Category: PTSD

Symposium

Guilt in the Treatment of PTSD Among Active Duty Military Personnel

Friday, November 17
3:30 PM - 5:00 PM
Location: Sapphire Ballroom B, Level 4, Sapphire Level

Keywords: Military | Prolonged Exposure | PTSD
Presentation Type: Symposium

Guilt is a commonly reported emotion among PTSD patients, but it is unclear whether guilt severity should impact PTSD treatment recommendations.  Two related issues have been debated: whether existing evidence-based treatments such as prolonged exposure (PE) therapy are effective in reducing PTSD symptoms among patients with high guilt, and whether PE is effective in reducing guilt severity relative to alternate treatments. We examined these questions among 366 treatment-seeking post-9/11 active duty military personnel with primary PTSD using data that were collected as part of a larger trial comparing: 1) Spaced-PE (S-PE; 10 sessions delivered over 8 weeks), 2) Present Centered Therapy, a manualized therapy that focuses on current life problems that may or may not be trauma- or PTSD-related (PCT; 10 sessions delivered over 8 weeks [the control comparison for S-PE]), 3) Massed-PE (M-PE; 10 sessions delivered over 2 weeks), and 4) Minimal Contact Control group (MCC; 10-15 minute therapist phone call weekly for 4 weeks [the control comparison for M-PE]). Participants completed the PTSD Symptom Scale – Interview Version (Foa et al., 1993) and Trauma Related Guilt Inventory (TRGI) – Brief (Kubany et al., 1996) at pre-treatment, post-treatment and follow-ups. All analyses were intention-to-treat. Results showed that baseline scores on the Responsibility, Wrongdoing, and Justification TRGI subscales did not impact reductions in PTSD for S-PE orPCT (ps=.387- .888). Reductions in guilt over time were significant across all conditions (all ps>.004), with no significant differences in reductions between M-PE and MCC (ps=.085- .88) or between S-PE and PCT (ps=.110-.927); an exception was a significant effect favoring S-PE over PCT on reductions on the Justification subscale, but this was due to significant baseline differences on this subscale. Thus, the current study found no evidence that baseline guilt impacts PTSD recovery during PE or PCT, suggesting that exposure therapy is not contraindicated for those reporting high guilt. We also found that all conditions were associated with reductions in guilt over time, suggesting that changes in guilt may occur following any intervention that successfully reduces PTSD symptoms. Notably, TRGI scores in this sample were lower than have been reported in civilian and veteran samples, which limited our ability to find treatment effects. 

Carmen McLean

Assistant Professor
University of Pennsylvania, Center for the Treatment and Study of Anxiety

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