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A common reaction following the experience of traumatic and victimizing experiences is feelings of guilt and shame. Guilt refers to the depreciation of specific actions that are reflected in such “should have” and “could have” statements such as:

  • “I should have known better.”
  • “I should have done something different.”
  • “I should have prevented it from happening.”
  • “I should have seen the warning signs earlier.”
  • “I never should have . . . ”

Shame refers to the depreciation or “put down” of self, personality and character.

  • “There is something seriously wrong with me.”
  • “I am evil, a monster.”
  • “I was totally responsible for what happened. I am inadequate and a bad person.”
  • “I did not deserve to survive.”

Such feelings of guilt and shame and the accompanying self-talk can be debilitating and decrease the quality of life. Thus, the way we think plays an important role in the maintenance and chronicity of posttraumatic stress and adjustment problems. To what degree do you have such emotionally-laden thoughts (What are called “hot cognitions”)? Consider the following Hinge Questions offered by the psychotherapist Edward Kubany (1994).

  • “Do you feel guilty about anything you did/anything you did not do/any feelings you had/any feelings you did not have/any thoughts or beliefs you had?”
  • “To what extent do you think you should have known better and could have prevented or avoided the outcomes?”
  • “In your judgment, was this outcome foreseeable and preventable?”
  • “How could you have known that this was going to happen?”
  • “What other options did you have at the time?”
  • “Is it possible that you made the best decision under the circumstances and is it possible that choosing other options might have led to worse outcomes?”

Individuals who have lingering guilt and shame hold beliefs of personal responsibility and insufficient justification for their actions. They may feel guilty and ashamed because they judge their actions and inactions as violations of their values that show up as “moral injuries” and “soul wounds.”

Guilt and shame are usually a result of Hindsight Bias, second-guessing or being a “Monday-morning quarterback.” Hindsight bias refers to the tendency to allow current knowledge about event outcomes to bias one’s recollections of what one knew before the outcomes were known. Hindsight bias contributes to the searching for the answers to “Why” questions for which there are no satisfactory answers. Hindsight bias contributes to “Only . . . if” thinking or what is called contra-factual thinking (the playing and replaying ruminations of alternative actions and outcomes). Individuals now have information that they did not have at the time of the traumatic event. In order to help allay intense feelings of guilt and shame there is a need to help individuals correct faulty beliefs that such outcomes were indeed foreseeable and preventable.

“The bottom line to the successful resolution of guilt is the development of a full recognition of what one knew and believed at the time of the event.

—Kubany & Ralston, 2008

“By changing my thinking errors and cognitive distortions, by becoming more aware of my tendency to engage in hindsight bias, I am no longer tormented by guilt.”

I remember my therapist saying: “If I am treating you with respect, and you are treating yourself with disrespect we are cancelling each other out. We need to be working together, on the same side of the ball. And you need to start giving yourself the same respect you want to get and deserve to get from others.”

For examples of possible interventions, go to About.com at ptsd.about.com/od/relatedconditions/a/guilt.htm

Action 64