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Comparing Exposure‐ and Coping Skills–Based Treatments on Trauma‐Related Guilt in Veterans With Co‐Occurring Alcohol Use and Posttraumatic Stress Disorders
Author(s) -
Capone Christy,
Tripp Jessica C.,
Trim Ryan S.,
Davis Brittany C.,
Haller Moira,
Norman Sonya B.
Publication year - 2020
Publication title -
journal of traumatic stress
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.259
H-Index - 134
eISSN - 1573-6598
pISSN - 0894-9867
DOI - 10.1002/jts.22538
Subject(s) - psychiatry , comorbidity , clinical psychology , psychology , posttraumatic stress , randomized controlled trial , substance abuse , exposure therapy , depression (economics) , medicine , anxiety , economics , macroeconomics
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) commonly co‐occur, and this comorbidity (PTSD–SUD) is associated with more severe symptoms and functional impairment than either disorder alone. Growing evidence indicates that trauma‐related guilt, typically concerning negative appraisals of one's actions or inaction during a traumatic event, is associated with PTSD, depression, suicidality, and, possibly, substance use. The present study examined whether integrated treatment for PTSD–SUD was effective in reducing trauma‐related guilt as measured by the Trauma‐Related Guilt Inventory. Data were drawn from a randomized clinical trial comparing the effectiveness of two integrated therapies on treatment outcomes in a sample of U.S. veterans ( N = 119) with comorbid PTSD and SUD. Participants were randomized to receive either Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE; n = 63) or Seeking Safety (SS; n = 56). The results indicated that global guilt decreased over time for the whole sample. However, there was a significant Treatment × Time interaction, such that participants in the COPE condition reported lower rates of global guilt, d = 0.940, over time compared to those in the SS condition, d = .498. To our knowledge, this was the first study to examine the effects of integrated PTSD–SUD treatment on trauma‐related guilt. The findings highlight that exposure‐based, trauma‐focused treatment for comorbid PTSD–SUD can be more effective in decreasing trauma‐related guilt, with potentially longer‐lasting effects, than non–exposure‐based treatment, adding evidence that patients with PTSD–SUD should be offered such treatment.