Assessing the Impact of Shame and Guilt in Recovery

Institution: Stanford University
Investigator(s): Janine Giese-Davis, Ph.D. -
Award Cycle: 2003 (Cycle IX) Grant #: 9IB-0191 Award: $152,094
Award Type: IDEA
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (2003)
Women with breast cancer may experience guilt and shame in ways that affect their recovery. Shame is a kind of negative evaluation of oneself as a whole person. Guilt, however, is defined as a feeling that one has acted in a way that is different from a social or moral expectation. Shame and unresolved guilt are associated with greater distress and could also impact physiology in ways that might weaken a body’s ability to respond well to stress. Women recovering from breast cancer treatment may experience shame due to the loss of their breasts, disruption of social contacts, changes in the way they view themselves, or in response to changes in their sexuality. Women may also feel guilt because they have not been able to spend as much time with their children or families, mistakenly believe that they have caused their cancer, think that their children may be at greater risk for cancer, or fear dying prematurely, thereby abandoning children and family members.

Our study has two goals. 1. To use recently developed methods to measure shame and guilt, as well as embarrassment and pride in women with breast cancer. We will be the first researchers to bring these methods to breast cancer research. One approach involves questionnaires, and another involves viewing videotapes of women and coding head and body movements that indicate that they are likely feeling shame. 2. To examine whether these feelings are common during recovery, and in what context these feelings are important. Because no one has examined these questions, we are proposing a pilot study in which women will tell us about their experiences with these emotions and give us feedback on our study methods.

For the first goal, we will learn how to recognize head and body movements from local experts knowledgeable in this field. We will use these techniques to code videotape in our own lab in order to insure that we can do this accurately. We will also look at whether this method of coding is similar to other methods we have used in previous research. For the second goal, we will recruit 10-12 women with non-metastatic breast cancer (within one year of diagnosis) who will complete surveys and participate in interviews. Their responses will provide us with information about the context and importance of shame, guilt, pride, and embarrassment in recovery from breast cancer. These women will also advise us in a final focus group by discussing the role of these emotions in recovery. Their feedback will also assist us in generating future ideas and research questions. Our long-term goals are to use a similar method but with a large group of women with breast cancer to understand the extent to which shame, guilt, embarrassment and pride matter to recovery and physical health.

We are concerned that women may suffer unnecessarily from increases in shame and guilt following breast cancer treatment, and that these feelings may impair their view of themselves, their relationships with family and friends, and their interactions with health care professionals. We want to study whether this is true. We also want to develop methods for helping women to understand these feelings in themselves and to help doctors and therapists notice when women are feeling shame and guilt so that they can more effectively help them to talk about these feelings. We believe the time has come to use these new methods for the study of shame, guilt, embarrassment, and pride to benefit women with breast cancer.


Final Report (2005)
Women with breast cancer may experience guilt and shame in ways that affect their recovery. Shame is a kind of negative evaluation of oneself as a whole person. Guilt, however, is defined as a feeling that one leas acted in a way that is different from a social or moral expectation. Shame and unresolved guilt are associated with greater distress and could also impact physiology in ways that might weaken a body's ability to respond well to stress. Women recovering from breast cancer treatment may experience shame due to the loss of their breasts, disruption of social contacts, changes in the way they view themselves, or in response to changes in their sexuality. Women may also feel guilt because they have not been able to spend as much tune wily their children or fauuilics. mistakenly believe that they have caused their cancer, think that their children may be at greater risk for cancer, or fear dying prematurely, thereby abandoning children and family members.

Our study has two goals. 1. To use recently developed methods to measure shame and guilt. as well as embarrassment and pride in women with breast cancer. We will be the first researchers to bring these methods to breast cancer research. One approach involves questionnaires, and another involves viewing videotapes of women and coding head and body movements that indicate that they are likely feeling shame. 2. To examine whether these feelings are common during recovery, and in what context these feelings are important. Because no one has examined these questions, we are proposing a pilot study in which women will tell us about their experiences with these emotions and give us feedback on our study methods.

We have interviewed 10 women with primary breast cancer and have examined how nntch shame, guilt, and pride they feel while telling their cancer story, talking about the impact of the breast cancer on their family and oil their sexuality. We have found, that while telling their cancer story women reported predominantly feelings of pride. During an interview focusing on the impact of breast cancer on their fanuly, women reported somewhat greater feelings of shame than guilt, and while talking about the impact of breast cancer oil their sexuality guilt was slightly higher than shame. Pride was lowest when talking about sexuality.

We have conducted additional emotion eliciting intcrvlews to confirm the accuracy of our measures. The same women participated in four separate interviews focusing on each emotion: guilt. pride, shame. and embarrassunenl. Our data demonstrate that we were successful at eliciting the emotions we were trying to in these interviews. We found that women were more open to disclosing events that generated pride, but a majority did disclose events that had generated share, guilt and embarrassment. Women are proud to have been able to complete a strenuous physical activity while recovering, for giving to friends and family during recovery, for joining support groups and giving to other cancer patients, for gaining personal strength during recovery, for being able to navigate the medical system and choose treatments that they preferred, and to continue to work and engage in productive activities. Although there is some overlap in the kinds of events that generated shame and pride, shame was reported primarily for negative bodily appearance, interactions with physicians, and inability to function competently. Guilt was reported for inability to fulfill role expectations with family and others, for doing better than others with breast cancer with whom they interact, for imposing on others when they were ill, and for doing things that they fell might have caused their cancer or may worsen their prognosis. Embarrassment was reported for being seen without clothing in public following surgery, for changes in appearance, for forgetting things or not acting as they did in the past.

Our long-term goals are to understand the role of these emotions in recovery from breast cancer and to train therapists how to best intervene with women feeling shame or guilt.


Symposium Abstract (2005)
Women with breast cancer may experience guilt and shame in ways that affect their recovery. Shame is a kind of negative evaluation of oneself as a whole person. Guilt, however, is defined as a feeling that one has acted in a way that is different from a social or moral expectation. Shame and unresolved guilt are associated with greater distress and could also impact physiology in ways that might weaken a body’s ability to respond well to stress. Women recovering from breast cancer treatment may experience shame due to the loss of their breasts, disruption of social contacts, changes in the way they view themselves, or in response to changes in their sexuality. Women may also feel guilt because they have not been able to spend as much time with their children or families, mistakenly believe that they have caused their cancer, think that their children may be at greater risk for cancer, or fear dying prematurely, thereby abandoning children and family members.

Our study has two goals. 1. To use recently developed methods to measure shame and guilt, as well as embarrassment and pride in women with breast cancer. We will be the first researchers to bring these methods to breast cancer research. One approach involves questionnaires, and another involves viewing videotapes of women and coding head and body movements that indicate that they are likely feeling shame. 2. To examine whether these feelings are common during recovery, and in what context these feelings are important. Because no one has examined these questions, we are proposing a pilot study in which women will tell us about their experiences with these emotions and give us feedback on our study methods.

We have interviewed 10 women with primary breast cancer and have examined how much shame, guilt, and pride they feel while telling their cancer story, talking about the impact of the breast cancer on their family and on their sexuality. We have found, that while telling their cancer story women reported predominantly feelings of pride. During an interview focusing on the impact of breast cancer on their family, women reported predominantly feelings of shame, and while talking about the impact of breast cancer on their sexuality guilt was the predominant emotion elicited.

Since we are the first researchers to examine pride, guilt, shame, and embarrassment in this way in women with breast cancer, we have conducted additional emotion eliciting interviews to confirm the accuracy of our measures of emotions listed above. The same women participated in 4 separate interviews focusing on each emotion: guilt, pride, shame, and embarrassment. Our data demonstrate that we were successful at eliciting the emotions we were trying to elicit in these interviews.


Symposium Abstract (2005)
The aim of this study was to conduct a first examination of both self-report and coded expression of pride in the context of breast cancer and depression. Pride is a self-conscious positive emotion, and the hypothesized facial cues of pride include a head tilt up, raised eyebrows, and a smile. This study assessed the consistency of facial cues for pride by examining videotapes of situations designed to induce a feeling of pride. More specifically, this study aimed to clarify the facial features of pride and compare the levels of pride expression in depressed and non-depressed women with breast cancer. The study was a pilot study, recruiting 11 female subjects diagnosed with primary breast cancer, with a mean of 33.4 months (SD=8.25) post-diagnosis, ranging in age from 42 to 74 years.

This study had several important findings: (1) The study confirmed that the direct method of asking subjects to recall or describe an emotional experience is an effective elicitor of pride cues. (2) This study showed that the completion of an easy puzzle that the subjects perceive as difficult is also an effective elicitor of pride cues. (3) This experiment reinforced the findings of previous studies that the facial cues for pride are smiling, raised eyebrows, and a head tilt up. (4) As predicted, the positive feelings of pride were not felt as much by those subjects who had higher levels of depressive symptoms, strengthening the association between depression and inability to experience positive emotion. (5) Subjects with higher levels of depressive symptoms expressed more of the hypothesized not-pride facial expressions, and fewer of the hypothesized pride facial expressions, than did subjects with lower levels of depressive symptoms, strengthening the association between depression and a lack of pride feelings.

This was the first study to attempt to elicit the emotion of pride and capture its spontaneous expressions on videotape. This experiment tried many different ways of eliciting pride, and some of these elicitors could be used for future experiments pertaining to pride. Self-conscious emotions (shame, guilt, pride, and embarrassment) have rarely been studied in women with breast cancer, and further systematic study of self-conscious emotional experiences and expressions could add new insight into the recovery process of women suffering from this often disfiguring disease.