Anxiety, shame, and guilt

When we aren’t able to constructively process difficult experiences, persistent feelings of nervousness, anxiety, shame, or guilt can result. These feelings can manifest as insomnia, irritability, social anxiety, difficulty forming healthy romantic relationships, and other challenges. To manage these feelings, some people resort to alcohol and substance abuse, compulsive gambling or sexual behaviors, or other harmful coping mechanisms.

Anxiety and trauma

People who experienced neglect, abuse, violence, or other forms of trauma can feel anxious for years after the trauma occurred, whether or not they were physically injured. Common symptoms of trauma that are related to anxiety include re-experiencing the traumatic event (or events) in nightmares or flashbacks, avoidance (making an effort to avoid people, things, or places associated with the trauma), panic attacks, sleep disturbances, and difficulty focusing or poor concentration. It may be difficult to connect some symptoms – such as insomnia or social anxiety – with traumatic events that happened years ago. In therapy, we can work towards a better understanding of what in your past powers the anxiety challenges that your experience in the present.

Guilt and trauma

Guilt is characterized by feelings of self-blame and remorse. Trauma-related guilt stems from a feeling or belief that you could have or should have done something different to stop or avert the traumatic event from occurring. Typically, these feelings of self-blame are not grounded in a realistic assessment of the circumstances, but in the unkind things survivors tell themselves in the aftermath of being victimized. For example, it is common for survivors of child sexual abuse to feel guilty for not stopping the adult abuser, or for survivors of rape to feel guilty that they did not take steps to prevent the rape. Sometimes, trauma survivors even feel guilty for having survived.

Shame

Many people who have experienced trauma blame themselves for their traumatic events – even if nothing could have been done to avoid the traumatic experience. Shame can damage your self-image and feelings of self-worth, making you feel deeply flawed. People who experience shame often feel unlovable and unsure of their place in society. Child abuse, sexual violence at any age, and intimate partner abuse are traumatic events that especially leave people vulnerable to developing debilitating feelings of shame.

Moving forward in therapy

In therapy, we will work towards a better understanding and healthier processing of the events that may have led to the challenges that you experience today. Addressing anxiety, guilt, and shame is often an integral part of trauma-informed therapy. In therapy, even people who experience acute feelings of anxiety, guilt, and shame can find support.

References

Bem, J. R., Strelan, P., & Proeve, M. (2021). Roads less travelled to self-forgiveness: Can psychological flexibility overcome chronic guilt/shame to achieve genuine self-forgiveness? Journal of Contextual Behavioral Science, 21, 203-211.

Capone, C., Norman, S. B., Haller, M., Davis, B., Shea, M. T., Browne, K., … & Westendorf, L. (2021). Trauma Informed Guilt Reduction (TrIGR) therapy for guilt, shame, and moral injury resulting from trauma: Rationale, design, and methodology of a two-site randomized controlled trial. Contemporary clinical trials, 101, 106251.

Goldblatt, M. J. (2013). Shame in psychodynamic psychotherapy of post-traumatic states. The Scandinavian Psychoanalytic Review, 36(2), 104–111.

Lee, D. A., Scragg, P., & Turner, S. (2001). The role of shame and guilt in traumatic events: a clinical model of shame-based and guilt-based PTSD. The British journal of medical psychology, 74(Pt 4), 451–466. https://doi.org/10.1348/000711201161109

Shi, C., Ren, Z., Zhao, C., Zhang, T., & Chan, S. H. W. (2021). Shame, guilt, and posttraumatic stress symptoms: A three-level meta-analysis. Journal of Anxiety Disorders, 82, 102443.