Transformative pathways: shame and fear of compassion as potential mechanisms of change in psychotherapy

It has been hypothesized that shame and fear of receiving compassion from others are interrelated processes in psychotherapy. However, little is known about how these factors influence each other in a clinical setting. This study examined the relationships between shame, fear of receiving compassion from others, and symptom distress at a within-patient level throughout psychotherapy.

The transdiagnostic sample consisted of 1,134 inpatients at Modum Bad receiving psychological treatment. Weekly self-reports measured symptom distress, fear of receiving compassion, and shame. The Latent Curve Model with Structured Residuals was used to examine the relationships between the variables at a within-patient level throughout therapy.

At a within-patient level, reciprocal predictive relationships were found between shame and symptom distress, and between fear of receiving compassion and symptom distress. Shame also predicted fear of receiving compassion, but not vice versa. Sensitivity analyses supported the relationship between shame and symptom distress across treatment units but indicated greater variation in relationships involving fear of receiving compassion.

The findings suggest that shame and fear of receiving compassion are dynamically involved in symptom change during psychotherapy. Shame appears particularly central, whereas the role of fear of receiving compassion may vary across treatment contexts.Trial registration: ClinicalTrials.gov identifier: NCT03503981.