Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

In the moment, is the strongest experience feeling exposed and unacceptable, or believing something globally true about yourself?

Most useful distinction

Shame is the painful exposed affect; negative core beliefs are the broader self, other, or world meanings that shame may activate.

Common confusion

Both can sound like global self-criticism and defectiveness.

Treatment difference

Shame work emphasises non-shaming contact and tolerable exposure; core belief work tests predictions and builds alternative meanings.

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Negative core beliefs

Negative core beliefs bias attention and meaning-making, often linking early experience to current automatic thoughts, affect, and behaviour.

CognitionDevelopmentalAttachment+1

Definition

AA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

BGlobal, rigid, overgeneralised beliefs about the self, others, or world that shape interpretation and emotional response.

Core process

AGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

BA schema-like belief filters events so ambiguous information is interpreted as confirming defectiveness, danger, unlovability, or failure.

Look for

ADowncast gaze · Concealment

BGlobal self-statements · Persistent themes across situations

Patient language

A“There is something wrong with me”

B“I am not good enough”

Maintaining cycle

AExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

BTrigger -> negative meaning -> affect -> coping behaviour -> apparent confirmation of belief

Treatment leverage

AReduce concealment and self-attack while building tolerable interpersonal safety.

BWork at the level of meaning, not only surface thoughts.

Check before using

AThe primary affect is guilt about a specific harm with intact self-worth.

BThe thought is situation-specific and changes with new evidence.

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Formulation language

A negative core belief of defectiveness appears to shape threat appraisals, self-criticism, and avoidance of disconfirming feedback.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

In the moment, is the strongest experience feeling exposed and unacceptable, or believing something globally true about yourself?

Most useful distinction

Shame is the painful exposed affect; negative core beliefs are the broader self, other, or world meanings that shame may activate.

Common confusion

Both can sound like global self-criticism and defectiveness.

Treatment difference

Shame work emphasises non-shaming contact and tolerable exposure; core belief work tests predictions and builds alternative meanings.

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Negative core beliefs

Negative core beliefs bias attention and meaning-making, often linking early experience to current automatic thoughts, affect, and behaviour.

CognitionDevelopmentalAttachment+1

Definition

AA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

BGlobal, rigid, overgeneralised beliefs about the self, others, or world that shape interpretation and emotional response.

Core process

AGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

BA schema-like belief filters events so ambiguous information is interpreted as confirming defectiveness, danger, unlovability, or failure.

Look for

ADowncast gaze · Concealment

BGlobal self-statements · Persistent themes across situations

Patient language

A“There is something wrong with me”

B“I am not good enough”

Maintaining cycle

AExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

BTrigger -> negative meaning -> affect -> coping behaviour -> apparent confirmation of belief

Treatment leverage

AReduce concealment and self-attack while building tolerable interpersonal safety.

BWork at the level of meaning, not only surface thoughts.

Check before using

AThe primary affect is guilt about a specific harm with intact self-worth.

BThe thought is situation-specific and changes with new evidence.

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Formulation language

A negative core belief of defectiveness appears to shape threat appraisals, self-criticism, and avoidance of disconfirming feedback.

Open full guide

Browse the map Use both hypotheses