Many people with borderline personality disorder (BPD) experience chronic shame. Shame is a self-conscious emotion that is associated with feeling self-hatred, self-loathing, and/or self-contempt. When this feeling is intense and pervasive, it can destroy relationships and is associated with dangerous behaviors such as deliberate self-harm and suicidality.
BPD and Shame
A growing research literature suggests that BPD is associated with a high-degree of shame-proneness, and that the relationship between BPD and shame may explain why individuals with BPD exhibit such high rates of suicidality and self-harm. For more on BPD and shame, read this article:
Despite growing recognition that shame may be central to BPD, very few treatment approaches specifically target shameful feelings. However, Shireen Rizvi, Ph.D., an Assistant Professor at Rutgers University and expert in Dialectical Behavior Therapy (DBT), has published some promising preliminary support for the use of the DBT skill "Opposite Action" in the treatment of shame.
What is Opposite Action?
"Opposite Action" is an emotion regulation skill taught in DBT. When you have a distressing emotion, such as fear or anger, that emotion comes with an action tendency. In fear, the action tendency is to escape or avoid the threatening situation. In anger, the action tendency is to get aggressive or fight. Sometimes these action tendencies are quite helpful to us, but if we experience emotions in situations where the emotion or the intensity of the emotion is unjustified, or if we engage in these actions without thinking, they can get us in trouble.
The basic premise of opposite action is to do the opposite of the action tendency that accompanies the emotion. So, if you are experiencing unjustified fear, you do the opposite of escaping or avoiding. That is, you approach the thing that is frightening you.
Opposite Action with Shame
Since shame is such a powerful emotion, and because it is so hard to be objective when we are evaluating our own feelings of shame, this exercise is best done with the help of a therapist. You can print out this article to bring to your therapist if they are not familiar with this approach. Even if you have a very advanced level understanding of the DBT skills, this exercise should not be conducted alone.
To use opposite action to reduce shame, the first step is to determine whether the shame you are experiencing is unjustified. To do this, you must ask yourself whether your actions or characteristics either violate your own moral code, or whether, if someone found out about your actions or characteristics, they would reject you. If neither of these conditions are true (and you will probably need your therapist's objective opinion to help you determine whether either of these are true), then your shame is unjustified.
Once you have determined whether your shame is justified or unjustified, you can practice acting in the way that is the opposite of your shame action tendency. This can be somewhat different for different people and/or situations, but when most people feel ashamed they either try to withdraw or hide, try to blame someone else, or act aggressively.
Let's say you feel shame about a traumatic event from the past. You and your therapist might work together to determine that your shame about the event is unjustified. Then, you will identify the action tendency that goes along with your shame (i.e., perhaps you feel like withdrawing from other people when you feel that shame). In this case, an opposite action would be to actually seek out social connection by calling a friend.
But what if you are ashamed of something that you did in the past, and that shame is justified (i.e., this behavior violated your own moral code and/or would cause others to reject you if they knew)? In this case, your action tendency might be to keep the past behavior a secret. But, perhaps instead your might choose the opposite action of revealing your transgression to your therapist and coming up with a plan for making amends.
Evidence for the Use of Opposite Action with Shame
There is evidence that this technique can reduce shame when used in conjunction with a therapist. In a pilot study, Dr. Rizvi examined the effects of an opposite action treatment for shame in five women with BPD. On average the women treated with this technique evidenced significant reductions in their shame about specific events.
Linehan, MM. "Skills Training Manual for Treating Borderline Personality Disorder." New York: Guilford Press, 1993.
Rizvi SL, Linehan MM. "The Treatment of Maladaptive Shame in Borderline Personality Disorder: A Pilot Study of 'Opposite Action.'" Cognitive and Behavioral Practice; 12(4):437-447, 2005.