Shame regulation strategies used by children and adolescents : a systematic scoping and narrative review.

Abstract

Strong theoretical support exists for the disrupting and pervasive negative consequences associated with the shame affect (e.g., depression, disordered eating, non-suicidal self-injury, personality pathology, prevention of treatment-seeking) not reflecting intrinsic features of shame itself, but rather being consequences of maladaptive shame regulation and environmental influences (e.g., abusive interpersonal relationships, which may activate maladaptive regulatory strategies). Fundamental to the development of shame regulation patterns, or scripts, are developmental factors, particularly the generation of the self-concept and attachment relationship(s). This scoping review investigates shame regulation strategies used by children and adolescents, terminology in extant literature used to describe these strategies, and gender differences in regulation strategies. Electronic database searches (e.g., PsycINFO, Medline, and Education Source databases) were supplemented by reference-checking of included articles. Eighteen theoretical and empirical publications were included. The quality of included empirical studies was assessed; data was extracted against standardised templates and synthesised narratively. Substantial diversity was present in all key review outcomes, reflective of both the youth of the field and limitations in measurement tools. A theoretical framework for the aetiology of shame regulation scripts was developed to capture findings and drive future testable hypotheses. The framework includes compass of shame regulation strategies attack self, withdrawal, attack other, avoidance (Nathanson, 1994), as well as soothe self and restore relationships scripts. Clinical implications include shifting therapeutic focus from shame itself towards behaviours indicative of maladaptive shame regulation scripts, the understanding of which is central to the pursuit of minimising negative outcomes associated with maladaptive shame regulation.