Do Shame & "Rock Bottom" Decrease Dysregulated Behavior? No!

You’ve heard it dozens (hundreds?) of times:

• People who struggle with dysregulated behavior need to hit rock bottom before they can change.

• People with dysregulated behavior need to be torn down before they can be built back up.

• If a person does not stop a dysregulated behavior despite negative consequences, that person needs to be shamed into stopping the behavior.

"Shaming" is an attempt to cause someone to feel humiliated, unacceptable, and deserving of being judged as "bad." Social media recently buzzed with a picture of a couple passed out in a car after opioid use – with their children in the backseat. Other viral pictures have included:

• overweight individuals in front of heaping plates of food,
• patients smoking while being treated for smoking-related diseases, and
• children holding signs detailing their dysregulated behaviors for the world to see.

The explanations under the pictures were similar: The person posting the picture was doing so in an attempt to shame the other person into stopping the dysregulated behavior.

But shaming isn’t always public. Sometimes shaming is private – by well-meaning relatives or treatment providers who were not trained in evidence-based treatments. Some people with dysregulated behavior get so desperate about their ability to overcome the behavior that they even shame themselves.

I once knew an adolescent girl who had trouble regulating her eating. In desperation, the girl wrote notes to herself and put them all over the kitchen.

• On the freezer: “Eat ice cream and you’ll get even fatter.”
• On the breadbox: “Ugly + fat = YOU.”
• Finally, on the inside of the lid of the cookie jar (which was shaped like the head of a pig): “Fat!”

However, despite widespread (and erroneous!) beliefs, shaming does not stop dysregulated behavior. In fact, the reality is the opposite. Shame actually increases the chance a person will continue to engage in dysregulated behavior.

I am going to repeat that sentence just to make sure you do not miss it.

Shame increases the chance that a person will continue to engage in dysregulated behavior.

There’s more. Once a person stops a dysregulated behavior, shame is a strong predictor of relapse.

So, why is the myth about shame (and hitting rock bottom) so widespread? At one time, many treatment professionals thought that dysregulated behavior was explained by one or both of the following.

• People who struggle with dysregulated behavior are so immature and self-absorbed that they don’t fully realize that the behavior has negative consequences. Thus, these people practically have to be hammered over the head about how bad they are to fully realize the consequences and change.

• People who struggle with dysregulated behavior have a serious and pervasive character flaw. Thus, they have to be psychologically “torn down” and then rebuilt to be less-flawed human beings.

Important: Both of those theories have been disproven again and again (and again and again).

Instead, an evidence-supported explanation for dysregulated behavior is much less dramatic.

If you have trouble resisting urges to engage in dysregulated behavior, you likely have difficulties experiencing, tolerating, and coping with negative emotions. (Click here for an explanation.) Dysregulated behavior helps “turn off” uncomfortable or painful emotions – at least in the short-term. So if you struggle with dysregulated behavior, it makes sense that you have strong urges to engage in your behavior of choice when you experience uncomfortable or painful emotions.

And it makes sense that feelings of shame – feelings that you are bad and deserving of humiliation – would bring up intense urges to engage in the dysregulated behavior.

Now the question becomes: If you struggle with dysregulated behavior, how can you use this knowledge to help yourself?

• First, do not shame yourself as an attempt to make yourself overcome the behavior. At best it will leave you feeling worse about yourself. At worst it will increase your dysregulated behavior.

Embarrassment Essential Reads

An Evidence-Based Way of Overcoming Shame

Managing Embarrassment

• Second, when seeking treatment, look for a provider who does not use a critical, judgmental style. Instead, look for someone compassionate who will help you learn to tolerate negative emotions and gain new methods of coping. (I am not saying that the treatment will be easy or that the provider will not challenge you. I am just saying that shaming and criticizing are not effective ways to do so.)

• Third: If you know people who think that shame is a way to get themselves or others to overcome dysregulated behavior, you might want to share this post with them.

The next post in this series will continue to discuss myths about dysregulated behavior. Until then, remember:

• Some people might think that anyone who does not use a shaming and critical approach to address dysregulated behavior is being "too easy" on themselves or others.

• In that case, the question becomes: What is the goal?

• Is the goal to be tough but ineffective? Or is the goal to do what has been shown to actually help overcome dysregulated behavior?

^{Thanks to Nancy Burns and Cameron Pugach for their contributions to this post.}