Post-traumatic guilt 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. These experiences may occur in the context of combat or other traumatic events such as military sexual traumas. Among Veterans with post-traumatic stress disorder (PTSD), 54% endorse post-traumatic guilt in their lifetime, 41% endorse current post-traumatic guilt, and 35% report being moderately to extremely bothered by their guilt. Guilt is associated with numerous mental health problems, including PTS), depression and suicidality, and alcohol and other substance use problems. Guilt can persist for many years (over 40) without treatment. There is an urgent need for treatments that help Veterans resolve guilt from events that occurred during deployment.

The primary goal of this project is to determine if a promising intervention will help Veterans feel less deployment-related guilt and less distress related to their guilt. Trauma Informed Guilt Reduction (TrIGR) is a one-on-one talk therapy that is delivered over six weekly sessions. It is the first intervention focused specifically on reducing 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 and Active Duty Marines showed improvements in guilt, PTSD symptoms, and depression symptoms, making this larger evaluation of TrIGR using a rigorous scientific design a next logical step. In addition to reducing deployment-related guilt, we will test if TrIGR therapy reduces shame and overall distress, and improves quality of life. We will accomplish this by randomly assigning participants to receive either TrIGR or a comparison intervention, Supportive Care Therapy (SCT). We propose to have 150 Veterans go through this study, and the entire study is expected to take 4 years to complete.

The proposed study holds promise for identifying an effective treatment to address deployment-related guilt, a distressing and debilitating post-traumatic experience for many Service members and Veterans. If found to be effective, TrIGR can be immediately delivered in Department of Veterans Affairs and military healthcare 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.