Application of cognitive therapy for trauma-related guilt (CT-TRG) with a Vietnam veteran troubled by multiple sources of guilt

Kubany and Manke (1995) presented a model of guilt that emphasizes its cognitive elements and described a structured cognitive therapy format aimed at alleviating trauma-related guilt (CT-TRG). This article illustrates the practice of CT-TRG with a Vietnam combat veteran suffering from several ''classic'' Vietnam War-related sources of guilt. Seven sources of guile were addressed over 7 hours in a 1-day ''marathon'' therapy session. After therapy, the veteran reported dramatic reductions in guilt, PTSD, and depression symptomatology and a marked increase in self-esteem. These improvements were sustained at 8- and 22-month follow-ups. It is suggested that intensive treatment of multiple guilt issues may be necessary to alleviate overall guilt among many combat veterans and survivors of other kinds of traumatic events as well. Numerous descriptions of therapist-client interactions illustrate some of the nuances of CT-TRG and may facilitate its implementation by interested clinicians.