Shame and Mental Health

Shame is one of the most powerful yet least understood human emotions. It is that deep, sinking feeling that whispers, “I am not good enough.” Unlike fleeting embarrassment or guilt, shame reaches into our sense of identity, often shaping how we see ourselves and how we relate to others. While rarely discussed openly, shame plays a silent but pervasive role in many mental health difficulties — from depression and anxiety to perfectionism and trauma-related disorders. Understanding shame, and learning how to work with it, can be a vital step toward genuine healing and self-acceptance.

Shame often sits beneath the surface of many psychological struggles, quietly driving distress without being recognised. People living with depression may feel worthless or undeserving of care; those with anxiety might constantly worry about being judged or exposed; perfectionists often push themselves relentlessly to avoid feelings of inadequacy. Even trauma responses such as withdrawal or emotional numbing can be rooted in deep shame.
From a psychiatric perspective, shame can act as both a symptom and a maintaining factor in mental illness. It reinforces negative self-beliefs, reduces help-seeking, and fuels cycles of self-criticism and avoidance. Yet, because shame is such a painful emotion, many people suppress or deny it — making it hard to identify in therapy.

By bringing shame into awareness and exploring it safely, individuals can begin to unhook from its grip, paving the way for recovery that is not just about symptom relief, but about rebuilding self-worth.

Although shame and guilt are often used interchangeably, they are profoundly different emotional experiences. Guilt arises when we recognise that we have done something wrong — an action we regret or wish to repair. Shame, by contrast, is about who we believe we are. Where guilt says, “I did something bad,” shame says, “I am bad.”

In therapy, this distinction matters. Guilt can motivate positive change and repair; shame tends to lead to withdrawal and isolation. Someone who feels guilty about shouting at a loved one might apologise and try to improve communication. Someone who feels ashamed may conclude they are unlovable or incapable, reinforcing self-blame.
“Unlike guilt emotions, feelings of shame extend beyond the ‘bad behavior’ reflecting, more generally, a defective objectionable self” (Lewis, 1971)
Psychological research shows that excessive shame is linked with depression, social anxiety, and post-traumatic stress. Therapists therefore work carefully to help clients shift from shame to guilt — from global self-condemnation to specific accountability and compassion. Recognising that behaviour can be changed while self-worth remains intact is a key step in emotional recovery.

Shame is not only a mental or emotional experience — it is profoundly physical. Many people describe a visceral reaction: the urge to shrink, hide, or disappear. In her book Understanding and Treating Chronic Shame, by Pat DeYoung, she writes:

‘The classic shame response is hyperarousal and a desperate struggle to contain it: blushing, sweating, trying to shrink, slumping the shoulders, dropping the head, averting the eyes, covering the face. This state of shame is excruciating’.

Physiologically, shame activates the body’s threat response, increasing cortisol and triggering patterns of tension and collapse. Chronic shame can leave the nervous system in a prolonged state of defence, contributing to muscle tightness, fatigue, and even digestive or immune issues.

Psychosomatic research has increasingly highlighted how emotional suppression — especially of self-conscious emotions like shame — can manifest as physical symptoms. Health anxiety, chronic pain, or fatigue can sometimes be expressions of emotional distress that has nowhere else to go.

Integrating body awareness into therapy — through mindfulness, breathwork, or trauma-informed movement — helps people reconnect safely with their physical selves. Learning to notice and soothe the bodily sensations of shame can transform it from an overwhelming state into something that can be observed, understood, and eventually released.

While shame is a universal emotion, its triggers and expressions are deeply influenced by culture. In some societies, shame is tied to social harmony — keeping one’s behaviour in line with collective expectations. In others, it is tied to individual achievement, beauty, or success. Family upbringing, gender roles, and religious teachings can all shape how shame is learned and expressed.

In the digital age, shame has found new forms. Social media platforms often amplify comparison, criticism, and public exposure, leaving many people vulnerable to what psychologists call “social evaluative threat” — the fear of being negatively judged by others. Even seemingly benign scrolling can reinforce unrealistic standards of how one should look, act, or feel.

Want to learn more about how the constant stream of images and content on social media can shape our perception of ourselves? Read more here.

For clinicians, recognising the cultural and social context of shame is essential. What feels “shameful” in one setting may be neutral or even valued in another. Sensitive psychoeducation can help individuals understand how external pressures have shaped their inner world — and begin to rewrite those messages with compassion and choice.

Shame thrives on silence and self-criticism. The first step to breaking its cycle is recognising it for what it is: a learned emotional response, not a truth about who we are. Cognitive Behavioural Therapy (CBT) for example, can help individuals identify the self-critical thoughts that maintain shame (“I’m useless,” “I always fail”) and replace them with balanced alternatives.
Acceptance and Commitment Therapy (ACT) offers another path — not fighting shame, but making space for it. By noticing shame without judgment, people learn that emotions, even painful ones, can rise and fall naturally. Meanwhile, Compassion-Focused Therapy (CFT) directly targets the harsh inner critic, building a gentler internal voice grounded in empathy rather than punishment.
In practice, recovery often involves learning small acts of self-kindness — acknowledging pain, allowing rest, or reaching out for support. Over time, these moments of compassion and forgiveness help rewire the brain’s threat systems, promoting emotional safety and resilience.

Shame convinces us we must hide — yet connection is its antidote. Sharing our experiences with safe, understanding others breaks the secrecy that keeps shame alive. Group therapy and peer support can be especially powerful: hearing “me too” dissolves isolation and restores a sense of belonging.

Therapeutic relationships also play a central role. A compassionate therapist models acceptance and curiosity, helping clients feel seen without judgement. Over time, this relational safety becomes internalised — allowing individuals to approach their own emotions with the same warmth they once feared they didn’t deserve.

At Positive Mind Works, we have therapists who specialise in trauma and emotion regulation, and can work with clients to understand and transform patterns of shame. Through evidence-based approaches and compassionate care, therapy becomes not just a space for symptom relief, but a process of reclaiming dignity and self-worth.

Shame may be a universal human emotion, but it does not have to define us. When we learn to recognise its presence, understand its roots, and approach it with curiosity rather than fear, it begins to lose its power. If you think you could benefit from shame psychoeducation, body awareness, therapy, or connection with others, get in touch today.