The indirect effects of trauma-related shame and experiential avoidance on PTSD and suicidality

Experiential avoidance (EA), characterized by avoiding distressing thoughts or emotions, is one factor that has been consistently associated with both increased posttraumatic stress disorder (PTSD) severity and suicide risk. While EA is theorized to maintain symptomology through negative reinforcement of avoidance behaviors, EA may also be linked with PTSD and suicidality by elevating other cognitive-affective risk factors, including the feelings of worthlessness and self-blame about a trauma that is commonly referred to as trauma-related shame. To address this gap, the current study recruited trauma-exposed community adults (N = 185, 76.76% female, Mage = 35.58, SDage = 10.86) to complete self-report measures of EA, trauma-related shame, PTSD symptoms, and suicidality. A significant indirect effect emerged such that EA predicted greater suicidality (B = 0.005, SE = 0.001, 95% CI = [0.002, 0.008]) and PTSD symptom severity (B = 0.084, SE = 0.033, 95% CI = [0.028, 0.157]) through trauma-related shame, even when controlling for trauma load, age, and biological sex. These findings highlight the importance of trauma-related shame for understanding the associations among EA, PTSD symptom severity, and suicidality. Future research should explore the prospective roles of EA and trauma-related shame in PTSD and suicidality over time.