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Research

Measuring Shame Through a Combination of Self-Report, Language and Body Posture May Be Clinically Helpful

Understanding the connection between shame and healthcare-relevant outcomes necessitates multiple modes of measurement.

In stigmatized illnesses such as human immunodeficiency virus (HIV), shame and other negative self-conscious emotions are associated with suboptimal engagement in healthcare via stress and avoidance coping. However, shame is challenging to assess via self-reporting. Research has shown that people express emotions in different ways, including self-reported emotion, what they say (using shame-related words), and facial and body movements.  While people may be self-conscious about expressing or revealing shame, combining ways to measure shame could be helpful in improving accurate assessment. 

In a new study of individuals recently diagnosed with HIV, researchers found that a combination of measuring shame—self-report, language, and body posture—are necessary to predict stress and avoidance behaviors in healthcare settings. Relying on one method they found is insufficient—while using multiple, complementary measures better predicted stress and specific types of coping. 

“This multi-modal approach (self-report, linguistic, and nonverbal) provides a way to examine the different ways individuals experience and express shame, that are often assumed to be captured by self-report,” explains corresponding author Abigail Batchelder, PhD, MPH, associate professor of psychiatry.

The researchers used previously collected data from two large studies involving people recently diagnosed with HIV, which included videos of participants describing their recent diagnosis. All interviews were transcribed and all participants were immediately asked about their emotions. The researchers evaluated word choice using a library of shame-related words and phrases they developed consistent with the Linguistic Inquiry Word Count method to determine the proportion of particular words in each narrative. Informed by previous work identifying body movements associated with self-conscious emotion, the authors coded the narrative videos for three movements associated with shame: head down, shoulders slumped and chest narrowed. Finally, they used statistics to assess the associations between the three types of measurement of shame and confirmatory factor analysis to assess whether these combined techniques together produced a better measurement of shame. They also evaluated whether each technique was associated with stress and avoidance coping strategies.

“Clinically, our results indicate that even if a patient denies experiencing shame, if they use words indicating they may be experiencing shame or have movement indicating they are experiencing shame, they may benefit from opportunities to talk about their experience or seek support (psychotherapy) to get beneficial support,” adds Batchelder, who also is vice chair and chief of psychology at Boston Medical Center.

These findings appear online in the journal Journal of Health Psychology.