Abstracts Category : Other

Internalized Shame and Shame Tolerance in Inpatient Treatment for Substance Use Disorders

by Jessica Lee Armstrong

Internalized shame, a construct that assesses the extent to which an individual identifies with the experience of feeling deeply flawed, unworthy, and defective (Cook, 1987, 1991, 2001), has been associated with negative clinical outcomes in substance use disorders (SUDs; Harper, 2011). Tolerance for shame-related distress, or shame tolerance, has been associated with other forms of psychopathology (Schoenleber & Berenbaum, 2010, 2012), and may serve to moderate the relationship between internalized shame and SUD treatment outcomes. This mixed-methods study explores internalized shame and shame tolerance in the context of early recovery from SUDs, particularly as they are associated with inpatient treatment success and participant experiences with relapse. Self-report measures and interviews were used, and thematic analysis (Braun & Clarke, 2006) was utilized in analyzing qualitative data. Quantitative analyses did not find support for the moderating effects of shame tolerance on the impact of internalized shame on treatment outcomes in individuals with SUDs in inpatient treatment. However, there was a significant interaction between gender, prior relapse, and internalized shame, such that women with prior relapse presented with higher internalized shame and lower shame tolerance than women with no prior relapse or men in either condition. A semi-structured interview and subsequent qualitative analyses were utilized to explore participant experiences with relapse and treatment. Results revealed superordinate and subthemes related to each of three content areas relapse experiences, abstinence in response to craving, and current treatment experiences and interview excerpts are included to highlight each theme. Clinical implications, limitations, and future directions are discussed.