Trauma-related shame and guilt as time-varying predictors of posttraumatic stress disorder symptoms during imagery exposure and imagery rescripting—A randomized controlled trial

Abstract

Objective: The specific aims of this study are to examine trauma-related shame and guilt as time-varying predictors of symptoms of posttraumatic stress disorder (PTSD). Method: Sixty-five patients were included in the statistical analyses and the multilevel modeling analyses supported three major findings. Results: (i) Patients with a higher level of shame and guilt at the start of treatment displayed a higher level of PTSD symptoms over the course of treatment compared to other patients. (ii) Time-specific change in shame and guilt predicted the level of PTSD symptoms 3 days later from session to session during treatment. (iii) No significant differences were evident between prolonged exposure (PE) and modified PE to include imagery rescripting in the within-person process of change in PTSD symptoms from session to session during therapy. Conclusions: This trial reports the first evidence that within-person change in shame and guilt predicts change in PTSD symptoms from session to session during treatment.

Abstract

Objective: The specific aims of this study are to examine trauma-related shame and guilt as time-varying predictors of symptoms of posttraumatic stress disorder (PTSD). Method: Sixty-five patients were included in the statistical analyses and the multilevel modeling analyses supported three major findings. Results: (i) Patients with a higher level of shame and guilt at the start of treatment displayed a higher level of PTSD symptoms over the course of treatment compared to other patients. (ii) Time-specific change in shame and guilt predicted the level of PTSD symptoms 3 days later from session to session during treatment. (iii) No significant differences were evident between prolonged exposure (PE) and modified PE to include imagery rescripting in the within-person process of change in PTSD symptoms from session to session during therapy. Conclusions: This trial reports the first evidence that within-person change in shame and guilt predicts change in PTSD symptoms from session to session during treatment.

Zusammenfassung:

Ziele: Die Ziele der gegenwärtigen Studie sind es Trauma bezogene Scham und Schuld als zeitlich variierende Prädiktoren der Symptome Posttraumatischer Belastungsstörung (PTBS) zu untersuchen. Methode: 65 Patienten wurden in die statistische Analyse miteinbezogen und die multi-level Analysen haben 3 Hauptbefunde unterstützt. Ergebnisse: (i) Patienten mit einem höheren Level von Scham und Schuld zum Beginn der Behandlung zeigten ein höheres Level an PTBS Symptomen über den Therapieverlauf verglichen mit anderen Patienten. (ii) Zeitspezifische Änderungen in Scham und Schuld haben das Level der PTBS Symptome 3 Tage später von Sitzung zu Sitzung während der Behandlung vorhergesagt. (iii) In Bezug auf diese intraindividuellen Zusammenhänge zeigten sich keine Unterschiede zwischen prolongierter Exposition (PE) und modifizierter PE, bei der imaginatives Überschreiben mit einbezogen wurde. Schlussfolgerung: Diese Studie berichtet erste Evidenz dafür das intraindividuelle Veränderungen von Scham und Schuld Erfahrungen Veränderungen in PTBS Symptomen sitzungsweise vorhersagen.

Objetivo: Os objetivos específicos deste estudo consistiram em analisar sentimentos de vergonha e culpa associados ao trauma, enquanto preditores variáveis no tempo, de sintomas de perturbação de stress pós-traumático (PSPT). Método: Sessenta e cinco pacientes foram incluídos nas análises estatísticas e a modelagem multinível conduziu a três conclusões principais. Resultados: (i) Os pacientes com níveis mais elevados de vergonha e culpa no início do tratamento exibiram um maior nível de sintomas de PSPT ao longo do tratamento, comparativamente aos outros pacientes. (ii) Uma alteração específica ao nível do tempo nos sentimentos de vergonha e culpa predisse o nível de sintomas de PSPT após 3 dias, de sessão para sessão, durante o tratamento. (iii) Não foram encontradas diferenças significativas entre a exposição prolongada (EP) e a EP modificada com base na inclusão da revisão imagética no processo intrapessoal de mudança ao nível dos sintomas de PSPT, de sessão para sessão, durante a terapia. Conclusões: Este estudo reporta a primeira evidência de que a mudança intrapessoal ao nível dos sentimentos de vergonha e culpa prediz mudança nos sintomas de PSPT, de uma sessão para outra, durante o tratamento.

目標：本研究的具體目的在檢視將「與創傷有關的羞恥感與罪惡感」作為不同時期的創傷後壓力症候群（PTSD）的預測因子。方法：有56位病患納入統計分析，多層次模式分析結果支持以下三個研究發現。結果：（i）相較於其他病患，在治療初期即有較高程度羞恥及罪惡感的病患，在治療過程中均展現較高的PTSD症狀。(ii)針對特定時間，治療過程中每次療程的三天後羞恥感及罪惡感的改變情形可預測PTSD的症狀程度。（iii）個體內在無論是接受延長暴露（PE）或是修正後的PE（納入想像式的再腳本化），在治療歷程中PTSD的改變情形並無顯著差異。結論：本研究是第一個支持個人內在PTSD的羞恥感及罪惡感症狀會隨著治療歷程有所改變的研究。

Keywords:

• shame
• guilt
• treatment of PTSD
• trauma
• within-person effects

Notes

1. Stage I in IR is identical to Stage I in IE. The rescripting Stages II and III are in addition to imaginal exposure.

2. The reliability indexes for scores of short-form measures of trauma-related shame and guilt with one-facet measurement designs were evaluated by means of Cronbach's alpha.

3. See footnote 2.

4. Index of reliability estimated by means of generalizability study in a multi-facet measurement design, which is most appropriately analyzed within the more liberalized generalizability theory approach than classical test theory.

5. The use of raw scores in interpretation of the results may result in an error of inference called ecological fallacy, in which a researcher mistakenly believes that the observed relationship between two variables at the aggregated level also applies at the individual level (Curran & Bauer, 2011).