UC San Diego

Purpose of review

The purpose of this review is to describe Trauma-Informed Guilt Reduction Therapy (TrIGR), the Non-Adaptive Guilt and Shame (NAGS) model that underlies TrIGR, and the research supporting the use of TrIGR to treat the guilt and shame components of moral injury. TriGR is a 6-session individual psychotherapy that helps clients consider their role in the traumatic event and find constructive ways to express important values, so that they no longer need to express values by suffering through guilt and shame.

Recent findings

A recently completed randomized controlled trial of TrIGR versus supportive care therapy included 144 post-9/11 veterans. TriGR showed greater reductions in trauma-related guilt, PTSD symptoms, and depression symptoms. Participants in TrIGR had greater likelihood of losing their PTSD diagnosis and showing clinical meaningful change in PTSD and depression symptoms. Mean attendance was high; 5.3 out of 6 sessions.

Summary

TrIGR is efficacious in reducing guilt that is common to moral injury as well as PTSD and depression symptoms among combat veterans. The next steps in the program of research to develop and evaluate TrIGR are studies with diverse trauma types and populations as well as relative effectiveness studies comparing TrIGR to other evidence-based treatments for moral injury and PTSD.