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Shame: The Other Emotion in Depression and Anxiety

Psychologists have identified anywhere between 6 and 10 basic emotions experienced by humans. The American psychologist Paul Ekman who developed an “atlas of emotions” mapping more than 10,000 facial expressions, identified six universal or “primary” emotions: anger, disgust, fear, happiness, sadness, and surprise. It will come as a surprise to no one that the primary emotion in depression is sadness and in anxiety fear. However, many people with one of those disorders experience an excess of both emotions. It is estimated that at least 85% of people with major depression also experience serious anxiety symptoms, while symptoms of depressed mood occur in 75% or more of people with an anxiety disorder. In all those case, feelings of sadness and fear combine to form a stew of toxic emotions.
A third emotion, shame, is often present in both disorders. Most psychologists consider shame a “secondary” emotion, one that forms in reaction to another emotion. Some classify it as a secondary emotion of sadness, while others consider it a tertiary emotion that combines fear and disgust. In my own life, and probably everybody else’s, shame seems to involve all three of those emotions.
Shame is one of the most negative and debilitating feelings we experience because it combines other negative emotions. We frequently feel ashamed of our negative emotions, such as anger, fear, sadness and hate, in a process that serves to reinforce those feelings. 
Shame is one of the most negative and debilitating feelings we experience because it combines other negative emotions.
Shame is sometimes confused with guilt. But there’s an important difference. Guilt arises from a negative evaluation of one’s behavior, while shame arises from a negative evaluation of one’s self. Guilt is the feeling of doing wrong, while shame is the feeling of being wrong. As such, guilt can be a powerful motivator to change one’s behavior for the better. Shame can have the opposite effect, making a person feel that change is hopeless because the problem is one’s self. This is what makes shame such a toxic emotion.
Anyone who has struggled with depression or anxiety, has probably struggled with shame as well. Shame is what makes a depressed person feel too worthless to get out of bed in the morning, or causes an anxious person to avoid social gatherings for fear of drawing undue attention to one’s perceived flaws. This is not to deny the role of environment and our own internal wiring in these disorders. Feelings are tied to both those things. Recognizing the role that shame plays in depression, anxiety, and other disorders can be an important step to restoring hope that recovery is possible.
Shame is not always a harmful emotion in its milder forms of shyness and humility. But toxic shame destroys self-esteem and fuels the negative emotions in depression and anxiety. You can recognize toxic shame in these common messages people tell themselves:
I’m so stupid. I can’t do anything right!
I’m always saying the wrong thing. What is wrong with me?
I’m so fat. I look horrible. I can’t go to that party.
I’m such a mess. I hate myself.
Most people engage in this kind negative self-talk from time to time. People with depression and anxiety tend to do it a lot more often and with frequently debilitating effects.
Victims of trauma and abuse are especially susceptible to toxic shame. But it does not take an abusive childhood or severe misfortune to experience dysfunctional levels of this emotion. More often, it results from shaming messages we receive from parents, teachers, other authorities, and peers that we internalize and tell ourselves over-and-over.
One exercise I have successfully used to cope with toxic shame is positive re-framing (also known as cognitive restructuring). An example is how I dealt with a poor body image related to my posture and gait, something I felt ashamed of for many years. Some of that shame goes back to middle school gym class where the teacher once ridiculed me in front of the class, calling me “Twinkle Toes Boll” for the way I ran on the balls of my feet. It mattered to no one that I had been born with the congenital disability known as clubfoot. For every other kid in Mr. B’s sixth grade class that day it was just another callous insult, like those he hurled at all his students. But for me it was deeply humiliating.
Thirty-some years later when I was treated for a previously undiagnosed necrosis of my anklebones, I discovered that the running problem was not something wrong with me. It was something in my foot. Once during the course of my months-long treatment at Yale Orthopedics, a new intern who examined me looked up from the x-rays and asked in astonishment how I was able to walk. When I saw how much that puzzled him, I realized that I was not weak or flawed for not being able to run around a basketball court as gracefully as the top athletes in my class. I was strong, mentally and physically, just to have been in the game. At that moment, I gained a kind of compassion for myself that turned my shame into pride.
Of course, it also helped to see the dozens of comments on my middle school Facebook page which ranked Mr. B. as the worst teacher in the history of the school. Both discoveries are instances of cognitive restructuring. In the first, I reframed my experience of shame into pride by having the compassion for myself that the “shamer” never showed me. In the second, I devalued the shamer by seeing him through other people’s eyes as the bully he really was. The sad truth is that many bullies are also driven by toxic shame, which they disavow by projecting onto others.
If you are lucky, you have some moments in your life when you figure these things out as if from a gift that arrives by chance. Most of the time you have to work at it. Cognitive restructuring is a great tool for ridding yourself of toxic shame. You can read about it in a blog post or book. But it tends to work best when you have a skilled and caring person helping you do the positive reframing. 
Sometimes a loving friend or family member can fulfill that role. Therapy can also help. Most likely, you will need to find a therapist trained in a cognitive approach, such as cognitive behavior therapy (CBT) or dialectical behavior therapy (DBT), to do it well.
Toxic shame can be an intensely destructive, debilitating emotion, especially if you experience depression, anxiety, or other disorders. Fortunately, there is hope in the way of cognition-based therapies used in combination with other best practices, such as medication, mindfulness, and self-care techniques.
Jay Boll

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Dawn T Barry Hulme, Director, Marriage and Family Therapist MFCC 50153, Masters in Psychology with emphasis in Marriage and Family Therapy

As the founder and lead counselor of Windows of Hope Counseling Center, it was my hope to create a non-profit agency offering effective and affordable counseling to the community. It is my belief that everyone deserves to be nurtured and supported during their healing process. Many times while on our life journey we can become confused and experience difficulty finding our way. My hope is to help clients become anchored so that when life difficulties become part of their journey they stay flexible while keeping their direction intact. I specialize with couples and individuals using "Imago" therapeutic techniques along with mindfulness based practices.

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