Sonya B Norman1,2,3,4, Christy Capone5,6, Kaitlyn E Panza2,4, Moira Haller2,4, Brittany C Davis7,8, Paula P Schnurr1,9, M Tracie Shea5,6, Kendall Browne10,11,12, Gregory J Norman4, Ariel J Lang2,3,4, Alexander C Kline2,4, Shahrokh Golshan2,4, Carolyn B Allard2,13, Abigail Angkaw2,4. 1. Executive Division, National Center for PTSD, Hartford, Vermont, USA. 2. Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA. 3. Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA. 4. Department of Psychiatry, University of California, San Diego, La Jolla, California, USA. 5. Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA. 6. Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA. 7. Department of Mental Health, James A. Haley Veterans Hospital, Tampa, Florida, USA. 8. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA. 9. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. 10. Department of Research, Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA. 11. Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA. 12. Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA. 13. Department of Clinical Psychology, California School of Professional Psychology at Alliant International University, San Diego, California, USA.
Abstract
INTRODUCTION: Trauma-related guilt is common, associated with posttraumatic mental health problems, and can persist after posttraumatic stress disorder (PTSD) treatment. We compared the efficacy of two six-session psychotherapies, Trauma-Informed Guilt Reduction (TrIGR) and Supportive Care Therapy (SCT), for reducing trauma-related guilt. TrIGR helps patients accurately appraise their role in the trauma and re-engage in values. In SCT, patients guide session content. METHODS: A total of 184 veterans seeking VA mental health services were enrolled across two sites; 145 veterans (mean age: 39.2 [8.1]; 92.4% male; 84.8% with PTSD) who endorsed guilt related to a traumatic event that occurred during a post 9/11 Iraq or Afghanistan deployment were randomized and assessed at baseline, posttreatment, 3- and 6-month follow-up. RESULTS: Linear mixed models using intent-to-treat analyses showed guilt decreased in both conditions with a greater decrease for TrIGR (treatment × time, -0.22; F 1, 455.2 = 18.49, p = .001; d = 0.92) than supportive therapy. PTSD and depressive symptoms showed the same pattern. TrIGR had significantly higher likelihood of PTSD treatment response (67% vs. 40%), loss of PTSD diagnosis (50% vs. 14%), and meaningful change in depression (54% vs. 27%) than supportive therapy. Psychological distress and trait shame improved in both conditions. Quality of life did not change. CONCLUSIONS: Targeting guilt appears to be an effective means for reducing posttraumatic symptoms and distress. Published 2022. This article is a U.S. Government work and is in the public domain in the USA.
INTRODUCTION: Trauma-related guilt is common, associated with posttraumatic mental health problems, and can persist after posttraumatic stress disorder (PTSD) treatment. We compared the efficacy of two six-session psychotherapies, Trauma-Informed Guilt Reduction (TrIGR) and Supportive Care Therapy (SCT), for reducing trauma-related guilt. TrIGR helps patients accurately appraise their role in the trauma and re-engage in values. In SCT, patients guide session content. METHODS: A total of 184 veterans seeking VA mental health services were enrolled across two sites; 145 veterans (mean age: 39.2 [8.1]; 92.4% male; 84.8% with PTSD) who endorsed guilt related to a traumatic event that occurred during a post 9/11 Iraq or Afghanistan deployment were randomized and assessed at baseline, posttreatment, 3- and 6-month follow-up. RESULTS: Linear mixed models using intent-to-treat analyses showed guilt decreased in both conditions with a greater decrease for TrIGR (treatment × time, -0.22; F 1, 455.2 = 18.49, p = .001; d = 0.92) than supportive therapy. PTSD and depressive symptoms showed the same pattern. TrIGR had significantly higher likelihood of PTSD treatment response (67% vs. 40%), loss of PTSD diagnosis (50% vs. 14%), and meaningful change in depression (54% vs. 27%) than supportive therapy. Psychological distress and trait shame improved in both conditions. Quality of life did not change. CONCLUSIONS: Targeting guilt appears to be an effective means for reducing posttraumatic symptoms and distress. Published 2022. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Lauren M Borges; Sean M Barnes; Jacob K Farnsworth; Kent D Drescher; Robyn D Walser Journal: Front Psychiatry Date: 2022-06-30 Impact factor: 5.435