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San Diego Therapist Blog: Regina Huelsenbeck, PhD

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Posttraumatic Stress Disorder (PTSD) and Guilt. by San Diego Therapist: Regina Huelsenbeck, PhD

Posted by Regina Huelsenbeck on Fri, Sep 04, 2009
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In my work at the university, I see many trauma survivors; releasing guilt is a major focus in treatment. It's often imperative to release guilt to loosen the hold of PTSD symptoms (see below for general definition and description of PTSD symptoms).

Truly, many of us carry guilt about different things that have happened in our lives. We often believe that if we had just acted differently that things may have turned out better. "IF I had only taken his keys that night". "IF I had just been a nicer person or a better student, mom and dad would have stayed together". "I never should have gone out with her, I had a bad feeling and I should have trusted myself". 

3 basic ways we experience guilt:

1. We feel guilty that we did something that we should not have done, OR we feel guilty that we didn't do something that we should have done. (behaviors)

2. We feel guilty that we thought something that we shouldn't have thought or we feel guilty that we didn't think something that we "should" have thought of. (thoughts)

3. We feel guilty that we felt something we should not have felt or we feel guilty that we did not feel something that we should have felt.(feelings)

Guilt is defined as an uncomfortable or unpleasant feeling that is usually accompanied by beliefs that we should have thought, felt or acted differently.

Kubany, a Posttraumatic Stress Disorder (PTSD) clinician and researcher has said that if he only had one hour to work with a trauma survivor (specifically he works with domestic violence trauma survivors) he would spend it on releasing her guilt. He went further and said that if he only had 10 minutes to spend with a victim of DV he would spend it on Hindsight Bias.

Hindsight Bias is basically blaming yourself now for decisions that you made before you knew what you know now. You cannot make a decision back then from the knowledge you hold today (knowing the outcome of the event). But we argue, "no, I had a feeling that something bad might happen". However, this is NOT the same thing as knowing the specific outcome of the traumatic event. You only attained that specific knowledge after the event, and not before. This is an important thing to keep in mind when we are blaming ourselves. We simply can't possibly know then what we know now. 

Bottom line: Guilt is a killer. It is imperative to become aware of what guilt we might be holding onto. PTSD or no PTSD, guilt can clog up your ability move freely in relationship(s); to live fresh, clean and free. AND guilt helps no one. It will only keep you mired in destructive self-harming patterns. You deserve compassion.

"A loving heart is the truest wisdom" ~ Charles Dickens 

 

_______________________________________________________

3 basic symptom categories of PTSD:

Avoidance symptoms (Numbing, isolation, avoid anything which reminds you of the trauma etc.)
Intrusive symptoms (flashbacks, images, intrusive thoughts, or nightmares etc)
Hyperarousal symptoms (always feel keyed up or one edge, looking over shoulder constantly, great difficulty falling asleep or waking in middle of the night, easily startled, or anger etc)

 

 

 

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COMMENTS

As we try to help warriors wounded by PTSD, we must especially consider the factor of guilt. The individual may not bring it up--but it needs to be addressed. After all, many who have been in the war zone come to feel so guilty regarding what they have done that they come to see themselves as despicable human beings unworthy of living. This belief—fed by the guilt—has likely played into at least some of the suicides that have occurred in recent times. So indeed, it is imperative that therapists, clergy, and others seeking to provide help to our war veterans are prepared to deal with this--to facilitate cognitive restructuring.  
 
 
 
For warriors wounded by PTSD who embrace one of the Christian faiths, it may be helpful to discuss Saul who later became Paul. While he was once a persecutor of early Christians, he of course became not only one of Christ's disciplines, but so instrumental in the spread of Christianity.  
 
 
 
Indeed, people may well need to be reminded that one can become so overwhelmed by guilt that he or she does nothing--and hence, may be bothered by it for years to come. However, it is possible to use that guilt as a motivator to go forth and do something that is constructive and helps other—if not the world. And certainly, I think we were made aware at his funeral how Senator Edward Kennedy may have been doing this. Yes, he was in part probably trying to live out the family legacy he felt compelled to embrace. However, I also suspect he was trying to make amends for a young woman's death.  
 
 
 
On a much smaller scale, many people do this through working the twelfth step in a twelve-step program such as Alcoholics Anonymous or AA. Of course, they need to complete the other steps first. Many drop out at the fourth or fifth step because they don’t want to list those behaviors they feel guilty about—and then share them with another. But of course, this is a great way to begin to move beyond those harmful feelings of guilt.  
 

posted @ Thursday, September 10, 2009 2:12 PM by Dr. Diane England


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