Shame is a feeling that most people experience at some time in their lives, however, for some people, chronic shame can have some important effects both on a psychological and physical level of well-being. Shame has been commonly linked to mental illnesses such as anxiety (Zhong, Wang, Qian et al., 2008) and depression (Cheung, Gilbert & Irons, 2003), as well as having effects on physiological health, such as having significant effects on immunological functioning (Dickerson, Kemeny, Aziz et al., 2004). Because shame can have such a significant impact on a person's well-being, it is critical to find an effective intervention to treat and alleviate feelings of shame. Many different psychological approaches have proposed approaches that can help treat shame, in this particular essay the focus will be specifically on cognitive behavioral therapy (CBT). We will analyze the strengths and weaknesses of this approach, examining two important symptoms of shame – low self-esteem and social anxiety – evaluating how effectively CBT can be used to treat clients experiencing these symptoms and how this may link to the treatment of shame. CBT as a whole will also be evaluated and an alternative form of treatment will be briefly discussed in order to fully evaluate the effectiveness of CBT as a psychological intervention for these clients. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay To evaluate how effective CBT is in helping clients with shame, two of the main symptoms of shame will be examined individually. Van Vliet (2008, p233) stated that "In particular, shame is elicited in response to social rejection and other events that threaten the individual's self-esteem, social status, and sense of belonging", and Gruenewald, Kemeny , Aziz & Fahey ( 2004) were able to find a distinct link between an increase in shame and a decrease in self-esteem. Therefore the first aspect that will be evaluated is the effectiveness with which CBT can be used as a treatment for low self-esteem. In 2003, Hall and Tarrier proposed a form of cognitive behavioral treatment to address low self-esteem (particularly for patients suffering from psychosis). ). They tested this method of CBT on a sample of patients and found that, compared to patients who continued to receive regular treatment without any CBT intervention, there was a clinically significant increase in self-esteem. Hall & Tarrier measured self-esteem levels again three months after treatment and found that in most cases the benefits to self-esteem were maintained. The findings from this study suggest that CBT may be an effective intervention for improving clients' self-esteem, which, given the strong links between low self-esteem and shame, would also suggest that this form of treatment would have a positive impact on clients. feel ashamed. However, this study was very specifically focused on clients with psychosis. Although this treatment was shown to have strong benefits for participants in this study, there is no way to know whether it would have the same benefits if used to treat otherwise healthy individuals. This lack of generalizability makes it difficult to fully evaluate how effective this treatment truly is in improving general self-esteem issues. Furthermore, although the study was followed up three months after treatment, this is not clear evidence of a long-term solution. Ideally, for members of the general population whofeel ashamed, treatment should be effective in the long term. If patients were to continue to undergo treatment every three months, this would not only present an inconvenience, but could also start to have an even more negative impact on their self-esteem and lead to an increasingly strong feeling of shame. Another study conducted in 2007 (Taylor & Montgomery) examined how effective CBT was as a method for improving self-esteem among adolescents suffering from depression. A literature review was carried out, examining the effectiveness of the treatment in two previous studies. Their research found that although CBT led to an increase in participants' self-esteem, the increase was not clinically significant. However, they found that at a five-week follow-up, participants' self-esteem had continued to increase. Although not yet reaching significant levels, this suggests that CBT could lead to a gradual increase in self-esteem and therefore could potentially offer a long-term solution for the client's feelings of shame. Unfortunately, as with the study discussed previously, this review focused on a very specific group of customers, in this case focusing on adolescents between the ages of 13 and 18. This, again, may mean that the findings of this study cannot be generalized to a larger population. Additionally, this study did not examine the long-term effects that CBT had on self-esteem. Although the results showed that self-esteem appeared to increase gradually, the research was followed up only five weeks after treatment, and so it is unclear whether self-esteem will continue to rise to a stable level or whether it will start to decline again over time, the which, as previously mentioned, could lead to further negative effects for client shame. Finally, this review only examined research from two previous studies. The conclusions drawn from this study would be much more reliable if they had drawn data from a wider range of sources, and therefore further research may need to be conducted to fully evaluate how effective CBT can be in improving self-esteem. , and thus help clients who feel ashamed. The second aspect of shame that will be examined is social anxiety, which can be both the cause of shame and the result of shame. Pattison (2000) described the impact of shame as “…fear of exposure producing a strong desire to be covered…perceived threat of public exposure.” If CBT can effectively alleviate social anxiety and make the client feel more capable of going out into the world instead of feeling forced to hide, this should also help alleviate feelings of shame. A study by Hedman, Ström, Stünkel, & Mörtberg (2013) examined the link between social anxiety disorder (SAD) and shame and investigated how effectively CBT treated participants with SAD and effectiveness with which it reduced feelings of shame. Their results showed that there was a strong link between SAD and shame, finding that participants with SAD had significantly higher levels of shame than the control group. It was also found that following CBT, SAD symptoms were treated effectively and feelings of shame were significantly reduced. The results of this research not only confirm that treating SAD can also lead to an effective reduction in feelings of shame, but also show that CBT can be used to achieve this goal. However, the data used in this study was collected before and immediately after receiving treatment. They weren'tcollected follow-up data and therefore it cannot be said whether the effects of the treatment were long-lasting or not, or how long the treatment would have to last to have a positive and lasting effect on clients. Furthermore, when testing whether CBT was an effective treatment, all participants with SAD received the same treatment and so, although a significant improvement was seen, there is no control group to compare it to. Given the apparent link between social anxiety treatment and an impoverishment of feelings of shame, previous studies investigating whether CBT can treat social anxiety may also serve as evidence of CBT's effectiveness in treating clients with shame. One such study conducted in 2002 (Heimberg), evaluated how well CBT could treat SAD symptoms in both the short and long term. Patients were found to report fewer SAD symptoms and better quality of life six months after finishing treatment. However, although quality of life was improved, these participants still scored significantly lower than average, suggesting that while CBT may result in improvements for a client experiencing shame, it may not work as an effective long-term solution as quality of life of overall customer lifetime may still remain below average. A further literature review conducted by Rodebaugh, Holaway, and Heimberg (2004) evaluated the effectiveness of CBT in treating children and adolescents with SAD. They found that across the literature, all CBT techniques led to a significant reduction in SAD symptoms both compared to pre-treatment and compared to patients who had not yet received any treatment. They also found that, on average, improvements were maintained for up to twelve months after treatment ended. However, this study specifically focused on the impact of CBT on children and adolescents, so the results of the meta-analysis conducted may not accurately reflect the effects that CBT may have on adults. In addition to this, both Rodebaugh et al (2004) and Heimberg's (2002) studies identified that CBT was more effective when clients expected the treatment to help. For those clients who were more skeptical about the effects the treatment would have, the improvements felt were often less significant. This can create a problem when it comes to dealing with clients who feel shame, as one of the key emotions associated with shame is hopelessness. If a client experiencing shame already feels hopeless and feels that they are no longer able to help them, CBT may not have as much of a positive impact on these clients as it would on clients who already believe CBT will help them. Finally, the CBT approach as a whole will be examined. Mollon (2002a) states that “shame is a broken connection between a human being and others. A breakdown in understanding, expectation and acceptance necessary to feel like a valued member of the human family…the cure for shame is empathy.” With this in mind, in order to evaluate how effective CBT can be when dealing with clients who experience shame, it is necessary to examine the use of empathy in CBT. There are two main focuses of CBT: cognitive restructuring and behavioral activation (Nathan & Gorman, 2002). This is usually achieved through homework assigned to the client after each appointment. One criticism leveled at CBT therapists is that they can appear overly critical or uncaring, presenting more of a teacher role than the role of an empathetic therapist, as described by Ryle (2012) in his critique of.