Shame change in psychotherapy: A scoping review and meta-analysis

Introduction: Shame appears in several psychopathological conditions, including but not limited to post- traumatic stress disorders, eating disorders, depression, and personality disorders. Given its relevance, this trans-diagnostic and trans-theoretical contribution investigates whether individual psychotherapy can promote shame-reduction. Methods: PRISMA-ScR guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews) are applied to conduct a scoping review of empirical findings. A combination of the terms shame and psychotherapy is searched in PubMed and PsycInfo, identifying 2,520 unique records. Among them, we select (1) original quantitative studies; (2) published as journal articles; and (3) focused on the impact of individual psychotherapy on patients’ shame. All treatment approaches are eligible for the review, provided that they include individual psychotherapy, alone or in combination with other treatment modules. A random-effect meta-analysis is also performed on a subset of studies to quantify shame change, using within-group effect sizes for each study or study branch (i.e., separate within-group effect sizes are computed in studies comparing two or more treatments, one for each treatment group). Results: Twenty-two quantitative studies are in line with our criteria. Treatment types are heterogenous, with a prevalence of cognitive-behavioral approaches. Nineteen studies (86.36%) report significant shame reductions from pre- to post-treatment. The meta- analysis indicates a significant and moderate reduction (i.e., medium effect-size) in shame across treatments (Standardized Mean Change = .61). Multi-module treatments are associated with slightly higher effect-sizes compared to purely individual ones, while trial duration and assessment of shame do not affect Standardized Mean Change. Discussion: Psychotherapy is effective at producing shame-change. Individual modules and additional interventions may have additive effects in reducing negative emotionality, and shame in particular.