Trauma Informed Guilt Reduction Therapy. Treating Guilt and Shame Resulting from Trauma and Moral Injury

Table of Contents

Part 1 Introduction and background 1. Introduction 2. The connection between guilt and shame and mental health problems 3. Overview of TrIGR

Part 2 Preparation and case related considerations 4. Is TrIGR the right choice for your client? 5. Assessment of guilt, shame, PTSD, and other posttraumatic distress 6. Preparing clients for TrIGR 7. Considerations for therapists 8. Therapist self-care 9. TrIGR in a group format

Part 3 Therapist manual Module 1: Introduction to posttraumatic guilt and shame Session 1: Overview of TrIGR, introduction to guilt and shame Session 2: Common problems and types of guilt related to trauma Module 2: Debriefing the traumatic event and appraising trauma-related guilt and shame Session 3 and 4: Guilt appraisal Module 3: Commitment to living a value-driven life and setting value-driven goals Session 5: Commitment to living a value-driven life and setting value-driven goals Session 6: A plan to live a valued life

Part 4 Client workbook Workbook Module 1: Introduction to posttraumatic guilt and shame Session 1: Overview of TrIGR, introduction to guilt and shame Session 2: Common problems and types of guilt related to trauma Workbook Module 2: Debriefing the traumatic event and appraising trauma-related guilt and shame Session 3 and 4: Guilt appraisal Workbook Module 3: Commitment to living a value-driven life and setting value-driven goals Session 5: Commitment to living a value-driven life and setting value-driven goals Session 6: A plan to live a valued life

Authors

Sonya Norman Professor, Department of Psychiatry, University of California San Diego, USA. Sonya Norman, PhD, received her B.A. from Vassar College in cultural anthropology and her PhD in counseling psychology from Stanford University. She is a Professor of Psychiatry at the University of California San Diego School of Medicine and director of the PTSD Consultation Program at the VA's National Center for PTSD. She previously directed a PTSD treatment program for Veterans who served in Iraq and Afghanistan. Dr. Norman conducts research in treating posttraumatic guilt, shame, and moral injury as well as in the treatment of PTSD and addictions. She is passionate about bringing together clinical work and research such that her research ideas are born from her clinical work and the goal of her research is to improve treatment outcomes for people who have experienced trauma. She has served as a training director for a postdoctoral fellowship in evidence-based psychotherapy. Dr. Norman has had research grants funded by the National Institute of Health, the Department of Defense, and the VA and has over 100 publications related to posttraumatic guilt and shame, PTSD and associated problems. Carolyn Allard Associate Professor and Program Director, PhD Program, California School of Professional Psychology, Alliant International University and Associate Professor, Department of Psychiatry, University of California San Diego, USA. Carolyn B. Allard, Ph.D., ABPP, received her B.A. (Hons.) from Queen's University in Kingston, Canada, and her Ph.D. in Clinical Psychology from the University of Oregon in Eugene, U.S.A. Dr. Allard is a licensed and board certified clinical psychologist who has served as Director of the Veterans Affairs San Diego Healthcare System Military Sexual Trauma & Interpersonal Trauma Clinic and Advanced Fellowship in Women's Health, Associate Professor of Psychiatry at University of California San Diego, and Clinical Director of a private-sector residential mental health program. She currently is the PhD Program Director at the California School of Professional Psychology at Alliant International University and has a private practice. For over 20 years, Dr. Allard has worked with survivors of many different types of trauma and specializes in the treatment of complex posttraumatic reactions to chronic and severe interpersonal trauma, including PTSD, dissociation, guilt and shame. She has trained hundreds in working with trauma survivors, from entry level students to seasoned professionals, and she is an active trauma researcher who has published articles in several scientific journals. Kendall Browne Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, USA. Kendall Browne, PhD, earned her PhD from the San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology where she was a National Institute on Alcohol Abuse and Alcoholism predoctoral fellow for four years. She is currently a licensed psychologists and core faculty member within the VA Centers of Excellence in Substance Addiction Treatment and Education and an Acting Assistant Professor in the Department of Psychiatry and Behavioral Sciences within the University of Washington, School of Medicine. Dr. Browne has training and expertise in the assessment and treatment of substance use disorders and co-occurring trauma-related symptoms. Her research efforts to date have largely focused on health services work aiming to develop and evaluate evidence-based practices for substance use disorders and co-occurring posttraumatic stress disorder. Christy Capone Assistant Professor, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, USA. Christy Capone, PhD is a licensed, clinical psychologist with the Department of Veterans Affairs in Providence, RI. She is an Assistant Professor in Psychiatry and Human Behavior at the Warren Alpert School of Medicine at Brown University. Dr. Capone works with military veterans in the Trauma Recovery Services clinic at the VA where she provides individual and group psychotherapy related to co-occurring posttraumatic stress disorder and substance use. She serves as a clinical supervisor and research mentor to psychology and psychiatry residents who are learning to deliver evidence-based psychotherapies and conduct clinical research. Informed by her clinical work with veterans, Dr. Capone became interested in how to best address trauma-related guilt and shame, a common and vexing problem that arose again and again in therapy and for many clients presented a formidable barrier to wellness and recovery. Dr. Capone's research interests have focused on this area for the past several years and she currently has a research grant funded by the Department of Defense. Dr. Capone also conducts research in novel treatments for co-occurring PTSD and substance use and has published several manuscripts in this area. Brittany Davis Assistant Professor, Department of Psychiatry, Morsani School of Medicine, University of South Florida, USA. Brittany Davis, Ph.D. received her Ph.D. in clinical psychology from the California School of Professional Psychology at Alliant International University. She is a licensed clinical psychologist with the Department of Veterans Affairs at the James A. Haley Veteran's Hospital and is an Assistant Professor at the University of South Florida's Department of Psychiatry and Behavioral Neurosciences. Dr. Davis values training and education and has served as a clinical supervisor for psychology and psychiatry residents. Dr. Davis has remained active in research with a focus on trauma-related disorders, guilt and shame, and substance use disorders. Dr. Davis specializes in the treatment of PTSD and comorbid substance use disorders, and has utilized treatment approaches with flexibility and creativity, to assist with active duty service members, first responders, and veterans within inpatient, residential, and outpatient settings. Dr. Davis works collaboratively with her clients and believes that if willing, all individuals have the capacity and capability to successfully overcome the distress of difficult times that may occur within the lifetime. Edward Kubany formerly Research Clinical Psychologist, Department of Veterans Affairs, National Center for PTSD, Honolulu, Hawaii. Edward Kubany, PhD., ABPP specialized in the assessment and treatment of PTSD and posttraumatic guilt in his research and clinical practice for close to forty years. He was a research clinical psychologist with the Department of Veterans Affairs, National Center for PTSD, in Honolulu, Hawaii for fourteen years. Dr. Kubany has numerous peer-reviewed publications and was principle investigator or co-principal investigator on four federal grants. He is first author of a self-help book for women who survived interpersonal violence, Healing the Trauma of Domestic Violence, and a clinician guide, Treating PTSD in Battered Women. Dr. Kubany was on the forefront of bringing attention to the role of posttraumatic guilt in PTSD and posttraumatic distress as early as the 1990's. He developed measures and intervention strategies for posttraumatic guilt that are widely used to this day. His work in understanding posttraumatic guilt and in intervention strategies was critical to the development of TrIGR.