Changes in guilt cognitions mediate the effect of trauma-informed guilt reduction therapy on PTSD and depression outcomes

IF 2.5 3区心理学 Q2 PSYCHOLOGY, CLINICAL

Journal of Clinical Psychology Pub Date : 2024-02-10 DOI:10.1002/jclp.23659

Alexander C. Kline, Katia M. Harlé, Kaitlyn E. Panza, Brandon Nichter, Robert Lyons, Michelle Pitts, Moira Haller, Carolyn B. Allard, Christy Capone, Sonya B. Norman

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引用次数: 0

Abstract

Objective

Trauma-informed guilt reduction therapy (TrIGR), a six-session cognitive behavioral therapy targeting trauma-related guilt and distress, reduces guilt and symptoms of posttraumatic stress disorder (PTSD) and depression, yet little is known regarding how and why TrIGR may be effective.

Method

This study examined treatment-related changes in avoidant coping and trauma-related guilt cognitions as possible mediators of treatment effects on PTSD and depression outcomes at 3- and 6-month follow-up. Data were from a randomized controlled trial for treatment of trauma-related guilt comparing TrIGR and supportive care therapy among 145 post-9/11 US veterans (M_age = 39.2 [8.1], 93.8% male).

Results

At pretreatment, most (86%) met PTSD criteria. Intent to treat analyses using parallel mediation models indicated changes in guilt cognitions, but not avoidant coping, mediated the effect of TrIGR on reducing PTSD severity at 3-month (a × b = −0.15, p < 0.01, 95% CI: [−0.24 to −0.06], p = 0.001) and 6-month (a × b = −0.17, 95% CI: [−0.26 to −0.07], p = 0.001) follow-up. Similarly, changes in guilt cognitions, but not avoidant coping, mediated the effect of TrIGR on reducing depression severity at 3-month (a × b = −0.10, 95% CI: [−0.18 to −0.02], p = 0.02) and 6-month (a × b = −0.11, 95% CI: [−0.20 to −0.03], p = 0.01) follow-up.

Conclusions

Compared to guilt cognitions, changes in avoidant coping were less integral to downstream PTSD and depression symptom reduction. Guilt cognition change may be a salient active ingredient of PTSD and depression treatment for those with trauma-related guilt and a key therapy element to which providers should be attuned.

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内疚认知的改变是创伤知情内疚减轻疗法对创伤后应激障碍和抑郁症疗效的中介作用。

目的：创伤知情内疚感减轻疗法（Trauma-informed guilt reduction therapy，简称TRIGR）是一种针对创伤相关内疚感和痛苦的认知行为疗法，为期6个疗程，可减轻内疚感以及创伤后应激障碍（PTSD）和抑郁症状，但人们对TRIGR如何以及为何有效知之甚少：本研究考察了回避应对和创伤相关内疚认知中与治疗相关的变化，这些变化可能是 3 个月和 6 个月随访时创伤后应激障碍和抑郁症治疗效果的中介因素。数据来自一项治疗创伤相关内疚感的随机对照试验，该试验对 145 名 9/11 事件后的美国退伍军人（年龄 = 39.2 [8.1]，93.8% 为男性）进行了 TrIGR 和支持性护理疗法的比较：在治疗前，大多数人（86%）符合创伤后应激障碍标准。使用平行中介模型进行的治疗意向分析表明，内疚认知的变化（a × b = -0.15，p）中介了 TrIGR 在 3 个月后降低创伤后应激障碍严重程度的效果，而回避应对的变化（a × b = -0.15，p）则没有中介效果：与内疚认知相比，回避应对的变化对减少创伤后应激障碍和抑郁症状的影响较小。内疚认知的改变可能是创伤后应激障碍和抑郁症患者治疗的一个突出的积极因素，也是治疗者应该注意的一个关键治疗要素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychology PSYCHOLOGY, CLINICAL-

CiteScore

5.40

自引率

3.30%

发文量

177

期刊介绍： Founded in 1945, the Journal of Clinical Psychology is a peer-reviewed forum devoted to research, assessment, and practice. Published eight times a year, the Journal includes research studies; articles on contemporary professional issues, single case research; brief reports (including dissertations in brief); notes from the field; and news and notes. In addition to papers on psychopathology, psychodiagnostics, and the psychotherapeutic process, the journal welcomes articles focusing on psychotherapy effectiveness research, psychological assessment and treatment matching, clinical outcomes, clinical health psychology, and behavioral medicine.