. 2020 Feb 15:263:405-412.

doi: 10.1016/j.jad.2019.11.164. Epub 2019 Dec 2.

Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults

Nicole J LeBlanc¹, Emma R Toner², Emily B O'Day³, Cynthia W Moore⁴, Luana Marques⁵, Donald J Robinaugh⁶, Richard J McNally⁷

Affiliations

¹ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA; Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA. Electronic address: njleblanc@mgh.harvard.edu.
² Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
³ Department of Psychology, Temple University, 1701 North 13th Street, Office 417, Philadelphia, PA 19122, USA.
⁴ Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit Street, YAW 6900, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
⁵ Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
⁶ Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
⁷ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.

PMID: 31969271
PMCID: PMC7307182
DOI: 10.1016/j.jad.2019.11.164

Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults

Nicole J LeBlanc et al. J Affect Disord. 2020.

. 2020 Feb 15:263:405-412.

doi: 10.1016/j.jad.2019.11.164. Epub 2019 Dec 2.

Authors

Nicole J LeBlanc¹, Emma R Toner², Emily B O'Day³, Cynthia W Moore⁴, Luana Marques⁵, Donald J Robinaugh⁶, Richard J McNally⁷

Affiliations

¹ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA; Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA. Electronic address: njleblanc@mgh.harvard.edu.
² Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
³ Department of Psychology, Temple University, 1701 North 13th Street, Office 417, Philadelphia, PA 19122, USA.
⁴ Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit Street, YAW 6900, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
⁵ Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
⁶ Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA.
⁷ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.

PMID: 31969271
PMCID: PMC7307182
DOI: 10.1016/j.jad.2019.11.164

Abstract

Background: Self-blame following bereavement has been implicated in the development of post-loss psychopathology. However, prior studies have not distinguished between the emotions of shame versus guilt. This study examined the cross-sectional associations among bereavement-related shame, bereavement-related guilt, and two mental disorders that commonly arise after bereavement: complicated grief and depression. In addition, exploratory analyses examined the associations between bereavement-related pride and post-loss psychopathology.

Methods: Participants included 92 bereaved adults who experienced the death of a family member at least one year prior to the study. Participants completed self-report measures of complicated grief symptoms, depression symptoms, shame, guilt, and pride.

Results: Shame and guilt were positively correlated with complicated grief and depression symptoms. When controlling for their shared variance, only shame remained a significant predictor of post-loss psychopathology. Follow-up analyses indicated that the effect of guilt on psychopathology depended on the level of shame, and vice versa. At low shame, guilt predicted psychopathology; however guilt did not predict psychopathology at moderate to high shame. At low to moderate guilt, shame predicted psychopathology; however shame did not predict psychopathology at high guilt. Pride negatively predicted depression symptoms, but not complicated grief symptoms, when we controlled for shame and guilt.

Limitations: Limitations include the cross-sectional design and modest sample size.

Conclusions: Our analyses identify shame as the more pathogenic moral emotion for bereaved adults. However, whereas guilt in the absence of shame is often considered adaptive, we found that guilt predicted greater psychological distress at low levels of shame in this sample.

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Conflict of interest statement

Declaration of Competing Interest None

Figures

**Figure 1.**
Conditional effect of guilt on CG symptoms at different levels of shame. *Note.* Solid line represents the point estimate for the conditional effect of guilt on CG symptoms at different levels of shame. Dashed lines represent the upper and lower limit of the 95% confidence interval around this point estimate. Levels of shame for which the 95% confidence interval does not include zero (i.e. levels of shame from 5–8.99) indicate levels of shame for which the effect of guilt on CG symptoms is significant. The State Shame and Guilt Scale shame subscale ranges from 5–25.

**Figure 2.**
Conditional effect of shame on CG symptoms at different levels of guilt. *Note.* Solid line represents the point estimate for the conditional effect of shame on CG symptoms at different levels of guilt. Dashed lines represent the upper and lower limit of the 95% confidence interval around this point estimate. Levels of guilt for which the 95% confidence interval does not include zero (i.e. levels of guilt from 5–13.04) indicate levels of guilt for which the effect of shame on CG symptoms is significant. The State Shame and Guilt Scale guilt subscale ranges from 5–25.

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References

1. APA, 1994. Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV). American Psychiatric Association, Washington, D.C.
1. APA, 2013. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, Washington, D.C.
1. Au TM, Sauer-Zavala S, King MW, Pretrocchi N, Barlow DH, Litz B, 2017. Compassion-based therapy for trauma-related shame and posttraumatic stress: Initial evaluation using a multiple baseline design. Behavior Therapy 48, 207–221. doi: 10.1016/j.beth.2016.11.012 - DOI - PubMed
1. Barr P, 2004. Guilt- and shame-proneness and the grief of perinatal bereavement. Psychology and Psychotherapy: Theory, Research, and Practice 77, 493–510. doi: 10.1348/1476083042555442 - DOI - PubMed
1. Barr P, 2012. Negative self-conscious emotion and grief: An actor-partner analysis in couples bereaved by stillbirth or neonatal death. Psychology and Psychotherapy: Theory, Research, and Practice 85, 310–326. doi: 10.1111/j.2044-8341.2011.02034.x - DOI - PubMed

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Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults

Affiliations

Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials