Optimizing trauma-focused treatments to address guilt and shame: Clinical considerations and strategies

Trauma-related guilt and shame are common following traumatic or potentially morally injurious events. Improving guilt and shame is often a goal of treatment, and providers express a desire for more strategies to manage guilt and shame for individuals with posttraumatic stress disorder (PTSD) and moral injury. Evidence-based psychotherapies for PTSD, such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing therapy, have been found to improve trauma-related guilt and shame among individuals with PTSD and/or moral injury. This paper provides an overview of the assessment of trauma-related guilt and shame, as well as therapist considerations for treatment, and explores each treatment, its evidence, and its approach to treating guilt and shame. Applied techniques and strategies to maximize effectiveness in addressing guilt and shame are provided for each of these treatments. Future research is needed to inform clinical decision-making, the treatment of residual shame and guilt, and the assessment of trauma-related shame and guilt throughout treatment.