with a measure of illness-related shame (IRS).

Papers that met the inclusion criteria were quality assessed and results synthesised to provide narrative summary. A multiple baseline, single case experimental design was used to track changes in compassion, illness cognitions, self-efficacy, social functioning and psychological wellbeing, with daily and weekly measures, over a ten-session structured CFT intervention.

RESULTS: Results of the review indicated illness-related shame has been tested in a small but diverse number of health conditions and is prevalent in all conditions studied. Associated factors were heterogenous however, the presence of IRS was most commonly associated with reduced wellbeing, increased anxiety and depression, and cognitive fusion. In the CFT group, improved self-compassion was reported across all individuals. Changes on measures related to psychological adjustment were not consistent across individuals. The process of change was gradual, with quantifiable change most commonly demonstrated within the last four sessions of the group.

CONCLUSIONS: IRS is present across a range of LTC groups. Further research is needed to identify differences in the prevalence between LTC populations and clarify the role of IRS as a target for psychological intervention. A CFT group for various and multiple health conditions was effective in producing changes in self-compassion. A clearer understanding of the link between compassion and adjustment to illness is sought to inform changes to intervention or measurement, in order to produce and demonstrate therapeutic change.