Trauma‐Related Guilt: Conceptual Development and Relationship With Posttraumatic Stress and Depressive Symptoms

Abstract

Despite high prevalence and concerning associated problems, little effort has been made to conceptualize the construct of posttraumatic guilt. This investigation examined the theoretical model of trauma-related guilt proposed by Kubany and Watson (2003). This model hypothesizes that emotional and physical distress related to trauma memories partially mediates the relationship between guilt cognitions and posttraumatic guilt. Using path analysis, this investigation (a) empirically evaluated relationships hypothesized in Kubany and Watson's model, and (b) extended this conceptualization by evaluating models whereby guilt cognitions, distress, and posttraumatic guilt were related to posttraumatic stress disorder (PTSD) symptoms depression symptom severity. Participants were male U.S. Iraq and Afghanistan veterans (N = 149). Results yielded a significant indirect effect from guilt cognitions to posttraumatic guilt via distress, providing support for Kubany and Watson's model (β = .14). Findings suggested distress may be the strongest correlate of PTSD symptoms (β = .47) and depression symptoms (β = .40), and that guilt cognitions may serve to intensify the relationship between distress and posttraumatic psychopathology. Research is needed to evaluate whether distress specific to guilt cognitions operates differentially on posttraumatic guilt when compared to distress more broadly related to trauma memories.

Mid-Treatment Reduction in Trauma-Related Guilt Predicts PTSD and Functioning Following Cognitive Trauma Therapy for Survivors of Intimate Partner Violence

“…In addition, a dismantling study of CTT is warranted to evaluate the necessity of the TRG module, which is purported to be the key mechanism of the treatment (Kubany et al, 2003(Kubany et al, , 2004Kubany & Ralston, 2008;Kubany & Watson, 2002). Because TRG is associated with PTSD caused by other types of trauma as well (e.g., Browne et al, 2015), targeting TRG more explicitly and systematically may enhance the effectiveness of treatments in other populations. Although current gold standard treatments for PTSD are very effective, there remains room for improvement as up to 50% of people who start one of the evidence-based treatments do not experience remission (Bradley et al, 2005; IOM & Committee on Treatment of Posttraumatic Stress Disorder, 2008).…”

“…Therefore, identifying promising leverage points for change, such as TRG, and developing and testing interventions targeting these, are critical to improving outcomes. Indeed, guilt and shame are features of other psychopathology (e.g., Browne et al, 2015) so that targeting these may be a viable transdiagnostic intervention.…”

A model comparison approach to trauma-related guilt as a mediator of the relationship between PTSD symptoms and suicidal ideation among veterans

“…Figure 1A depicts Kubany’s model of trauma-related guilt. Brown and colleagues (2015) recently evaluated Kubany and Watson’s (2003) model of trauma-related guilt as a predictor of PTSD and depression symptoms. They found that guilt cognitions and distress had direct effects on PTSD and depressive symptoms, whereas global guilt did not.…”

“…Although the TRGI has proven useful, the content of the distress subscale has raised concern (e.g., Browne et al, 2015). The distress subscale measures undifferentiated emotional distress related to trauma, e.g., “What happened causes me emotional pain” (Kubany et al, 1995; Kubany et al, 1996).…”

Sport coaches’ experiences of athlete injury: the development and regulation of guilt

“…There is also a lack of consensus over the precise relationship between guilt and the development of post-traumatic stress. Here, whereas the DSM-5 (APA, 2013) situates guilt as one of a constellation of post-traumatic stress symptoms, Lee et al (2001) and Kubany and Watson (2003) have forwarded models of trauma-related guilt that conceptualize the emotion as constitutive of a type of post-traumatic response that drives other symptoms of post-traumatic stress (Browne, Trim, Myers, & Norman, 2015).…”