The role of shame and guilt in traumatic events: A clinical model of shame‐based and guilt‐based PTSD

Abstract

Post-traumatic stress disorder is currently classified as an anxiety disorder with fear as the predominant emotion. This has led to the development of treatment techniques such as exposure aimed at alleviating fear. This article highlights the need to address other emotional responses, in particular shame and guilt, when assessing and treating PTSD. Hence, it presents two clinical models of shame-based PTSD and guilt-based PTSD. These models are offered as aids to clinicians in assessing and formulating cases of PTSD where shame and guilt are salient issues. The models highlight the importance of assessing meaning in the context of pre-existing schemas and address two pathways to the development of shame and/or guilt: schema congruence and schema incongruence. Several treatment implications are drawn from the models.

The role of guilt in Posttraumatic Stress Disorder

“…This article will focus on the concept of guilt as defined by Tilghman-Osborne et al (2010). In relation to traumatic events, this definition fits within the clinical model of guilt-based PTSD proposed by Lee et al (2001). This model states that evaluation of the personal meaning of a traumatic event by the individual may crucially influence the development of PTSD.…”

“…A growing body of evidence now indicates that, contrary to traditional accounts, PTSD may not primarily be an anxiety-based disorder. Instead, a wide range of other emotions accompanies PTSD and may be central to its development and maintenance (Lee, Scragg, & Turner, 2001; Power & Fyvie, 2012). Accordingly, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) changed its classification of PTSD from anxiety-related disorder to trauma- and stressor-related disorder and added anger, guilt, and shame alongside fear as significant emotional responses to trauma.…”

“…The emotion of guilt in particular has been consistently linked to the development and maintenance of PTSD symptomatology (Kubany & Watson, 2003; Lee et al, 2001; Wilson, Drozdek, & Turkovic, 2006). Using a self-report measure, Henning and Frueh (1997) found severity of combat-related guilt in veterans to be positively correlated with re-experiencing and avoidance symptoms of PTSD, as well as with a general measure of PTSD severity.…”

“…Beliefs about the self are not altered and therefore feelings of guilt are limited to the event-related memory (circumscribed guilt). Still, a feeling of violation of personal standards or responsibility may cause individuals to experience guilt-based intrusions that are characterized by replaying what happened in order to find indications when and how the individual could have acted differently to prevent the traumatic event (ruminative replay; Lee et al, 2001). …”

“…The evaluation of personal involvement may be influenced by factors such as perceived wrongdoing, responsibility, and self-blame (Foa & Rothbaum, 1999; Kubany et al, 1996). Feelings of guilt, in turn, may form the basis of trauma-related intrusions typical of PTSD symptomatology (Lee et al, 2001). Thus, this model proposes guilt to function as a meditational process underlying the development of PTSD following a traumatic experience.…”