Although patients with inflammatory bowel disease seem to be prone to high levels of shame, the mechanisms behind the impact of chronic illness–related shame on patients’ functioning have not been explored yet. This study aims to address these gaps using a sample of 161 patients with inflammatory bowel disease who completed self-report measures on an online survey. The results from path analyses showed that chronic illness–related shame presented direct and indirect effects on psychological health (R2 = .66) and social relationships (R2 = .46). The indirect effects were mediated by experiential avoidance and uncommitted living. Possible explanations to these findings and clinical implications are discussed.
BaumeisterRFLearyMR (1995) The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin117: 497–529.
3.
BondFWHayesSCBaerRA, et al. (2011) Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy42: 676–688.
4.
CanavarroMCSerraAVSimoesMR, et al. (2009) Development and psychometric properties of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-100) in Portugal. International Journal of Behavioral Medicine16(2): 116–124.
5.
CasatiJTonerBBde RooyEC, et al. (2000) Concerns of patients with inflammatory bowel disease: A review of emerging themes. Digestive Diseases and Sciences45: 26–31.
6.
ChawlaNOstafinB (2007) Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology63(9): 871–890. DOI: 10.1002/jclp.20400.
7.
CheungMSPGilbertPIronsC (2004) An exploration of shame, social rank and rumination in relation to depression. Personality and Individual Differences36: 1143–1153.
8.
CohenJCohenPWestS, et al. (2003) Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. (3rd edn). Mahwah, NJ: Lawrence Erlbaum Associates.
9.
CresswellJDWelchWTTaylorSE, et al. (2005) Affirmation of personal values buffers neuroendocrine and psychological stress response. Psychological Science16: 846–851.
10.
Crohn’s and Colitis Foundation of America (CCFA) (2005) Living with IBD [Brochure]. New York: Crohn’s and Colitis Foundation of America.
11.
Crohn’s and Colitis Foundation of America (CCFA) (2010) Surgery for Crohn’s Disease and Ulcerative Colitis [Brochure]. New York: Crohn’s and Colitis Foundation of America.
12.
FerreiraNB (2011) Investigating the role of psychological flexibility and the use of an acceptance and commitment therapy based intervention in irritable bowel syndrome. Doctoral dissertation, University of Edinburgh, Edinburgh.
13.
GilbertP (1997) The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy. British Journal of Medical Psychology70: 113–147.
14.
GilbertP (1998) What is shame? Some core issues and controversies. In: AndrewsBGilbertP (eds) Shame: Interpersonal Behavior, Psychopathology, and Culture. New York: Oxford University Press, pp. 3–31.
15.
GilbertP (2000) The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology & Psychotherapy7(3): 174–189.
16.
GilbertP (2002) Body shame: A biopsychosocial conceptualization and overview with treatment implications. In: GilbertPMilesJ (eds) Body Shame: Conceptualization, Research and Treatment. New York: Routledge, pp. 3–47.
17.
GilbertP (2007) The evolution of shame as a marker for relationship security. In: TracyJLRobinsRWTangneyJP (eds) The Self-Conscious Emotions: Theory and Research. New York: Guilford Press, pp. 283–309.
18.
GilbertPMcGuireMT (1998) Shame, status, and social roles: Psychobiology and evolution. In: GilbertPAndrewsB (eds) Shame: Interpersonal Behavior, Psychopathology, and Culture. New York: Oxford University Press, pp. 99–125.
19.
GraffLAWalkerJRLixL, et al. (2006) The relationship of inflammatory bowel disease type and activity to psychological functioning and quality of life. Clinical Gastroenterology and Hepatology4(12): 1491–1501.
20.
HadlandsmythKWhiteKSNesinAE, et al. (2013) Proposing an acceptance and commitment therapy intervention to promote improved diabetes management in adolescents: A treatment conceptualization. International Journal of Behavioral Consultation and Therapy7(4): 12–15.
21.
HairJFAndersonRETathamRL, et al. (1998) Multivariate Data Analysis. Upper Saddle River, NJ: Prentice-Hall International.
22.
HallNJRubinGPDougallAHunginPSNeelyJ (2005) The fight for “health-related normality”: A qualitative study of the experiences of individuals living with established inflammatory bowel disease (ibd). Journal of Health Psychology, 10(3): 443–455. DOI: 10.1177/1359105305051433.
23.
HayesAFPreacherKJMyersTA (2011) Mediation and the estimation of indirect effects in political communication research. In: ErikPHolbertLR (eds) Sourcebook for Political Communication Research: Methods, Measures, and Analytical Techniques.Abingdon, UK: Taylor & Francis, pp. 457–488.
24.
HayesSCLuomaJBBondF, et al. (2006) Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy44: 1–25.
25.
HayesSCStrosahlKDWilsonKG (2012) Acceptance and commitment therapy: The process and practice of mindful change (2nd edn). New York: The Guilford Press.
26.
HayesSCWilsonKWGiffordEVFolletteVMStrosahlK (1996) Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6): 1152–1168. DOI: 10.1037/0022-006X.64.6.1152.
27.
HooperDCoughlanJMullenMR (2008) Structural equation modelling: Guidelines for determining model fit. The Electronic Journal of Business Research Methods6(1): 53–60.
28.
HuLBentlerPM (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal6(1): 1–55.
29.
IBM Corp Released (2013) IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corporation.
30.
JowettSLSealCJPearceMS, et al. (2004) Influence of dietary factors on the clinical course of ulcerative colitis: A prospective cohort study. Gut53(10): 1479–1484.
31.
KellettSGilbertP (2001) Acne: A biopsychosocial and evolutionary perspective with a focus on shame. British Journal of Health Psychology6: 1–24.
32.
KimSThibodeauRJorgensenR (2011) Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin137(1): 68–96.
33.
KlineP (2000) The Handbook of Psychological Testing (2nd edn). London: Routledge.
34.
KlineR (2005) Principles and Practice of Structural Equation Modeling (2nd edn). New York: The Guilford Press.
35.
KurinaLMGoldacreMJYeatesD, et al. (2001) Depression and anxiety in people with inflammatory bowel disease. Journal of Epidemiology and Community Health55(10): 716–720.
36.
LevineJSBurakoffR (2011) Extraintestinal manifestations of inflammatory bowel disease. Journal of Gastroenterology and Hepatology7: 235–241.
37.
McCrackenLVowlesKE (2008) A prospective analysis of acceptance of pain and values-based action in patients with chronic pain. Health Psychology27(2): 215–220.
38.
McCrackenLMEcclestonC (2006) A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. European Journal of Pain10(1): 23–29.
39.
McDermottEMullenGMoloneyJ, et al. (2015) Body image dissatisfaction: Clinical features, and psychosocial disability in inflammatory bowel disease. Inflammatory Bowel Diseases21(2): 353–360.
40.
MatosMPinto-GouveiaJ (2010) Shame as a traumatic memory. Clinical Psychology and Psychotherapy17(4): 299–312.
41.
MoodyGProbertCSJSrivastavaEM, et al. (1992) Sexual dysfunction amongst women with Crohn’s disease: A hidden problem. Digestion52(3–4): 179–183.
42.
MoodyGAMayberryJF (1993) Perceived sexual dysfunction amongst patients with inflammatory bowel disease. Digestion54(4): 256–260.
43.
MountifieldRBamptonPProsserR, et al. (2009) Fear and fertility in inflammatory bowel disease: A mismatch of perception and reality affects family planning decisions. Inflammatory Bowel Diseases15(5): 720–725.
44.
Pinto-GouveiaJGregórioSDinisA, et al. (2012) Experiential avoidance in clinical and nonclinical samples. International Journal of Psychology and Psychological Therapy12(2): 139–156.
45.
RowlinsonA (1999) Inflammatory bowel disease 3: Importance of partnership in care. British Journal of Nursing8(15): 1013–1028.
46.
RuizFJ (2010) A review of acceptance and commitment therapy (ACT)empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy10(1): 125–162.
47.
SainsburyAHeatleyRV (2005) Review article: Psychosocial factors in the quality of life of patients with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics21(5): 499–508.
48.
SchumackerRELomaxRG (2004) A Beginner’s Guide to Structural Equation Modeling (2nd edn).Mahwah, NJ: Lawrence Erlbaum Associates.
49.
SegalZVWilliamsJMGTeasdaleJD (2002) Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York: Guilford Press.
50.
StrosahlKHayesSCWilsonKG (2004) An acceptance and commitment therapy primer: Core therapy processes, intervention strategies, and therapist competencies. In: HayesSCStrosahlK (eds) A Practical Guide to Acceptance and Commitment Therapy. New York: Springer, pp. 31–58.
51.
TangneyJFischerK (1995) Self-Conscious Emotions: The Psychology of Shame, Guilt, Embarrassment, and Pride. New York: Guilford Press.
52.
TangneyJPDearingRL (2002) Shame and Guilt. New York: Guilford Press.
53.
TangneyJPWagnerPGramzowR (1992) Proneness to shame, proneness to guilt, and psychopathology. Journal of Abnormal Psychology101: 469–478.
54.
The WHOQOL Group (1998) The World Health Organization Quality of Life Assessment (WHOQOL): Development and general psychometric properties. Social Science & Medicine46: 1569–1585.
55.
TrindadeIAFerreiraCPinto-GouveiaJ. (2015a) Chronic illness-related shame: Development of a new scale and novel approach for IBD patients’ depressive symptomatology. Submitted manuscript.
56.
TrindadeIAFerreiraCPinto-GouveiaJ. (2015b) Inflammatory bowel disease: The harmful mechanism of experiential avoidance for patients’ quality of life. Journal of Health Psychology1–11. DOI: 10.1177/1359105315587142.
57.
TrindadeIAFerreiraCPinto-GouveiaJNoorenL (2015) Clarity of personal values and committed action: Development of a shorter Engaged Living Scale. Journal of Psychopathology and Behavior Assesment. DOI: 10.1007/s10862-015-9509-7.
58.
TrompetterHRten KloosterPMSchreursKMGFledderusMWesterhofGJBohlmeijerET (2013) Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical and chronic pain sample. Psychological Assessment25(4): 1235–1246. DOI: 10.1037/a0033813.
59.
TrachterABRogersAILeiblumSR (2002) Inflammatory bowel disease in women: Impact on relationship and sexual health. Inflammatory Bowel Diseases8(6): 413–421.
60.
TrompetterHRten KloosterPMSchreursKMG, et al. (2013) Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical and chronic pain sample. Psychological Assessment25(4): 1235–1246.
61.
WalkerJREdigerJPGraffLA, et al. (2008) The Manitoba IBD cohort study: A population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders. American Journal of Gastroenterology103(8): 1989–1997.
62.
WilsonKGMurrelAR (2004) Values work in acceptance and commitment therapy: Setting a course for behavioral treatment. In: HayesSCFolletteVMLinehanMM (eds) Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition. New York: Guilford Press, pp. 120–151.
