man-gestures-as-he-speaks-to-therapistGuilt and shame may linger even after successful treatment of PTSD causing distress and other negative feelings for the Veteran. Feeling guilty often happens when we say or do something that violates our personal values. The discrepancy between our strong beliefs and our behaviors serves to remind us not to engage in the behavior again, so some guilt can be adaptive. But, sometimes, guilt becomes so powerful that it can interfere with our thinking and reasoning and result in even more guilt, shame and distress.

Research by Dr. Sonya Norman and her colleagues found that Veterans who felt guilt and shame about their combat trauma had more severe PTSD and depression symptoms. Some of the Veterans believed that continuing to feel guilt and shame is necessary to keep them from violating their values. The persistence of guilt is associated with unhealthy thinking that can further increase distress.

Based on this understanding of post-traumatic guilt, Dr. Sonya Norman and her team developed a treatment aimed at changing thoughts and behaviors that become associated with guilt. Their intervention, called TrIGR, short for Trauma Informed Guilt Reduction, is a six session psychotherapy that targets thoughts associated with traumatic guilt, and it helps the Veteran re-evaluate their behaviors with these changed ways of thinking and reasoning. It also focuses on identifying and clarifying personal values and helping the Veteran set plans to re-engage and live according to values in a meaningful way.