Shame as an evolved basic affect - Approaches to it within the Comprehensive Resource Model (CRM)

Shame is an evolved emotional response which requires relational evaluation at a prefrontal cortical level but which has the visceral sensation and defence response impulse of a basic affect. We argue that the severe forms of shame, those residual from traumatic interpersonal experiences, have midbrain and diencephalic components mediating experiences of painful withdrawal while anhedonia is derived from a negatively valenced state of the mesolimbic dopamine system. This specific form of separation distress, with a characteristic sense of exclusion and unworthiness, benefits in treatment from the presence of attachment resources which allow secure access to the core distress. We discuss the use of the Comprehensive Resource Model (CRM) in the psychotherapy of post-traumatic states in which shame is prominent.