{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:51:33Z","timestamp":1789696293124,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Clin Psychol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Shame is related to a host of social and psychological problems including depression, PTSD, social anxiety, substance misuse, borderline personality disorder, eating disorders, and self\u2010directed violence. Shame is an acutely painful emotion that motivates humans to protect the \u201cflawed\u201d or \u201cfragile\u201d self, often through withdrawal or avoidance. Consequently, many clients who frequently and intensely experience shame persistently avoid life situations where shame could be triggered and engage in frequent self\u2010criticism geared toward self\u2010improvement. Though well\u2010intentioned, these repeated attempts to reduce or avoid shame can exacerbate the sense of being defective, other, or unworthy already associated with shame and prevent people from living out their values in relationship with themselves and important others. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to promote psychological and behavioral flexibility in response to painful internal experiences, like shame. This case illustration depicts how ACT can be applied to target shame by incorporating a collaborative case conceptualization process and principles from affective science to help the client respond more flexibly to shame when it is cued, and take steps to cultivate a more compassionate, values\u2010driven relationship with self and others. The client, Courtney, was an adult heterosexual cisgender white woman working in secondary education. She presented to therapy with symptoms of anxiety, depression, and self\u2010esteem issues and underwent 20 sessions of ACT for shame. By the final session, Courtney reported significantly reduced shame and self\u2010criticism and increased self\u2010compassion.<\/jats:p>","DOI":"10.1002\/jclp.23810","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T07:50:10Z","timestamp":1747381810000},"page":"878-887","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Case Study on Transforming Shame: The Role of Acceptance and Commitment Therapy in Fostering Psychological Flexibility and Self\u2010Compassion"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2540-9534","authenticated-orcid":false,"given":"M. Kati","family":"Lear","sequence":"first","affiliation":[{"name":"Portland Psychotherapy Clinic, Research, &amp; Training Center Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason B.","family":"Luoma","sequence":"additional","affiliation":[{"name":"Portland Psychotherapy Clinic, Research, &amp; Training Center Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/20008066.2022.2132599"},{"key":"e_1_2_5_3_1","volume-title":"Internalized Shame Scale: Technical Manual","author":"Cook D. 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C.","year":"2011"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2021.11.017"},{"key":"e_1_2_5_11_1","first-page":"78","volume-title":"Shame: Interpersonal Behavior, Psychopathology, and Culture","author":"Keltner D.","year":"1998"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/ehs.2022.43"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/pspa0000037"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2019.101808"},{"key":"e_1_2_5_15_1","doi-asserted-by":"crossref","unstructured":"Luoma J. S. L.Rossi Y.Sereda et al.2022.An Acceptance\u2010Based Intersectional Stigma Coping Intervention for People With HIV Who Inject Drugs \u2013 an Open\u2010Label RCT in St. Petersburg Russia(SSRN Scholarly Paper No. 4182419).https:\/\/doi.org\/10.2139\/ssrn.4182419.","DOI":"10.2139\/ssrn.4182419"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144-020-00920-z"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/16066350701850295"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0026070"},{"key":"e_1_2_5_19_1","first-page":"110","article-title":"Incorporating Affective Science into ACT to Treat Highly Self\u2010Critical and Shame\u2010Prone Clients","volume":"1","author":"Luoma J. B.","year":"2020","journal-title":"Innovations in Acceptance and Commitment Therapy: Clinical Advancements and Applications in ACT. Oakland, CA: New Harbinger"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2014.12.016"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100611"},{"key":"e_1_2_5_22_1","volume-title":"Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol","author":"Lynch T. 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