Internal and External Shame in Healthy and Chronically Ill Samples: Exploring Links to Psychological Health
Abstract
This study aimed to examine the role of decentering and committed action as mediators of the link of external and internal shame with psychological health, in people with a chronic disease diagnosis (n = 223) and without chronic disease (n = 230). Participants with chronic disease presented higher levels of both external and internal shame. Path analysis results showed that these variables seem to be negatively linked to psychological health and that their effects on this outcome seem to be reduced by the mechanisms of decentering and committed action. The tested model explained 56% of psychological health's variance and was invariant across groups. This study emphasizes the importance of taking a decentered stance towards internal experiences and behaving accordingly to one's personal values on psychosocial functioning, independently of disease status. These results may have particular relevance to individuals with high levels of shame.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is a positive correlation between chronic illness and internal shame.
“Previous studies have identified a positive correlation between chronic illness and internal shame (Matos-Pina, Trindade, and Ferreira 2022)”
From Illness Stigma and Shame in People With Chronic Illnesses vs. SARS‐CoV‐2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self‐Compassion. (2024) · cites this paper as Matos-Pina, Trindade, and Ferreira 2022
Previous research has shown a positive direct effect of shame on symptoms of depression.
“This was unexpected, in light of previous research showing a positive direct effect of shame on symptoms of depression (Matos-Pina, Trindade, and Ferreira 2022;Trindade, Ferreira, and Pinto 2017).”
From Illness Stigma and Shame in People With Chronic Illnesses vs. SARS‐CoV‐2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self‐Compassion. (2024) · cites this paper as Matos-Pina, Trindade, and Ferreira 2022
Cites
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 1× · see citing works
“…of the psychological flexibility model of Acceptance and Commitment Therapy (ACT; Hayes et al., 1999), defined as a present-oriented process related to a lifelong on-going pattern of effective actions that are based on personal goals and life chosen values (Hayes et al., 2006; McCracken, 2013).”
BackgroundShame, guilt, and depressive symptoms: A meta-analytic review.
Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011) · Psychological Bulletin · doi:10.1037/a0021466 · Cited by 866 · see citing works
Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007) · Behavior Therapy · doi:10.1016/j.beth.2006.08.003 · Cited by 810 · cited 5× · see citing works
“The EQ presented good internal reliability, both in the original version ( α = 0.83; Fresco et al., 2007) and in the Portuguese validation study ( α = 0.81; Gregório et al., 2015).”
BackgroundInfluentialAlonso, J., Ferrer, M., Gandek, B., Ware, J. E., Aaronson, N. K., Mosconi, P., Rasmussen, N. K., Bullinger, M., Fukuhara, S., Kaasa, S., et al. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000018472.46236.05 · Cited by 786 · see citing works
Trompetter, H. R., ten Klooster, P. M., Schreurs, K. M. G., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013) · Psychological Assessment · doi:10.1037/a0033813 · Cited by 184 · cited 1× · see citing works
“Recent developments have shown that committed action is linked with a higher subjective perception of psychological health and well-being (Trindade et al., 2015a, 2015b; Trompetter et al., 2013), and decreased psychological responses to stress (Cresswell et al., 2005).”
BackgroundMcCracken, L. M. (2013) · The Journal of Pain · doi:10.1016/j.jpain.2013.02.009 · Cited by 172 · see citing works
Castilho, P., Pinto‐Gouveia, J., & Duarte, J. (2015) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1881 · Cited by 143 · see citing works
Self-management intervention for chronic pain in older adults: A randomised controlled trial
Nicholas, M. K., Asghari, A., Blyth, F. M., Wood, B. M., Murray, R., McCabe, R., Brnabic, A., Beeston, L., Corbett, M., Sherrington, C., et al. (2013) · Pain · doi:10.1016/j.pain.2013.02.009 · Cited by 137 · see citing works
McCracken, L. M., Chilcot, J., & Norton, S. (2015) · European Journal of Pain · doi:10.1002/ejp.589 · Cited by 127 · see citing works
A systematic review of quality of life in adults with muscle disease
Graham, C. D., Rose, M. R., Grunfeld, E. A., Kyle, S. D., & Weinman, J. (2011) · Journal of Neurology · doi:10.1007/s00415-011-6062-5 · Cited by 104 · see citing works
Clarity of Personal Values and Committed Action: Development of a Shorter Engaged Living Scale
Trindade, I. A., Ferreira, C., Pinto-Gouveia, J., & Nooren, L. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-015-9509-7 · Cited by 53 · see citing works
Self-citationCoutinho, M., Trindade, I. A., & Ferreira, C. (2021) · Journal of Health Psychology · doi:10.1177/1359105319860167 · Cited by 25 · see citing works
Trindade, I. A., Marta‐Simões, J., Ferreira, C., & Pinto‐Gouveia, J. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2125 · Cited by 24 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Berglund, S., Danielsson, A., Jakobsson Støre, S., Carreiras, D., Carvalho, S. A., Blomqvist‐Storm, M., Pinto, H., Palmeira, L., Pereira, M., & Trindade, I. A. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70009 · Cited by 6 · see citing works
Self-citation
- Authors
- Matos-Pina, I., Trindade, I. A., & Ferreira, C.
- Affiliations
- University of Gothenburg (SE)
- University of Coimbra (PT)
- Venue
- Journal of Clinical Psychology in Medical Settings
- Published
- 2022-01-27
- Volume
- 29
- Issue
- 2
- Pages
- 412-420
- ISSN
- 1068-9583 (ISSN-L)
- 1573-3572
- OpenAlex
- W4210440238
- Cited by
- 8
- References
- 13
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 2
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Psychology in Medical Settings (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Social Psychology › Emotions and Moral Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internalized shame, external shame, decentering, committed action, chronic disease, mental health, psychosocial functioning, mediation, personal values
- MeSH terms
- Chronic Disease, Health Status, Humans, Mental Health, Shame
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
