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A cognitive behavioural therapy (CBT) approach for working with strong feelings of guilt after traumatic events

Published online by Cambridge University Press:  09 September 2021

Kerry Young ,
Zoe J. Chessell Open the ORCID record for Zoe J. Chessell [Opens in a new window] ,
Amy Chisholm ,
Francesca Brady ,
Sameena Akbar ,
Millay Vann ,
Khadija Rouf  and
Lucinda Dixon
Kerry Young*
Affiliation:
Woodfield Trauma Service, 7A Woodfield Road, London W9 2NW, UK Oxford Rose Clinic, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
Zoe J. Chessell
Affiliation:
Woodfield Trauma Service, 7A Woodfield Road, London W9 2NW, UK
Amy Chisholm
Affiliation:
Woodfield Trauma Service, 7A Woodfield Road, London W9 2NW, UK The Helen Bamber Foundation, 15–20 Baynes Street, London NW1 0TF, UK
Francesca Brady
Affiliation:
Woodfield Trauma Service, 7A Woodfield Road, London W9 2NW, UK The Helen Bamber Foundation, 15–20 Baynes Street, London NW1 0TF, UK
Sameena Akbar
Affiliation:
Woodfield Trauma Service, 7A Woodfield Road, London W9 2NW, UK
Millay Vann
Affiliation:
Woodfield Trauma Service, 7A Woodfield Road, London W9 2NW, UK
Khadija Rouf
Affiliation:
Complex PTSD Service, Campbell House, Campbell Square, Northampton NN1 3EB, UK
Lucinda Dixon
Affiliation:
Oxford Rose Clinic, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
*
*Corresponding author. Email: kerryyoung1@nhs.net
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Abstract

This article outlines a cognitive behavioural therapy (CBT) approach to treating feelings of guilt and aims to be a practical ‘how to’ guide for therapists. The therapeutic techniques were developed in the context of working with clients with a diagnosis of post-traumatic stress disorder (PTSD); however, the ideas can also be used when working with clients who do not meet a diagnosis of PTSD but have experienced trauma or adversity and feel guilty. The techniques in this article are therefore widely applicable: to veterans, refugees, survivors of abuse, the bereaved, and healthcare professionals affected by COVID-19, amongst others. We consider how to assess and formulate feelings of guilt and suggest multiple cognitive and imagery strategies which can be used to reduce feelings of guilt. When working with clients with a diagnosis of PTSD, it is important to establish whether the guilt was first experienced during the traumatic event (peri-traumatically) or after the traumatic event (post-traumatically). If the guilt is peri-traumatic, following cognitive work, this new information may then need to be integrated into the traumatic memory during reliving.

Key learning aims

  1. (1) To understand why feelings of guilt may arise following experiences of trauma or adversity.

  2. (2) To be able to assess and formulate feelings of guilt.

  3. (3) To be able to choose an appropriate cognitive technique, based on the reason for the feeling of guilt/responsibility, and work through this with a client.

  4. (4) To be able to use imagery techniques to support cognitive interventions with feelings of guilt.

Keywords

cognitive behavioural therapy (CBT)cognitive techniquesguiltimagerypost-traumatic stress disorder (PTSD)

Information

Type
Invited Paper
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e26
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Kubany, E. S., & Ralston, T. C. (2006). Cognitive therapy for trauma-related guilt and shame. In Follette, V. M. & Ruzek, J. I. (eds), Cognitive-Behavioral Therapies for Trauma (pp. 258–289). Guilford Press.Google Scholar
Lee, D. A., Scragg, P., & Turner, S. (2001). The role of shame and guilt in traumatic events: a clinical model of shame-based and guilt-based PTSD. British Journal of Medical Psychology, 74, 451–466.CrossRefGoogle ScholarPubMed
Murray, H., & Ehlers, A. (2021). Cognitive therapy for moral injury in post-traumatic stress disorder. The Cognitive Behaviour Therapist, 14.CrossRefGoogle Scholar
Norman, S., Allard, C., Browne, K., Capone, C., Davis, B., & Kubany, E. (2019). Trauma Informed Guilt Reduction Therapy: Treating Guilt and Shame Resulting from Trauma and Moral Injury. Academic Press.Google Scholar

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