(PS10-15) Evaluating Changes in Trauma-Related Guilt: A Comparison of TMT and PE

Abstract Text:

Background: Trauma-related guilt (TRG) is associated with the development and maintenance of posttraumatic stress disorder (PTSD). The present study aimed to compare the effects of a three-week Trauma Management Therapy intensive outpatient program (IOP) to a compressed two-week Prolonged Exposure (CPE) program on self-reported TRG symptoms.

Method: Generalized linear modeling with mixed effects examined the moderating effects of the TMT IOP and CPE on change in Trauma-Related Guilt Inventory (TRGI) scores among a sample of active duty military personnel. Participants were assessed and randomly assigned to receive the TMT IOP (n = 43) or CPE treatment (n = 57). Changes in TRGI scores were measured from pre-treatment to post-treatment, as well as to 3-month and 6-month follow-ups. These effects were then examined among three different trauma types (e.g., combat, military sexual trauma (MST), and other trauma).

Results: Among participants whose index trauma involved combat exposure, TRGI scores were significantly lower in both the CPE and TMT treatment groups at post-treatment (β = -9.26, p = .008; β = -9.28, p = .011, respectively), 3-month follow-up (β = -10.67, p = .005; β = -12.71, p = .002), and 6-month follow-up (β = -12.06, p = .003; β = -15.69, p < .001) compared to pre-treatment. Among participants whose index trauma was MST, TRGI scores were significantly lower in both CPE and TMT at post-treatment (β = -19.86, p < .001; β = -37.34, p < .001, respectively), 3-month follow-up (β = -22.71, p < .001; β = -25.60, p < .001), and 6-month follow-up (β = -34.48, p < .001; β = -23.93, p < .001) compared to pre-treatment. While participants in the MST group who received TMT reported a greater decrease in TRGI symptoms at post-treatment than those who received CPE, their scores appeared to increase between post-treatment and the 3-month and 6-month follow-ups, whereas participants in the MST group who received CPE continued to experience decreases in TRGI scores after treatment. Among participants whose index trauma was classified as other, TRGI scores were significantly lower in the CPE group but not the TMT group at post-treatment (β = -12.53, p = .044; β = -6.00, p = .463, respectively), 3-month follow-up (β = -20.18, p = .004; β = -4.55, p = .606), and 6-month follow-up (β = -17.37, p = .012; β = -4.80, p = .587).

Conclusion: Both TMT and CPE appear to result in significant reductions in TRGI scores among active duty personnel with combat traumas or MST. TMT may be particularly beneficial in reducing TRGI scores as it includes guilt-specific therapeutic interventions (e.g., Socratic questioning or responsibility pies) in addition to exposure therapy that can be tailored to an individual’s treatment needs. However, the increase in TRGI scores at 3-month and 6-month follow-ups (compared to post-treatment) among TMT participants whose index trauma was MST suggests that booster sessions targeting TRG may be needed.