Clinical Effectiveness and Implementation of Trauma-Informed Guilt Reduction Therapy Compared to Prolonged Exposure
Abstract
Guilt stemming from traumatic experiences is common among Service Members and military Veterans. Service Members and Veterans often report perpetrating, failing to prevent, or witnessing acts during deployment that violate the values they live by in their civilian lives. Guilt among Service Member and Veterans is also common from other types of traumas, such as suicides of a loved one or not being able to stop a loved from experiencing some form of harm. Guilt is associated with numerous mental health problems, including posttraumatic stress disorder (PTSD), depression and suicide risk. It is also a core feature of moral injury which is also associated with a great deal of distress and more severe PTSD and depression symptoms. In our work, we have found that a treatment focused on reducing trauma-related guilt among Veterans called Trauma Informed Guilt Reduction Therapy (TrIGR) also reduced PTSD and depression symptoms and led to half of Veterans with PTSD no longer having a PTSD diagnosis. This shows that there is an urgent need for effective treatments that help Veterans with PTSD resolve guilt from events that occurred during deployment. The primary goal of this project is to determine whether a promising intervention, TrIGR, will help Veterans with their PTSD symptoms comparably to a well-established effective PTSD treatment, Prolonged Exposure (PE). We will also evaluate whether TrIGR helps Veterans function better and feel less depressed. TrIGR is a one-on-one talk therapy that is delivered over six sessions. It is the first intervention focused specifically on reducing trauma- related guilt and the distress caused by guilt and it is much briefer than most existing interventions for post- deployment problems (e.g., PTSD, depression). The therapy is brief so that it can be delivered in a variety of clinical settings where lengthy interventions may not be realistic, such as primary care or military mental health clinics on bases where military personnel may be getting ready to redeploy. Our previous studies of TrIGR with Veterans who deployed post 9/11 showed improvements in guilt, PTSD symptoms, and depression symptoms, making this larger evaluation of TrIGR compared to an established PTSD treatment that is longer a critical next step. We will accomplish this by randomly assigning participants to receive either TrIGR or PE. We propose to have 158 Veterans who served post 9/11 go through this study and the entire study is expected to take four years to complete. We will run the study across three VAs (Madison, Minneapolis, and New Orleans). We will use a research design that will let us concurrently compare TriGR and PE while also learning about what strategies are helpful to implement TrIGR into DOD and VA health care settings and what barriers may arise to make implementation more challenging. This design will prepare us to successfully implement TrIGR in clinical settings if we find it to be as good as PE in treating PTSD. We will include a panel of Veterans that will help guide us on making decisions in how we conduct the study so that it is most relevant to Veterans. We will also interview participants, therapists, and administrators to learn about the benefits and challenges of offering TrIGR so that we can use that information to guide us in the future. The proposed study holds promise for identifying an effective treatment for PTSD among Service Members and Veterans with PTSD and guilt. If found to be effective, TrIGR can be immediately delivered in VA and military health care settings, including primary care and behavioral health clinics, and may be adaptable even earlier in the deployment cycle. The treatment is brief and thus would be minimally disruptive to an active-duty schedule or the busy life of a returning Veteran. The expected improvements in mental health problems will also positively impact Veterans’ families and society more generally. Thus, the proposed study is highly
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310861
Entities
People
- Sonya B Norman
Organizations
- United States Army
- Veterans Medical Research Foundation of San Diego