The Impact of Shame on the Dual Harm in Adolescents: The Role of Cognitive Flexibility

doi:10.21203/rs.3.rs-4813234/v1

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The Impact of Shame on the Dual Harm in Adolescents: The Role of Cognitive Flexibility

https://doi.org/10.21203/rs.3.rs-4813234/v1

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Dual harm is a grave public health concern within the adolescent population, linked to mental disorders and extreme behaviors such as suicide. However, the psychological mechanisms underlying dual harm in adolescents are poorly understood. This study aims to investigate the role of shame in adolescent dual harm, as well as the mitigating effects of cognitive flexibility, based on the cognitive-emotional model of dual harm. This study employs two sequential experiments. Experiment 1 manipulates subjects' shame using a shame induction task, measuring dual harm with scores from the Tabasco Sauce Paradigm and Cold Pressor Test. The results reveal that compared to the control group, the intervention group exhibits higher levels of dual harm behaviors. Experiment 2 builds upon this foundation, employing the Wisconsin Card Sorting Test to measure cognitive flexibility. The results replicate those of Experiment 1 and further demonstrate that reduced cognitive flexibility exacerbates dual harm. Shame is considered to trigger dual harm, which cognitive flexibility can mitigate.

dual harm

shame

cognitive flexilibity

adolescents

Dual harm is a significant public health issue affecting individual psychological well-being 1, referring to the co-occurrence of self-harm and aggression. Dual harm increases the incidence of mental disorders 2, leading to self-harm, violent crimes, and even extreme behaviors such as suicide and homicide 3. The current global incidence rate of dual harm exceeds 15% 2, posing a significant threat to individual. However, existing research only measures and studies dual harm from a single concept (self-injury or aggression) 4, lacking a comprehensive understanding of the mechanisms underlying individuals' simultaneous tendencies towards both approach and avoidance behaviors. Individuals in adolescence undergo physical development and explore their self-worth. They experience heightened self-awareness and sensitivity to self-image and external evaluations 5, leading to shame 6. This influences identity formation and social development, exhibiting early signs of dual harm. However, research on shame in adolescents remains limited. Therefore, exploring whether and how shame impacts adolescents can extend research perspectives on individual emotional development, potentially reducing adolescents' internalizing and externalizing problems.

Shame refers to the humiliating experience of being devalued and worthless by the gap between the real and ideal selves after negative behaviors 7. It can lead to a self-loathing tendency of "I am unpopular" 8. The Compass of Shame model suggests that individuals facing shame adopt various internalized and externalized coping strategies, such as aggression towards others, self-attack, avoidance, and withdrawal, resulting in different orientations 9. However, this theory explains only from the perspectives of self-harm and aggression towards others, without integrating the two to explore the internal mechanisms guiding shame towards dual harm. In reality, individuals often engage in both self-harm and aggression towards others simultaneously. Shame as a behavioral defense mechanism 10, prompting individuals to express self-importance by approach and avoidance 11. The cognitive-emotional model of dual harm points out that states that threats and challenges generate shame to exacerbate dual harm 12. To avoid experiencing shame in the short term, individuals avoid negative experiences at the expense of long-term self-harm 13. However, this reinforces shame and induces angry attacks directed toward the outside world due to threats to self-esteem, and causes dual harm 14. Although research has found that dual harm is closely related to depression and anger 15. However, neither of hem is the root 17. Among them, depression is caused by self-oathing, which is a persistent low and sad mood 18. And anger as an activated emotion is influenced and moderated by other factors, such as shame and disgust 17. Both induce dual harm focusing on self-injury and aggression, rather than dual harm. Shame exacerbates emotional and cognitive conflict 19. It causes dual harm to release emotions, cope with frustration, or perform interpersonal functions 20.

Cognitive flexibility refers to the ability to adjust thinking and emotional experiences in the face of change or the need to adapt to new situations 22. It plays an important role in social adaptation and emotional development. Fixed thinking patterns exacerbate stubborn negative self-evaluation. Cognitive flexibility adjusts emotional responses and strategies to reduce shame. Cognitively inflexible individuals adjust their thinking slowly, are emotionally fixated, and are so immersed in negativity that they have difficulty separating emotion from rationality 23, making false self-attributions that exacerbate shame. The theory of resilience posits that cognitive flexibility facilitates cognitive restructuring and emotional regulation, thereby enhancing the ability to accept reality 24. Individuals with flexible cognition have higher psychological resilience, promptly adjusting their responses based on feedback. They employ positive strategies to reduce shame, thereby avoiding dual harm. However, some studies have found that cognitive flexibility increases an individual's acceptance of harmful behavior 25, leading individual to view suicide as a means to alleviate pain 26. This may be related to the selection of participants, all of whom are individuals with self-injury behaviors. The cognitive-emotional model of dual harm points out that cognitive factors affect individuals' cognitive assessment and coping strategies of stressors 12. Cognitive flexibility promotes individuals to adopt a more positive and adaptive way of thinking when facing negative events 27. This adaptability helps break the cycle of dual harm by allowing individuals to adjust their behavior based on feedback. Therefore, this study employs behavioral experiments to explore the mechanism of dual harm in adolescents, aiming to investigate whether shame exacerbates dual harm and whether cognitive flexibility mitigates the exacerbating effect of shame on dual harm.

In this study, we broadened previous research by exploring the relationship between shame and dual harm. Furthermore, we analyzed which type of dual harm can reduce shame more, thus providing a basis for the second path of the cognitive-emotional model of dual harm. In addition, this study included cognitive flexibility, a cognitive factor that plays an important role in emotional development, to explore the possible mitigating effect of cognitive flexibility. We proposed three hypotheses:

H1 Shame triggers dual harm.

H2 Self-injury is more effective at alleviating shame than aggression.

H3 Cognitive flexibility alleviate the impact of shame on dual harm.

Experiment 1: The Influence of Shame on Dual Harm

Method

Participants

Using the Adolescent Self-Injury Questionnaire and the Reactive-Proactive Aggression Questionnaire. Eighty-two Chinese middle school student, aged 12–16 years (34 males: M = 13.97, SD = 0.80; 48 females: M = 14.02, SD = 0.91) are recruited from a middle school in Hebei, China. All participants are right-handed, physically and mentally healthy, with normal or corrected vision. Ethical procedures are followed, and both participants and their guardians are informed and signed an Informed Consent Form. Participants receive appropriate compensation after the experiment.

Design

This experiment use a 2 (shame: priming, control) × 2 (time: pre-test、post-test) two-factor mixed experimental design. The between-group variable is shame, the within-group variable is time. And the dependent variables are the scores of the two dimensions of dual harm (self-injury and aggression), namely, the length of time(s) the subjects put their hands in cold water and the level of chili powder selected by the subjects in the hot sauce experiment.

Materials

The Adolescent Self-injury Behavior Questionnaire.

The scale includes 19 questions and consists of two parts28. The total score is the sum of the product of the number of self-injury behaviors and the degree of harm. A score of 0 indicates no self-harm behavior, otherwise it indicates self-harm behavior. The higher the score, the more serious the self-harm behavior. This study use this questionnaire to measure the self-harm situation of the subjects "in the past year". The Cronbach’s α is 0.817.

The Reactive-Proactive Aggression Questionnaire.

The scale contains 6 questions, divided into two dimensions: reactive aggression and proactive aggression29. A 5-point scoring system is used. Higher scores indicate more severe aggressive behavior. In this study, the Cronbach’s αis 0.771.

Shame priming.

The typical shame events are used to induce shame emotions in the subjects30. The shame event described "you" being caught by the bookstore owner for stealing books from the bookstore, which is about 300 words. After reading, the subjects are asked to self-assess their corresponding emotions, with "1" indicating "not at all" and "7" indicating "very shameful".

Dual harm task.

The hot sauce experiment and the cold pressor experiment are used 31. The procedure of the hot sauce experiment is as follows: the subject first receive a completed taste preference questionnaire. The experimenter tell the subject that this is completed by subject A (virtual subject) in the next room, and as shown in the questionnaire, subject A do not like spicy food. Then the subject is told to choose one from 5 levels of chili powder ("1 = not at all" to "5 = add a lot") and add it to the hot sauce recipe of subject A. The selection process is kept confidential. The specific procedure of the cold pressor experiment is as follows: the subject is told to spread out the non-dominant hand, put the hand into a circulating cold water basin at a constant temperature of 2°C for as long as possible, submerge the water to the wrist, and tell the subject that the test will last for 5 minutes, but the subject is allowed to remove the hand at any time.

Procedure

The subjects sat independently in a quiet laboratory. The experimenter introduce the experiment and ask the subjects to read and sign the informed consent form. Then the first step is carried out. The subjects are divided into two groups, one for the hot sauce experiment and the other for the cold pressor test. They rate their degree of shame on a 7-level scale. In the second step, the subjects complete the shame priming task and answer the retrospective question. Then, the first step is repeated, and the hot sauce experiment and the cold pressor test are carried out respectively and the shame questions are answered. Finally, the experimenter give the corresponding experimental remuneration.

Results

Manipulation Check

The results of the independent sample t-test showed that compared with the control group, the priming group reported more shame after completing the shame priming task, t(80) = 23.24, p < 0.001, d = 0.62. This shows that shame priming is effective.

Dual Harm Task.

The results of repeated measures analysis ANOVA (see Table 1) shows that, on self-harm, the main effect of shame is significant, F _(1,39) = 6.49, p < 0.05; η² = 0.14, and the main effect of time is significant, F _{(1, 39)} = 20.41, p < 0.001; η² = 0.34. The interaction effect between shame and time is significant, F _(1,39) = 5.72, p < 0.05; η² = 0.13. The simple effect analysis is shown in Fig. 1. In terms of aggressive behavior, the main effect of shame is significant, F _(1,39) = 4.32, p < 0.05; η² = 0.10, and the main effect of time is significant, F _(1,39) = 28.74, p < 0.001; η² = 0.42. The interaction effect between shame and time is significant, F _(1,39) = 15.24, p < 0.001; η² = 0.28. The simple effect analysis is shown in Fig. 2.

Table 1

Scores of the two groups of subjects on different types of dual harm(M ± SD)
Shame	Dual harm
	Self-injury		Aggression
	Pre-test	Post-test	Pre-test	Post-test
Priming	104.71 ± 42.80	151.94 ± 32.07	2.29 ± 0.69	3.35 ± 0.86
Control	93.95 ± 36.97	107.79 ± 47.43	2.29 ± 0.81	2.83 ± 0.72

Shame Task.

In order to further explore which type of dual injury can better reduce shame, an independent sample t test is conducted on the difference in shame scores between the pre- and post-tests of the initiation-self-injury group and the initiation-attack group, see Table 2. The results showed that the two The difference in group score difference is significant, t₍₃₂₎ = 4.29, p < 0.001, d = 0.80, indicating that self-injury can alleviate shame better than aggressive behavior.

Table 2

Shame scores of subjects with different types of dual injury over time(M ± SD)
Dual harm	Shame-priming group
Dual harm	Pre-test	Post-test
Self-injury	2.76 ± 1.83	1.81 ± 0.70
Aggressive	2.78 ± 1.85	2.07 ± 1.06

Experiment 2: The Influence of Shame on Dual Harm

Method

Participants

Using the Adolescent Self-Injury Questionnaire and the Reactive-Proactive Aggression Questionnaire. Eighty-two Chinese middle school student, aged 12–16 years (44 males: M = 14.03, SD = 0.87; 48 females: M = 14.00, SD = 0.83) are recruited from a middle school in Hebei, China. All participants are right-handed, physically and mentally healthy, with normal or corrected vision. Ethical procedures are followed, and both participants and their guardians are informed and signed an Informed Consent Form. Participants receive appropriate compensation after the experiment.

Design

This experiment use a 2 (shame: priming, control) × 2 (cognitive flexibility: high, low) two-factor between-subjects design. The independent variables are shame and dual harm type. The dependent variable is dual harm score, that is, the summed mean of the ratings of how long the subjects kept their hands in the cold water and the ratings of chili powder selected in the hot sauce experiment.

Materials

Shame priming and dual harm experiments are the same as Experiment 1.

Cognitive flexibility.

The cognitive flexibility task uses the Wisconsin card sorting task(WCST)32. The task is to sort cards according to color, shape and bibliography, with an interval of 500 milliseconds between cards. After each sorting, the computer automatically gives correct or incorrect feedback, and the subjects switch between the classification dimensions. The total number of correct classifications of the subjects is used as the standard for distinguishing high and low cognitive flexibility.

Procedure

The subjects sat independently in a quiet laboratory. The experimenter introduce the experimental situation and aske the subjects to read and sign the informed consent form. Then the first step is carried out. The subjects complete the WCST and the shame priming task and answer the retrospective question. Then,the subjects complete the hot sauce experiment and the cold pressor experiment tasks, and rate the degree of shame they experienced on a 7-level scale. Finally, the experimenter give the corresponding experimental compensation.

Results

Manipulation Check

The results of the independent sample t-test showed that compared with the control group, the priming group reported more shame after completing the shame priming task, t₍₉₀₎=27.68, p < 0.001, d = 0.60. This shows that shame priming is effective.

Dual Harm Task.

A paired sample t test is conducted on the results of different groups, see Table 3. The results show that there is no significant difference in the pre-test between each group. An independent t-test is conducted on the post-tests of each group and find that only the dual harm behavior of the participants in the priming-cognitive inflexibility group has significant differences in the pre- and post-tests.

Table 3

Paired samples t-test for dual harm behaviors in different groups (N = 92)
Cognitive flexibility	Dual harm
Cognitive flexibility	Shame-control group	Shame-priming group
High	2.05 ± 0.65	2.35 ± 0.52
Low	2.00 ± 0.85	2.97 ± 0.54

Analyzing the experimental data of different groups in sequence, it is found that the main effect of cognitive flexibility is not significant, F _{(1, 88)} = 2.83, p = 0.09; η² = 0.03, that is, subjects with different cognitive flexibility are in dual situations. There are no significant differences in harmful levels. The interaction effect between shame and cognitive flexibility is significant, F _(1,88) = 6.26, p < 0.05; η² = 0.07. The results of simple effects analysis show that under the shame priming condition, see Fig. 3, the main effect of cognitive flexibility is significant, F _(1,88) = 4.33, p < 0.05; η² = 0.05, that is, the shame priming group subjects engage in less dual harm behavior under cognitive flexibility.

Shame is the key of emotional condition that sustains dual harm in adolescents 20. When individuals experience inadequacy or defectiveness in front of others, they often feel intense shame. This shame exacerbates self-vulnerability, prompting dual harm to alleviate inner pain to restore control 19. Furthermore, shame motivates individuals to maintain social interaction through dual harm33. Especially when an individual is rejected by a group, the moral regulatory function of shame is more likely to be triggered. The self-attacking cognitive pattern leads to individuals believe they should pay a price for their inadequacy, expressing self-punishment through internal anger to deny rejection information and shame 34. The Pain and Threat-defense Model views shame as social pain, which triggers emotional and physical pain, leading to harm 36. Studies indicates that externalized shame that tends to lead to anger and blame, which mediates maladaptive personality traits 37, and results in aggression towards others 38, thereby exacerbating dual harm. When anger is associated with shame, individuals tend to have more difficulty conducting self-immersion analysis 39. This means that negative emotions are more complicated when activated by shame. Under the interaction of emotions and the lack of emotional regulation strategies, shame quickly activates the stress system, shifting the focus of shame—self-identity—through dual harm 35.

Although shame leads to dual harm, high-shame individuals are more likely to relieve shame through self-harm rather than aggression. Self-harm increases the individual's illusion of control rather than venting emotions. On the contrary, aggression may reduce the individual's sense of control because it involves the reactions of others and the consequences of the behavior. Compared with self-injury, the negative feedback of aggressive behavioris not conducive to self-image and social interaction 40. This negative feedback reinforces upward expression intentions and self-attack schemas, which feeds back into individual personality traits and expectations, leading to self-injury. In addition, shame itself may prompt individuals to avoid social interactions and possible conflicts, leading to self-attack.

Cognitive flexibility buffers shame and protect against harmful beliefs. When facing overload events, individuals seek adaptation and reassess abilities in order to cope with negative emotion 41. As a dynamic development process, cognitive flexibility provides mental resources to face shame to cognitive reconstruction, reassess and interpret negative events, thereby preventing long-term psychological pain to maintain a normal development trajectory 42. Conversely, Individuals with low cognitive flexibility cannot adjust their cognitive and emotional strategies, and are prone to fall into negative thinking cycles and over-focus on negative self-evaluations 43. They find it difficult to manage the relationship between shame and the triggers of harmful behavior 44, and then vent their emotions or seek a sense of control through dual harm. The cognitive-emotional model of dual harm points out that the results of dual harm behavior will affect individual environmental reactions and experiences, thereby strengthening or weakening maladaptive schemas 12. Cognitive flexibility can prevent the vicious cycle of shame, interrupt negative thinking and emotional reactions, avoid emotional escalation and behavioral loss of control, and thus reduce dual harm 45.

Limitations and implications

The study could benefit from improvements in several areas. Firstly, environmental variables influencing dual harm are not considered. The cognitive-emotional model of dual harm suggests that life events can shape personality traits, influence current emotions and cognitive mechanisms, thereby impacting dual harm 12. Future research could explore the role of life events in triggering shame-induced dual harm. Additionally, the use of techniques such as ERPs, physiological sensors, and fMRI could elucidate the cognitive neural mechanisms through which shame influences dual harm.

Despite some limitations, this study has certain theoretical and practical significance. First, This study has refined the cognitive-emotional model of dual harm, revealing that adolescents' sense of shame has a stimulating effect on triggering dual harm, and it has identified that cognitive flexibility plays a critical role in suppressing dual harm, offering new directions for preventing dual harm among adolescents in the future. Additionally, from an emotional perspective, this paper delves into the role of different types of dual harm in emotional expression, providing new insights for subsequent targeted research. Based on the findings of this study, it is suggested that educators design and implement cognitive flexibility training activities to foster adolescents' abilities in flexible problem-solving and emotional regulation. During this process, educators must respect the subjective needs of adolescents and minimize emotional issues arising from inappropriate interactions. Particularly in smart learning environments, educators should pay close attention to the issue of cognitive load and, by strategically allocating media resources and technological tools, offer personalized emotional support to reduce the incidence of dual harm.

Shame triggers adolescents' dual harm; compared with aggression, self-injury can reduce shame more; and cognitive flexibility plays a mitigating role in this process.

Author contributions

PengYun Yan: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. YaFan Wang: Data curation, Writing – review & editing, Writing - original draft. ZhiXiong Jiang: Data curation, Writing - review & editing. Ao Zhang :Writing - review & editing, Data curation. LongFei Wang: Conceptualization, Data curation, Writing – review & editing. GuoLi Zhang: Data curation, Writing – review & editing, Funding acquisition, Project administration.

Funding

Special Funds for Fundamental Research Operating Expenses of the Central Universities to Support Subjects (2022YB003)（Science Foundation of Ministry of Education of China）.

Data availability

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

Declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Beijing Sport University. Informed consent was obtained from all participants.

Consent for publication

All authors have read the manuscript and agreed to submission and publication.

Competing interests

The authors declare that they have no competing interests.

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No competing interests reported.

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You are reading this latest preprint version

The Impact of Shame on the Dual Harm in Adolescents: The Role of Cognitive Flexibility

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Abstract

Figures

Introduction

Current study

Experiment 1: The Influence of Shame on Dual Harm

Method

Participants

Design

Materials

Procedure

Results

Manipulation Check

Experiment 2: The Influence of Shame on Dual Harm

Method

Participants

Design

Materials

Procedure

Results

Manipulation Check

Discussion

Limitations and implications

Conclusions

Declarations

References

Additional Declarations

Status:

Version 1