Disengagement coping as a mediator between trauma-related guilt and PTSD severity (original) (raw)
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Guilt in the Treatment of Posttraumatic Stress Disorder Among Active Duty Military Personnel
Journal of Traumatic Stress, 2019
The current study examined the role of trauma‐related guilt on posttraumatic stress disorder (PTSD) symptom change during prolonged exposure therapy (PE) as well as the efficacy of PE in reducing three dimensions of guilt (responsibility, wrongdoing, and lack of justification) during treatment. Participants were 331 active duty U.S. military personnel seeking treatment for PTSD who were randomized to one of four groups: massed PE (10 sessions delivered over 2 weeks), spaced PE (10 sessions delivered over 8 weeks), present‐centered therapy (PCT; 10 sessions delivered over 8 weeks), or minimal contact control (MCC; weekly therapist phone check‐in for 4 weeks). The results showed that baseline guilt did not predict reductions in PTSD symptoms for spaced PE or for PCT, ps = .178–.387, ds = −0.02–0.07. Treatment condition (massed PE vs. MCC; spaced PE vs. PCT) did not moderate reductions in guilt for spaced PE versus PCT. Guilt decreased significantly over treatment in all groups, p <...
Trauma Informed Guilt Reduction Therapy With Combat Veterans
Cognitive and behavioral practice, 2014
Guilt related to combat trauma is highly prevalent among veterans returning from Iraq and Afghanistan. Trauma-related guilt has been associated with increased risk for posttraumatic psychopathology and poorer response to treatment. Trauma Informed Guilt Reduction (TrIGR) therapy is a 4-module cognitive-behavioral psychotherapy designed to reduce guilt related to combat trauma. The goals of this study were to describe the key elements of TrIGR and report results of a pilot study with 10 recently deployed combat veterans. Ten combat veterans referred from a VA Posttraumatic Stress Disorder (PTSD) or mental health clinic completed TrIGR over 4 to 7 sessions. Nine veterans completed the posttreatment assessment. This initial pilot suggests that TrIGR may help to reduce trauma-related guilt severity and associated distress. Changes in trauma-related guilt were highly correlated with reductions in PTSD and depression symptoms over the course of treatment, suggesting a possible mechanistic link with severity of posttraumatic psychopathology. TrIGR warrants further evaluation as an intervention for reducing guilt related to traumatic experiences in combat.
Journal of affective disorders, 2017
Suicidal ideation (SI) is a serious issue affecting U.S. veterans, and those with posttraumatic stress disorder (PTSD) are at an especially high risk of SI. Guilt has been associated with both PTSD and SI and may therefore be an important link between these constructs. The present study compared models of trauma-related guilt and used path analysis to examine the direct and indirect effects of PTSD and trauma-related guilt on SI among a sample of 988 veterans receiving outpatient PTSD treatment at a Veterans Affairs (VA) specialty clinic. Results showed that a model of trauma-related guilt including guilt-cognitions and global guilt (but not distress) provided the best model fit for the data. PTSD and trauma-related guilt had direct effects on SI, and PTSD exhibited indirect effects on SI via trauma-related guilt. The use of cross-sectional data limits the ability to make causal inferences. A treatment-seeking sample composed primarily of Vietnam veterans limits generalizability to ...
Development and validation of the sources of trauma-related guilt survey—war-zone version
Journal of Traumatic Stress, 1997
Despite clinical observations that many veterans have multiple sources of war-related guilt, many problematic guilt issues are commonly not treated or even detected by clinicians. We describe development of a survey that systematically assesses idiosyncratic sources of guilt across the spectrum of events that are potential sources of trauma-related guilt from the war-zone. A multimethod strategy was used to develop a survey with strong content validity. Results indicate the survey is temporally stable, substantially correlated with other measures of guilt, and highly correlated with measures of posttraumatic stress disorder (PTSD) and depression. Findings confirm that many Vietnam veterans have multiple sources of severe war-related guilt. The survey may have important clinical utility for problem identification, treatment planning, and evaluating treatment efficacy.
Development and Validation of the Sources f Trauma-Related Guilt Survey—War-Zone Version
Journal of Traumatic Stress, 1997
Despite clinical observations that many veterans have multiple sources of war-related guilt, many problematic guilt issues are commonly not treated or even detected by clinicians. We describe development of a survey that systematically assesses idiosyncratic sources of guilt across the spectrum of events mat are potential sources of trauma-related guilt from the war-zone. A multimethod strategy was used to develop a survey with strong content validity. Results indicate the survey is temporally stable, substantially correlated with other measures of guilt, and highly correlated with measures of posttraumatic stress disorder (PTSD) and depression. Findings confirm that many Vietnam veterans have multiple sources of severe war-related guilt. The survey may have important clinical utility for problem identification, treatment planning, and evaluating treatment efficacy.
Combat-related guilt and the mechanisms of exposure therapy
A B S T R A C T Exposure therapy (EXP) is one of the most widely used and empirically supported treatments for PTSD; however, some researchers have questioned its efficacy with specific populations and in targeting specific symptoms. One such symptom, guilt, has garnered increased attention in the PTSD treatment literature, as it is associated with worse symptomatology and outcomes. The current study examined cognitive changes in guilt in response to Intensive (3-week) and Standard (17-week) Trauma Management Therapy (TMT), and the potential mechanisms underlying TMT treatment. TMT is an exposure based intervention that does not include an emotional processing component after the imaginal exposure session. A portion of the sample completed measures of guilt. As a result, sample size for these analyses ranged from 39 to 102 and varied by the domain and measure. Of the 102 individuals that completed the PTSD Checklist-Military Version, 42 completed the Trauma Related Guilt Inventory, and 39 completed the Clinician Administered PTSD Scale supplemental guilt items. Participants reported significant reductions in trauma-related guilt symptoms over the course of the TMT interventions. Greater reductions in avoidance and prior session general arousal predicted the reduction of guilt symptoms. Exposure therapy may be effective in reducing trauma-related guilt even in the absence of the emotional processing component of treatment.
Gaining Control Over Traumatic Experiences: The Role of Guilt in Posttraumatic Stress Disorder
Journal of Aggression, Maltreatment & Trauma, 2017
The present study explores the relationship between guilt, sense of control, and posttraumatic stress disorder. Seventyeight participants who had experienced a traumatic event completed the following self-report measures online: the Posttraumatic Stress Diagnostic Scale, the Guilt Cognitions subscale of the Trauma-Related Guilt Inventory, the Posttraumatic Cognitions Inventory, and Sense of Control During the Trauma. Results revealed that "behavioral selfblame" that refers to functioning during the trauma, positively correlated with posttraumatic stress symptoms. However, when Sense of Control During the Trauma was introduced into the analysis, this correlation appeared only for participants who had experienced lack of control during the traumatic event. Among the participants who had experienced a sense of control, no such link was found. Results suggest that guilt may be produced to avoid feelings of helplessness following the trauma, because guilt conveys a sense of control.
Depression and Anxiety, 2010
Background: This study examined the degree to which combat-related guilt mediated the relations between exposure to combat-related abusive violence and both Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in Vietnam Veterans. Methods: Secondary analyses were conducted on data collected from 1,323 male Vietnam Veterans as part of a larger, multisite study. Results: Results revealed that combat-related guilt partially mediated the association between exposure to combat-related abusive violence and PTSD, but completely mediated the association with MDD, with overall combat exposure held constant in the model. Follow-up analyses showed that, when comparing those participants who actually participated in combat-related abusive violence with those who only observed it, combat-related guilt completely mediated the association between participation in abusive violence and both PTSD and MDD. Moreover, when comparing those participants who observed combat-related abusive violence with those who had no exposure at all to it, combat-related guilt completely mediated the association between observation of combat-related abusive violence and MDD, but only partially mediated the association with PTSD. Conclusions: These findings suggest that guilt may be a mechanism through which abusive violence is related to PTSD and MDD among combat-deployed Veterans. These findings also suggest the importance of assessing abusive-violence related guilt among combat-deployed Veterans and implementing relevant interventions for such guilt whenever indicated. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.
The Cognitive Behaviour Therapist
This article outlines a cognitive behavioural therapy (CBT) approach to treating feelings of guilt and aims to be a practical ‘how to’ guide for therapists. The therapeutic techniques were developed in the context of working with clients with a diagnosis of post-traumatic stress disorder (PTSD); however, the ideas can also be used when working with clients who do not meet a diagnosis of PTSD but have experienced trauma or adversity and feel guilty. The techniques in this article are therefore widely applicable: to veterans, refugees, survivors of abuse, the bereaved, and healthcare professionals affected by COVID-19, amongst others. We consider how to assess and formulate feelings of guilt and suggest multiple cognitive and imagery strategies which can be used to reduce feelings of guilt. When working with clients with a diagnosis of PTSD, it is important to establish whether the guilt was first experienced during the traumatic event (peri-traumatically) or after the traumatic event...
Behavior Therapy, 2019
Trauma-related cognitions about the self and the world have been identified as a mediator of posttraumatic stress disorder (PTSD) change during prolonged exposure (PE) therapy. However, the extent to which negative cognitions mediate PTSD change in other PTSD treatments is unclear. In addition, previous studies have not tested alternate mediators of PTSD change during PE. In a sample of 216 treatment-seeking active duty military personnel with PTSD, the present study examined the specificity of the negative cognition mediation effect in both PE and presentcentered therapy (PCT). In addition, we examined another possible mediator, cognitive emotion regulation. Lagged mediational analyses indicated that negative cognitions about the self and world and the unhelpful cognitive emotion regulation strategy of catastrophizing each significantly mediated change in PTSD from baseline to 6-month follow-up. In a combined model, the mediating effect of catastrophizing was greater than negative cognitions about the world, and similar to negative cognitions about the self. Moderated mediation analyses revealed that the effect of catastrophizing was greater in PE than in PCT. Findings show that traumarelated cognitions and, to a greater degree, the emotion regulation strategy catastrophizing, both mediate PTSD change. Further research is needed to determine whether these mediating variables represent mechanisms of therapeutic change.