Oh my god I am having major lightbulb moments!
I’m am doing a lit review around the effectiveness of CBT in survivors of SA/rape with PTSD...And the research already suggests that a major reason for it not being as effective as other therapies is... Survivors of SA have shame...

Who else has often a lot of shame? Ex-Christians/ex-evangelicals...therefore if you are an ex-evangelical with a history of SA/rape and you’re having trouble with making any progress in CBT, it makes a whole lot of sense why CBT would be incredibly triggering for you.

"re-living trauma and attempting to update hotspots without the development of an alternative feeling to end the shame state would simply lead to the exacerbation of shame and disgust rather than reduction of the emotion over time as would be predicted by the cognitive model..."

Self-compassion is not something that is readily practiced by American Evangelicals. We are told that self-care, self-love, and self-esteem are simply ungodly and that it's "Christ's compassion" that matters for our godliness and holiness. This is a breeding ground for shame.

If you are too busy self-flagellating then you do not have room to cultivate self-compassion. But self-compassion is the antidote to shame. There is also a link between shame and insecure attachment, something far too many of us former evangelicals are extremely familiar with.

I am going to link a study which addresses shame, self-compassion, and attachment and how they all coincide if you're interested in reading more. https://self-compassion.org/wp-content/uploads/publications/Gilbert.Procter.pdf

Adding to this some more research that I found... "The consideration of negative affect at each stage of the treatment process has the potential to enhance the ability of clinicians to provide ethical care."

"The inclusion of affective modules in CBT protocols for PTSD will potentially extend the length of treatment depending on the amount of time initially allocated to affect dysregulation."

"Although the extension of a CBT protocol is debatable, given the focus on providing brief, effective psychotherapy, Korner (1995) suggests that attending to positive and negative affect in session is likely to reduce destructive treatment outcomes."

"This approach is especially salient when treating PTSD, as current forms of CBT may exacerbate symptomatology in some clients, contributing to client dropout and nonresponse rates."

(negative affect in this writing sample refers specifically to anxiety, anger, shame, guilt, and sadness, with sadness being a low-arousal negative affect and the others being high-arousal negative affect)