Cognitive therapy for trauma-related guilt: Conceptual bases and treatment outlines

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There is consistent agreement that guilt has both affective and cognitive dimensions. We describe a conceptualization of event-related guilt in which cognitive elements play a crucial role. Factors posited as primary cognitive components or determinants of guilt include perceived wrongdoing, acceptance of responsibility, perceived lack of justification, and false beliefs about preoutcome knowledge caused by hindsight bias. Each cognitive component can be manifested as an irrational belief or faulty conclusion that can vary in magnitude. Numerous errors of logic that can lead trauma victims to draw faulty conclusions about their role in traumatic events are identified. Within the proposed model, correcting these thinking errors is considered the best way to alleviate guilt and is the primary task of cognitive therapy for trauma-related guilt (CT-TRG). With each guilt issue, a debriefing/imaginal exposure exercise precedes cognitive therapy. CT-TRG proper involves considerable psychoeducation and collaborative examination of each guilt component. Procedures are described for teaching clients to distinguish what they knew “then” from what they know “now” and to reassess perceptions of responsibility, justification, and wrongdoing in light of beliefs held and knowledge possessed when the trauma occurred. Several issues regarding applicability of the treatment model are discussed.

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