Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2019 Introducing Shame Resilience to Women Who Struggle with Complex Trauma and Substance Abuse Kirsten R. Robertson Follow this and additional works at: https://aura.antioch.edu/etds Part of the Clinical Psychology Commons Recommended Citation Robertson, Kirsten R., "Introducing Shame Resilience to Women Who Struggle with Complex Trauma and Substance Abuse" (2019). Dissertations & Theses. 478. https://aura.antioch.edu/etds/478 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact [email protected], [email protected]. INTRODUCING SHAME RESILIENCE TO WOMEN WHO STRUGGLE WITH COMPLEX TRAUMA AND SUBSTANCE ABUSE A Dissertation Presented to the Faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment of the Requirements of the Degree Doctor of Psychology By Kirsten Robertson March 2019 INTRODUCING SHAME RESILIENCE TO WOMEN WHO STRUGGLE WITH COMPLEX TRAUMA AND SUBSTANCE ABUSE This dissertation, by Kirsten Robertson, has been approved by the committee members signed below who recommend that it be accepted by the faculty of the Antioch University Seattle at Seattle, Washington in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY Dissertation Committee: __________________________ Dana Waters, Psy.D., ABPP Chairperson __________________________ Mark Russell, Ph.D., ABPP __________________________ Kathryn Sherrod, Ph.D. __________________________ Date ii © Copyright by Kirsten Robertson, 2016 All Rights Reserved iii ABSTRACT INTRODUCING SHAME RESILIENCE TO WOMEN WHO STRUGGLE WITH COMPLEX TRAUMA AND SUBSTANCE ABUSE Kirsten Robertson Antioch University Seattle Seattle, WA The relationship between shame and trauma has been documented in research beginning as early as the 19th century. Not until the second half of the 20th century did extensive research clearly define both trauma and shame, with the addition of Posttraumatic Stress Disorder (PTSD) as an official diagnosis in the field of mental health. Many researchers and clinicians believe an additional diagnosis should be added to the list of trauma-related mental health diagnoses—one that includes repeated traumatic experiences during childhood. Despite the known relationship between shame and various traumatic experiences, direct shame interventions have yet to find a place in standard therapeutic trauma-specific protocols. By implementing a group therapy curriculum designed by Dr. Brené Brown, based on her Shame Resilience Theory (SRT), this study was designed to assess possible empirical support related to the need for, and benefits of, addressing shame directly in participants who suffer from internalized shame and who have experienced traumatic childhood trauma, which has led to complex PTSD. iv Pre- and post-group measurements were quantitatively analyzed. The outcomes confirmed the initial hypotheses and resulted in significantly decreased internalized shame, a decline in trauma- related symptomology, with reason to pursue further clinical treatment for trauma-related issues. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu Keywords: complex PTSD, shame resilience, trauma, substance use, women v Dedication This dissertation is dedicated to all those who have experienced complex trauma and struggle as adults to feel worthy of love and belonging. May you find peace, healing, and may you know deep down at your core that you ARE absolutely worthy. vi Acknowledgements This dissertation would not have been possible without a ton of help. I want to first thank The Ranch, a residential recovery center in Tennessee, for introducing me to Dr. Brené Brown’s work and first showing me how much I love to work with individuals who have experienced complex trauma and who struggle with substance abuse. I learned so much and will forever be grateful. I would like to thank every teacher in college who helped me by writing a letter of recommendation and believing that one day I might be a good psychologist. This especially includes my mentor and committee member, Dr. Kathryn Sherrod. My life would not be the same without you. Thank you to my other committee members. My chair, Dr. Dana Waters, I knew by choosing you to guide me through this process, my dissertation would be solid and of quality. You did not let me settle for any less and for that, I am truly grateful. Dr. Mark Russell, you have always been an inspiration to me because of your strength, perseverance, and passion for change. Thank you both for being good role models. I have to thank Dr. Barbara Lui and Dr. Chalon Ervin at Therapeutic Health Services in Seattle, WA. Your faith, assistance, support, and generosity helped make this vision a reality. When reality took a turn, I could not have finished what I started without the help of Dr. Janet Adams-Westcott. Your flexibility and introductions made this possible. Thank you so much. Women in Recovery in Tulsa, OK also gets a gigantic thank you for what the program stands for, the people it helps, and the change I saw. Thanks for showing me that programs like this exist. A special thank you to Mimi Tarrasch, Roxanne Hinther, and my co-facilitator vii Lindsey Crawford. You all welcomed me in with open arms and helped me finish this project. I couldn’t have asked for a better fit. Last but not least, there are several additional people I would like to acknowledge. Most of all, I would like to thank the participants of this research. It has been both an honor and a privilege to witness you and your stories. Thanks for being willing to talk about shame with me. Lindsey Rankin and Kara Kerr, your wisdom in statistics saved me. Finally, thank you to my friends and family who supported me through the process of graduate school. Thanks for believing in me. I could never have done this on my own. viii Table of Contents Dedication ...................................................................................................................................... vi Acknowledgements ....................................................................................................................... vii List of Tables ...............................................................................................................................xiii List of Figures .............................................................................................................................. xiv CHAPTER I: INTRODUCTION .................................................................................................... 1 Differentiating Between Complex PTSD and PTSD ...................................................... 2 Barriers to the Treatment of Trauma .............................................................................. 3 Shame .......................................................................................................................... 3 The Need for Empirically Supported Shame Interventions ........................................ 5 Purpose of This Study ..................................................................................................... 6 Chosen Intervention .................................................................................................... 6 Hypotheses .................................................................................................................. 6 CHAPTER II: REVIEW OF LITERATURE ................................................................................. 9 The History of Trauma Symptomology .......................................................................... 9 Diagnostic Definitions .............................................................................................. 11 An Evolutionary Perspective on PTSD ..................................................................... 15 Developmental Impacts ............................................................................................ 18 The History of Shame ................................................................................................... 26 Emotions ................................................................................................................... 26 Shame ........................................................................................................................ 31 Shame and Trauma ....................................................................................................... 49 Interrelationship ........................................................................................................ 50 ix Effects ....................................................................................................................... 54 Treatment ...................................................................................................................... 63 Individual Work ........................................................................................................ 65 Dual Diagnosis with Substance Use ........................................................................