A model for treating COVID-19–related guilt, shame, and moral injury.

Abstract

During the unprecedented COVID-19 pandemic, people around the world have faced a myriad of heart-rending and ethically difficult scenarios (e.g., not being able to tend to a sick or dying loved one) that may lead to subsequent guilt, shame, or moral injury. Trauma-informed guilt reduction therapy is a brief intervention that helps clients accurately appraise their role in a stressful event (such as those experienced during the COVID-19 pandemic) and find positive ways to express important values going forward. Future studies of trauma-informed guilt reduction therapy with those affected by COVID-19 will be helpful for clarifying its effectiveness with this population.

Unemployment, Employability and COVID19: How the Global Socioeconomic Shock Challenged Negative Perceptions Toward the Less Fortunate in the Australian Context

“…While not predicted, these results are also interpretable in the context of the pervasive job loss that accompanied the COVID19 crisis. Haller et al (2020), for example, argue that the highly distressing, morally difficult, and cumulative nature of COVID19 related stressors presents a perfect storm to result in a guilt and shame responses. The context of mass job losses may leave "surviving" workers feeling increasingly guilty.…”

COVID-19 Psychological Implications: The Role of Shame and Guilt

“…Untreated guilt that is related with a stressor event can be associated with severe mental health complications including posttraumatic stress disorder, depression, suicidal ideation, problematic substance use, and poorer functioning and quality of life (Tracy et al, 2007;Bryan et al, 2014;Browne et al, 2015;Griffin et al, 2019). Also, in COVID-19 stress-related events, maladaptive guilt can result when distress is taken as evidence of wrongdoing (e.g., "I feel terrible so I must have done something horribly wrong") and making it impossible to evaluate actual evidence and come to an accurate perspective or change one's behavior, thereby maintaining and worsening personal distress (Haller et al, 2020;Sahoo et al, 2020). This type of emotion involves feelings of personal hyper-responsibility over aspects that the individual has little or no control.…”

“…This type of emotion involves feelings of personal hyper-responsibility over aspects that the individual has little or no control. Therefore, guilt can be easily elicited by experiences related to COVID-19 transmission (Haller et al, 2020;Ransing et al, 2020). A prolonged condition of uncertainty and constant alert related to COVID-19 combined with a fear of infecting others can determine a threat of maladaptive guilt that has disruptive consequences for mental health (Brooks et al, 2020).…”

“…Psychopathological symptoms elicited by shameful experiences can vary from eating disorders and depression to anxiety disorders (Cândea and Szentagotai-Tǎta, 2018;Oliveira et al, 2018;Melo et al, 2020). The highly distressing and cumulative nature of COVID-19related stressors can often be an ideal situation to result in shame response (although the actual prevalence will not be known for some time) (Haller et al, 2020;Ransing et al, 2020). Therefore, shame related to COVID-19 can engender traumatic aspects based on perceptions of having no value to others, or worse, of being dangerous to them (Dorahy et al, 2017).…”

Witnessing unnecessary suffering: A call for action and policy change to increase access to psycho‐oncology care

“…Although this may be unfamiliar and uncomfortable, being political is essential to promote access to care. Not being able to care for the patients who need us takes a stark toll and contributes to moral injury 4,5 . This is occurring at a time when we need to care for each other and support a diverse workforce that can rebuild trust and take action to increase access to care 6 .…”