Trauma Informed Guilt Reduction Therapy With Combat Veterans☆

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Highlights

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    Trauma-related guilt is highly prevalent among combat veterans.

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    Trauma Informed Guilt Reduction (TrIGR) therapy is designed to reduce guilt.

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    TrIGR may help to reduce trauma-related guilt severity and associated distress.

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    Changes in trauma-related guilt were correlated with reductions in PTSD symptoms.

Abstract

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.

Section snippets

Intervention

TrIGR was developed as a therapeutic tool to help veterans accurately appraise their combat trauma-related guilt and reidentify and reengage in their values to aid in their recovery from posttraumatic distress. TrIGR is based on the work of Kubany and colleagues (Kubany et al., 1995, Kubany, 2000, Kubany and Watson, 2003), who identified four types of cognitive errors present in individuals who experience trauma-related guilt. These cognition errors are hindsight-bias (i.e., believing that the

Participants

Ten post-9/11 combat veterans completed treatment, 9 of whom completed a posttreatment assessment (out of 22 who were referred and screened eligible, and 14 who were enrolled). Demographic and deployment characteristics of participants and dropouts are presented in Table 1. Inclusion criteria were having guilt and distress related to a combat-related trauma that occurred while serving in OEF/OIF. Exclusion criteria were having acute safety concerns (i.e., suicidality, homicidality, substance

Feasibility and Satisfaction

We completed a baseline screening with 21 male and 1 female outpatient veterans. Eight participants who qualified for the study chose not to enroll because they decided guilt was not their primary concern, chose another treatment option, preferred not to participate in research, decided not to pursue any psychotherapy, or did not return follow-up calls. We enrolled 13 male and 1 female outpatient veterans. Ten completed treatment and 9 completed their posttreatment assessment. Four participants

Discussion

Participation in TrIGR was associated with reductions in trauma-related guilt severity and distress. Satisfaction with the intervention was extremely high and the fact that no one dropped out during or immediately following the guilt module (which is believed to be the active ingredient or crux of the treatment) suggests acceptability of the intervention. Eight qualifying patients (36%) chose not to participate in the study following screening. This is consistent with the engagement rate of

Conclusion

Trauma-related guilt has been identified as having a role in the development and maintenance of multiple forms of posttraumatic psychopathology. Cognitive interventions to reduce trauma-related guilt may be a pathway by which to reduce symptoms of PTSD and other posttraumatic psychopathology (Held et al., 2011, Kubany et al., 1995). TrIGR therapy, a 4-module cognitive-behavioral psychotherapy designed to reduce nonadaptive posttraumatic guilt related to combat, showed promising results in this

Conflict of Interest Statement

This was funded by a School of Medicine Academic Senate Award to two of the authors. One author was supported by the Center of Excellence for Stress and Mental Health, another by an NIAAA T32 fellowship, and another by an NIAAA F31 fellowship. There are no real or potential conflicts of interest.

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    ☆

    This research was supported by a UCSD School of Medicine Academic Senate Award to Drs. Carolyn Allard and Sonya Norman, a NIAAA T-32 fellowship to Ursula Myers, an F-31 fellowship to Kendall Wilkins, and by the VASDHS Center of Excellence in Stress and Mental Health. We would like to thank Candice Colon for her help with data collection and entry.

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