Do Trauma Survivors Experience Shame after Fear? An Experimental Examination of a Basic Assumption in the Trauma Literature

The dominant theory of PTSD and, subsequently, current gold standard PTSD treatments are based on a model of dysregulated fear. However, a growing body of research suggests that other emotional responses, like shame, are important contributors to PTSD symptom maintenance. The current study sought to forward the trauma literature by using an experimental paradigm to test if trauma survivors, especially those distressed by an interpersonal (vs. non-interpersonal) trauma, experience shame in response to day-to-day experiences of fear. This experimental study used a pre-post between group design in which participants (N = 178) were randomized to receive either a fear or neutral emotion prime with postmanipulation state shame serving as the outcome measure. As predicted, the fear emotion prime interacted with PTSD symptom level to significantly predict postmanipulation state shame. Among participants who reported an interpersonal index trauma and received the fear emotion prime, those with high PTSD symptom levels reported significantly more postmanipulation shame than those with low symptom levels. Interestingly, among participants who reported a non-interpersonal index and received the fear emotion prime, those with high PTSD symptom levels reported significantly less postmanipulation shame than those with low symptom levels. Exploratory analyses did not implicate emotion regulation skill deficits in this relationship. This study contributes to the literature by demonstrating the relationship of shame to daily experiences of fear in the maintenance of PTSD symptoms, but further exploration into the dynamics of fear, shame, and PTSD represents a priority for the field of traumatology. This is, in part, because shame may impede the treatment and emotional processing of traumas in current gold standard exposure-based treatments