Interventions to reduce shame: A systematic review

Shame is a painful emotion associated with an array of poor health outcomes, yet is understudied in intervention research. The purpose of this study was to systematically review interventions to reduce shame and summarize instruments used in its measurement. We searched PubMed, PsycINFO, and CINAHL databases for the initial pool of articles. After deleting duplicates, we screened titles and abstracts on 1518 records, resulting in 63 studies forwarded for full-text review. Thirty-seven studies met inclusion criteria. Risk of bias tools were used to assess study quality. Data were extracted on study design, intervention, sample characteristics, shame measure, context, and effectiveness or efficacy. A pooled sample of 5128 individuals participated across 37 included studies; 16 used an RCT design, and 21 used pre/post-test. Seventeen standardized measures of shame were used. Shame was treated in a variety of behavioral health contexts. The most common interventions were Cognitive Behavioral Therapy and mindfulness. Eighty-nine percent of studies (n = 32) reported reductions in shame at post-test. Nine studies reported sustained reductions in shame over time. Shame occurs in a variety of contexts and is malleable. Common evidence-based interventions widely available to practitioners effectively reduced shame. Further research to clarify the construct of shame and its measurement is needed.