Survivor guilt is a common experience following traumatic events in which others have died. However, little research has addressed the phenomenology of survivor guilt, nor has the issue been conceptualised using contemporary psychological models which would help guide clinicians in effective treatment approaches for this distressing problem. This paper summarises the current survivor guilt research literature and psychological models from related areas, such as post-traumatic stress disorder, moral injury and traumatic bereavement. Based on this literature, a preliminary cognitive approach to survivor guilt is proposed. A cognitive conceptualisation is described, and used as a basis to suggest potential treatment interventions for survivor guilt. Both the model and treatment strategies require further detailed study and empirical validation, but provide testable hypotheses to stimulate further research in this area. Key learning aims (1) To appreciate an overview of the current available literature on the phenomenology and prevalence of survivor guilt. (2) To understand a preliminary cognitive conceptualisation of survivor guilt. (3) To understand and be able to implement treatment recommendations for addressing survivor guilt.

Survivor guilt' is a commonly used term in clinical settings and popular culture; however the phenomenon has largely been neglected in trauma-related research. There is a scarcity of research relating to the phenomenology and underlying mechanisms of survivor guilt, and no published studies to date that investigate treatment options. This study aimed to explore the lived experience of how individuals interpreted and made sense of surviving when others had died, with a view to gain a better understanding of survivor guilt. Six participants who had survived a traumatic event where others had died were interviewed. Through interpretative phenomenological analysis, a theoretical model was derived from the data, showing participants in an on-going dynamic of making sense of why they survived. Central to this model was persistent guilt about surviving and a sense of disentitlement to life, driving internal processes associated with sense-making and external processes associated with making amends. Examples from the interviews illustrate each component of the model. The results are discussed in light of existing literature on guilt, and implications for clinical interventions.