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Trauma-related guilt : : conceptual development and relationship with posttrauma psychopathology


Trauma-related guilt has been linked to more severe post traumatic outcomes, yet little effort has been made to conceptualize the construct of posttraumatic guilt or empirically evaluate existing theoretical models. To address this need, the present study conducted a systematic empirical evaluation of the theoretical model of trauma-related guilt proposed by Kubany and Watson (2003). This model hypothesizes that emotional and physical distress related to the trauma memory partially mediates the relationship between guilt cognitions and posttraumatic guilt. This investigation aimed to : (1) empirically evaluate Kubany and Watson's components of posttraumatic guilt model; (2) extend this model in male Veterans by evaluating models where by guilt cognitions, distress, and posttraumatic guilt were related to posttraumatic stress disorder (PTSD) and depression (MDD) symptom severity; and (3) explore the prognostic significance of posttraumatic guilt, PTSD, and MDD symptoms for treatment course in female IPV survivors. This investigation examined male Iraq and Afghanistan Veterans (n = 149) and female IPV survivors with (n =30) and without (n = 39) alcohol/substance use disorders. Aims 1 and 2 were evaluated using path analysis. Aim 3 was explored using Pearson's product moment correlations. Kubany and Watson's components of posttraumatic guilt model demonstrated the hypothesized indirect effect in male Veterans (indirect effect = .14, SE = .04, 95% CI = [.05-.21]). In the extended model examining the relationship between the components of posttraumatic guilt model and PTSD, the hypothesized indirect path suggesting the relationship between guilt-related cognitions, distress, and PTSD is mediated by posttraumatic guilt became non-significant as the model was respecified. Results related to MDD models paralleled these findings. Support for Kubany and Watson's model was inconsistent in female IPV survivors. Significant correlations were detected between change in posttraumatic guilt and change in PTSD (r = .52, p = .04) and MDD symptoms (r = .81, p < .01) from mid-treatment to post-treatment. Findings provide support for Kubany and Watson's model in male Veterans while highlighting the need to further define the distress component included in this model. Correlational findings within female IPV survivors suggest a mechanistic link may exist between trauma-related guilt and PTSD and MDD

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