| dc.description.abstract | Childhood sexual abuse (CSA) is a worldwide problem that increases survivors' likelihood of experiencing a range of physical and mental health conditions. Survivors often feel, or are made to feel, shame surrounding their experiences. These feelings of shame appear to play a role both in negative health outcomes as well as other elements of the experience, such as discouraging disclosure. Yet much remains to be understood about how and why shame has these effects. This thesis first provides some general background on CSA, including a discussion of global prevalence rates of CSA, and a description of short- and long-term somatic and psycho-social outcomes of CSA. The Irish historical and cultural context relevant to the current programme of work is then discussed, along with theories of shame in non-clinical and clinical contexts. Chapter 2 then reports the results of a pre-registered study that undertook a systematic review of the existing research on shame in the context of CSA, building on the recommendations of the scoping review of MacGinley et al., (2019). Out of the 168 studies selected for final analysis, 81 were quantitative, 81 were qualitative, and six were mixed-methods studies. The Results section analyses the quantitative and qualitative findings separately, with the Discussion section drawing these findings together and making recommendations for future research. Major themes that emerged from the body of research on this topic are: the negative effects of shaming experiences on survivors' desire to disclose CSA; the all-encompassing nature of shame in survivors; the mediating effect of self-compassion in the relationship between shame and adverse outcomes; the role of self-compassion and therapy in mitigating shame; and the lack of appropriate and dedicated ways to assess levels of shame in survivors. Next, Chapter 3 reports the results of a quantitative online questionnaire-based study, which recruited survivors of CSA from counselling/support services and social media support groups. Participants completed measures of general shame, trauma-related (i.e. CSA-related) shame, trauma-related guilt, selfcompassion, PTSD, and depression. Complete datasets on these variables were obtained for 37 participants. Hypothesised models of relations between PTSD and CSA-related shame were tested using linear multiple regressions, testing for the role of self-compassion as both a mediator and moderator. In addition to discussing the patterns of findings, issues encountered during recruitment and lessons learned from this for future work are discussed. Though no significant mediating or moderating effects were found in these iv regressions, significant correlations were found between CSA-related shame and a number of the outcome measures investigated, including a negative correlation with self-compassion, and positive correlations with general shame, PTSD, and depression. In addition, a direct effect was found in a regression between CSArelated shame and PTSD. Chapter 4 reports on the results of a qualitative study that conducted in-depth semi-structured interviews with survivors of CSA (n=2) and service providers at an Irish psychological clinic and a service supporting migrant women(n=3), examining the presence, role, and influence of shame in CSA. Both survivors of CSA had undergone psychological therapy and their interviews were analysed separately, to respect the uniqueness of each account. Interpretative phenomenological analysis was performed on the survivor interviews due to the small sample and the heterogeneity of their accounts, while general thematic analysis was performed on the service provider interviews due to the greater homogeneity of these accounts. In addition to insights gained from the content of the interviews, lessons learned from the process of recruitment are also discussed. Some major themes that emerged from the interviews are: the inseparability of shame from the survivors' sense of self; the deep impact of systemic failures to respond to survivor disclosures and suspicions of abuse; the impact of familial and community reactions to the abuse on survivor shame; and the role of self-compassion in reducing shame within a therapeutic context. The thesis then concludes by knitting together the findings from the three empirical studies. This section provides a high-level synthesis of what is known about shame and CSA, points to new avenues of future research, and suggests systemic, socio-cultural, and clinical changes to help prevent or mitigate shame in survivors. | en |
