Guilt, Shame and Compassionate Imagery in War: Traumatized German Soldiers with PTSD, a Pilot Study

Abstract

Background: The consideration of specific trauma-associated emotions poses a challenge for the differential treatment planning in trauma therapy. Soldiers experiencing deployment-related posttraumatic stress disorder often struggle with emotions of guilt and shame as a central component of their PTSD. Objective: The purpose of this study was to examine the extent to which soldiers’ PTSD symptoms and their trauma-related guilt and shame may be affected as a function of their ability to develop compassionate imagery between their CURRENT SELF (today) and their TRAUMATIZED SELF (back then). Method: The sample comprised 24 male German soldiers diagnosed with PTSD who were examined on the Posttraumatic Diagnostic Scale (PDS) and two additional measures: the Emotional Distress Inventory (EIBE) and the Quality of Interaction between the CURRENT SELF and the TRAUMATIZED SELF (QUI-HD: Qualität der Interaktion zwischen HEUTIGEN ICH und DAMALIGEN ICH) at pre- and post-treatment and again at follow-up. The treatment used was imagery rescripting and reprocessing therapy (IRRT). Results: Eighteen of the 24 soldiers showed significant improvement in their PTSD symptoms at post-treatment and at follow-up (on their reliable change index). A significant change in trauma-associated guilt and shame emerged when compassionate imagery was developed towards one’s TRAUMATIZED SELF. The degree and intensity of the guilt and shame felt at the beginning of treatment and the degree of compassionate imagery developed toward the TRAUMATIZED SELF were predictors for change on the PDS scores. Conclusions: For soldiers suffering from specific war-related trauma involving PTSD, the use of self-nurturing, compassionate imagery that fosters reconciling with the traumatized part of the self can effectively diminish trauma-related symptoms, especially when guilt and shame are central emotions.

Journalists covering the refugee and migration crisis are affected by moral injury not PTSD

“…This aetiological underpinning can explain the close association between moral injury and guilt and shame, 21 two emotions that are not part of the diagnostic criteria for PTSD even though they may be associated with it. 22 …”

Reescritura de Imágenes para el Tratamiento del Estrés Postraumático: Análisis y Revisión

“…Respecto al diseño utilizado se observa una alta diversidad: desde trabajos que no llevan a cabo asignación aleatoria ni utilizan grupo control (Alliger-Horn et al, 2016), hasta algunos con diseños metodológicos de mayor calidad que incluyen varias condiciones de tratamiento incluyendo lista de espera y asignación aleatoria .…”

A cognitive behavioural therapy (CBT) approach for working with strong feelings of guilt after traumatic events

“…Fortunately, a range of ideas have been suggested to target trauma-related guilt: restructuring of any erroneous cognitions underlying the guilt (Kubany, 1994;Kubany, 1997;Kubany et al, 2004;Murray and Ehlers, 2021), combining this cognitive work with a values focus (Norman et al, 2014), imagery rescripting (Alliger-Horn et al, 2016;Arntz et al, 2007;Grunert et al, 2007), and the development of self-compassion (Held and Owens, 2015;Held et al, 2018). Kubany and Watson (2003) also suggest that we may support survivors to tackle guilt by proactively making amends or via seeking forgiveness from self or other.…”