Shame and guilt in PTSD

Cunningham, Katherine C.

doi:10.1016/b978-0-12-816022-0.00006-5

Cited by 26 publications

(26 citation statements)

References 96 publications

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“…Furthermore, to our knowledge, there is a lack of studies exploring the relationship between disclosure of trauma and CPTSD, even though studies conducted in the context of PTSD shows that disclosure of trauma could have a robust therapeutic effect (Gradus, 2017). Traumatic experiences more commonly associated with CPTSD, such as interpersonal violence, could lead to more negative adverse emotional reactions such as shame or guilt (Cunningham, 2020), which are shown to inhibit trauma disclosure. Therefore CPTSD related trauma experiences could lead to a poorer negative self-concept, more adverse psychopathological reactions and poorer treatment outcomes (Bedard-Gilligan et al, 2012;MacGinley et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population

Kvedaraitė

Geležėlytė

Kairyte

et al. 2021

Int J Soc Psychiatry

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Background: After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance. Aims: This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ). Methods: The study sample included 885 participants (age M[ SD] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma. Results: The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population. Conclusion: Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.

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Section: Introductionmentioning

confidence: 99%

Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population

Kvedaraitė

Geležėlytė

Kairyte

et al. 2021

Int J Soc Psychiatry

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“…diagnostic criteria (American Psychological Association, 2013). Although the associations of shame and guilt with PTSD, and the role that they play in its severity, have been established (Cunningham, 2020; Cunningham et al, 2018), there have been conflicting results as to whether these other emotions are ameliorated by evidence-based PTSD treatments. Whereas some studies have shown a decrease in guilt when using PE (Rothbaum et al, 2003; Stapleton et al, 2006), other outcome studies have indicated that shame and guilt are associated with poorer outcomes when PE is used (Grunert et al, 2007).…”

Section: Shame Guilt and Anger In Ptsdmentioning

confidence: 99%

“…Theorists have proposed that shame and guilt contribute to the emotional aversiveness of the trauma memory and thus to increased frequency and intensity of intrusive memories of the trauma (Goldblatt, 2013; Taylor, 2015). Exposure to the traumatic memory may also lead to an exacerbation of these feelings if they are not directly addressed and treated (Lee et al, 2001; Taylor, 2015), thus harming the emotional processing of the traumatic event (Cunningham, 2020; Øktedalen et al, 2015). Although fear is current or future oriented, guilt is a retrospective emotion and less amenable to change through exposure—it may prevent the successful integration of the traumatic events with prior beliefs and maintain avoidant coping strategies that sustain PTSD (Vermetten & Jetly, 2018).…”

Section: Shame Guilt and Anger In Ptsdmentioning

confidence: 99%

“…They found that changes in trauma-related guilt and shame predicted changes in PTSD symptom severity 3 days later. Although empirically supported treatments for PTSD have been shown to reduce guilt (Cunningham, 2020), negative self-referent cognitions are a common residual symptom following treatment (Larsen et al, 2019). Similarly, although there is evidence that PTSD treatments reduce anger, there is often significant residual anger after treatment completion (Andrews et al, 2000; Dillon et al, 2020).…”

Section: Shame Guilt and Anger In Ptsdmentioning

confidence: 99%

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Beyond the conditioned fear model: Narrative reconstruction for a woman with posttraumatic stress disorder.

Gofman

Kivity

Peri

2022

Journal of Psychotherapy Integration

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Although fear is considered to be the dominant affect associated with posttraumatic stress disorder (PTSD), recent changes in diagnostic criteria have resulted in the addition of anger, guilt, and shame as significant emotional states linked with the disorder. The presence of these other emotions is associated with poorer prognosis, slower recovery, and more residual symptoms. However, treatment strategies for these other kinds of PTSD presentation have been less well explored than fear. Narrative reconstruction-an integrative treatment for PTSD-combines components of cognitive behavioral therapy, such as exposure and cognitive restructuring, alongside psychodynamic features. Incorporated psychodynamic elements include the expression of emotions, identification of recurring themes and patterns, interpersonal relationships, the influence of past experiences, and the integration of dissociated emotional schemas. During narrative reconstruction, the patient and therapist reconstruct an organized, coherent, and detailed written narrative of the patient's traumatic experience. Narrative reconstruction employs psychodynamic elements to help identify and address the underlying feelings of shame, guilt, and anger. To illustrate how these other emotions are dealt with in narrative reconstruction, a case study is presented of a woman with chronic PTSD who previously had limited success with exposure-based treatment. Unprocessed shame, anger, and loneliness are discovered, and connections are made to past and current family situations. Pre-to posttreatment, session-by-session, and follow-up data on clinician-administered and self-report measures demonstrate significant symptom reduction. Clinical vignettes and a case discussion demonstrate the therapeutic model and technique.

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“…It has been proposed that guilt and shame are involved in the aetiology and maintenance of trauma-related disorders for instance by driving behavioural avoidance and fostering dysfunctional beliefs about the trauma and its consequences (DeCou et al, 2016 ; Fletcher, 2011 ; Held et al, 2015 ; Pugh et al, 2015 ; Street & Arias, 2001 ). Some studies have directly compared the relative contribution of guilt vs. shame to PTSD (for an overview, see Cunningham, 2020 ), indicating that guilt and shame independently predict PTSD severity, with a somewhat higher association for shame than for guilt (Bannister et al, 2018 ; Cunningham, 2020 ; Shi et al, 2021 ). Further, shame but not guilt mediated PTSD symptom reduction during psychotherapeutic group treatment (Ginzburg et al, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

A brief measure of guilt and shame: validation of the Guilt and Shame Questionnaire (GSQ-8)

Hoppen

Schlechter

Arntz

et al. 2022

European Journal of Psychotraumatology

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Background: Guilt and shame regulate basic human processes such as social cognition and relations. Both emotions are also involved in the aetiology and maintenance of trauma-related mental disorders such as posttraumatic stress disorder (PTSD). However, a concise scale that adequately captures these constructs is currently lacking, impeding research efforts to understand them more thoroughly. Objective: To this end, we developed the eight-item Guilt and Shame Questionnaire (GSQ-8) in English, German, and Dutch. Method: We examined the reliability and validity of the GSQ-8 in a clinical sample of adults seeking treatment for childhood-trauma-related posttraumatic stress disorder ( n = 209), a sample of adults who had suffered at least one traumatic life event reporting different levels of PTSD symptoms ( n = 556), and a non-clinical sample of adults ( n = 156). Results: Theory-driven confirmatory factor analyses confirmed two correlated latent factors guilt and shame with four items for each factor. Across all samples, two-factor models yielded better model fit than one-factor solutions. Measurement invariance across the three samples, gender, and Dutch and German language was mostly established. Guilt and shame composite scores were associated with PTSD symptoms, depressive symptoms, life satisfaction, mental health-related quality of life, and self-blame, thus supporting scale validity. Importantly, both subscales predicted PTSD symptoms, depression, life satisfaction, and mental health-related quality of life over and above cognitions of self-blame. Conclusions: The GSQ-8 is a parsimonious, reliable, and valid tool to assess guilt and shame in clinical, sub-clinical, and non-clinical populations, allowing applications across a broad range of research questions.

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Shame and guilt in PTSD

Cited by 26 publications

References 96 publications

Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population

Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population

Beyond the conditioned fear model: Narrative reconstruction for a woman with posttraumatic stress disorder.

A brief measure of guilt and shame: validation of the Guilt and Shame Questionnaire (GSQ-8)

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