Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 23:10.1037/tra0002036.
doi: 10.1037/tra0002036. Online ahead of print.

Addressing pandemic-related guilt and shame in U.S. military veterans: A pilot randomized controlled trial of trauma-informed guilt reduction and supportive care therapy

Matthew L McCue  1 , Christy C Capone  2 , Jennifer S Wachen  3 , Katia M Harlé  1 , Brittany C Davis  4 , Kaitlyn E Panza  5 , Michelle Lyons  1 , Matthew T Luciano  5 , M Tracie Shea  6 , Moira Haller  7 , Tara E Galovski  3 , Paula P Schnurr  8 , Sonya B Norman  9
Affiliations

Addressing pandemic-related guilt and shame in U.S. military veterans: A pilot randomized controlled trial of trauma-informed guilt reduction and supportive care therapy

Matthew L McCue et al. Psychol Trauma. .

Abstract

Objective: The coronavirus disease-2019 pandemic created potentially morally injurious situations such as being unable to care for loved ones or making decisions that risked harming others. Such situations may elicit feelings of guilt and shame, which can lead to long lasting distress and functional impacts. This pilot study examined whether trauma-informed guilt reduction (TrIGR) reduced guilt and shame caused or worsened by the pandemic more than supportive care therapy (SCT).

Method: Seventy-two post-9/11 U.S. military veterans endorsing pandemic-related guilt were randomized to six sessions of either TrIGR or SCT. Participants completed the Trauma-Related Guilt Inventory, Trauma-Related Shame Inventory, and for those who endorsed a Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Criterion A trauma, the Clinician Administered Posttraumatic Stress Disorder (PTSD) Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, at baseline, posttreatment, and 1-month follow up. Linear mixed models examined within- and between-group changes over time.

Results: Both treatments reduced guilt and shame from baseline to posttreatment and 1-month follow up. Although TrIGR led to a more rapid reduction in shame by the end of treatment, SCT achieved comparable results at 1-month follow up. Among participants with PTSD, TrIGR resulted in greater reductions in guilt severity at follow up than SCT.

Conclusions: Findings suggest that veterans with PTSD and guilt may benefit more from trauma- or morally injurious event-focused interventions like TrIGR, while veterans without PTSD may be adequately supported by SCT. Larger, more diverse samples are needed to identify optimal approaches for guilt and shame arising from morally injurious events. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT02512445.

PubMed Disclaimer

Figures

Figure 1
Figure 1. CONSORT Diagram for Veterans Experiencing Pandemic-related Guilt
Figure 2
Figure 2. Greater Reductions in Shame from Pre to Post Treatment for TrIGR than SCT (N = 72)
Note. TRSI = Trauma Related Shame Inventory (Øktedalen et al., 2014). TrIGR = Trauma Informed Guilt Reduction. SCT = Supportive Care Therapy. Follow-up occurred one month after the completion of the course of therapy. Standard error bars around each time point are displayed. ns = not significant * = p < .05, ** = p < .01, *** = p < .001
Figure 3
Figure 3. Differing Reductions in Guilt Severity by Treatment Over Time Based on PTSD Diagnosis (N = 72)
Note. Guilt Severity = Global Guilt subscale of the Trauma Related Guilt Inventory (Kubany et al., 1996). Estimated marginal means for global guilt by PTSD diagnostic status. Thirty participants did not meet criteria; 42 participants did meet criteria for PTSD diagnosis based on baseline administration of the CAPS-5. Error bars indicate standard errors of the mean around each time point. Follow up assessment occurred one month after completing courses of treatment. ns = not significant * = p < .05, ** = p < .01, *** = p < .001
See this image and copyright information in PMC

References

    1. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, & Rubin GJ (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet, 395(10227), 912–920. 10.1016/S0140-6736(20)30460-8 - DOI - PMC - PubMed
    1. Breslau N, Chilcoat HD, Kessler RC, & Davis GC (1999). Previous Exposure to Trauma and PTSD Effects of Subsequent Trauma: Results from the Detroit Area Survey of Trauma. American Journal of Psychiatry, 156(6), 902–907. 10.1176/ajp.156.6.9025 - DOI - PubMed
    1. Breslau N, & Peterson EL (2010). Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma. Behaviour Research and Therapy, 48(10), 1063 1066. 10.1016/j.brat.2010.07.001 - DOI - PMC - PubMed
    1. Browne KC, Trim RS, Myers US, & Norman SB (2015). Trauma-related guilt: Conceptual development and relationship with posttraumatic stress and depressive symptoms. Journal of Traumatic Stress, 28, 134–141. 10.1002/jts.21999 - DOI - PubMed
    1. Bryan CJ, Morrow CE, Etienne N, & Ray-Sannerud B (2013). Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depression and Anxiety, 30, 55–60. 10.1002/da.22002 - DOI - PubMed

Associated data