VA San Diego is studying PTSD and moral wounds


Dr. Sonya Norman (pictured above, gray sweater, left) leads a meeting at the San Diego VA Medical Center regarding a talk therapy research program for Veterans who suffer from guilt and shame from deployment traumas.

Combat Veterans can experience long lasting emotional and spiritual pain from participating in, witnessing, or failing to prevent traumatic events that violate their core values or expectations of themselves or others. Some have described such experiences as “a deep soul wound that pierces a person’s identity, sense of morality and relationship to society” leaving Veterans to question who they are and how they can relate to others.

As a result, Veterans may experience symptoms of PTSD, depression or substance use, or they may consider ending their own lives. Health care professionals are working to understand and respond most effectively to Veterans who struggle with these issues. Some of the pressing questions for mental health professionals are:

  • What are effective ways to help service members and Veterans move past guilt and shame and forward into a full, healthy life?
  • How can Veterans regain a sense of peace and joy and reconnect with others?

Researchers at the San Diego VA are tackling these critical questions with research aimed to understand how to help Veterans recover from such events and resume their meaningful, fulfilling lives.

Trauma Informed Guilt and Shame Reduction Therapy is a talk therapy specifically for Veterans who suffer from guilt and shame from deployment traumas. Dr. Sonya Norman and colleagues at the VA San Diego PTSD treatment program developed the therapy, recognizing that many Veterans were suffering greatly from debilitating guilt and shame from combat traumas and that mental health providers had many questions about how to help them.

The goal of the therapy is to help Veterans process emotions and thoughts (such as “I deserve to suffer because of what I did”) from their combat trauma related guilt and to help Veterans identify and find positive ways to live in line with their morals and values, including those that were violated during the trauma.

Therapy can be delivered in a variety of settings

It is the first transdiagnostic (for any type of posttraumatic distress) intervention focused specifically on reducing guilt and shame and associated distress related to traumatic experiences. Focusing on a common problem like guilt that contributes to the development and maintenance of multiple disorders has the potential to help Veterans recover from the many types of emotional and psychiatric problems that are common after trauma.

The therapy is brief so that it can be delivered in a variety of clinical settings, such as primary care or military mental health clinics on bases where military personnel may be getting ready to redeploy.  In San Diego, Dr. Norman and colleagues are conducting a research study to help us understand the effectiveness of the therapy in reducing guilt and shame and associated problems such as PTSD, depression, substance use and suicidality.

Cognitively Based Compassion Training is a form of compassion meditation that was adapted by Dr. Ariel Lang and her colleagues to address the needs of Veterans with PTSD. This meditation practice is focused on developing a sense of “common humanity,” or an understanding that all human beings are fundamentally the same in their desire to be free of suffering and to find satisfaction in their lives.

Out of this understanding emerges a heartfelt desire for the well-being of the self and others, which may help Veterans to experience more positive emotions and to build stronger social connections. Early findings suggest that this type of meditation may be helpful in reducing symptoms of PTSD and depression. Dr. Lang is pursuing funding for a more definitive study of this approach.

Investigators at the San Diego VA are also looking at the ways in which Veterans who have moral injury, guilt and shame benefit from evidence based PTSD treatment such as Prolonged Exposure Therapy and Cognitive Processing Therapy.

About the authors:  Dr. Sonya Norman is director of the PTSD Consultation Program for the National Center for PTSD and is based in San Diego. Dr. Ariel Lang is the Acting Director of the Center of Excellence for Stress and Mental Health at the VA San Diego Healthcare System.



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  1. Frederick M. Dailey    

    My trauma will reach 50 years ago next week but I’ve never felt “survival guilt” so much as the “soul wound” that Dr. Norman describes. Revisiting it through the current Cognitive Processing techniques means to me the reopening of that wound & the last 20 years working with my VA psychiatrists & my Vet Center counselors have never convinced me that I want to do anything of that sort. If Dr. Norman can construct a new method that recognizes the existence of this variant of PTSD & the depth it reaches in a person’s psyche, she will be doing veterans a great favor.

  2. Wiltshire Glenn    

    Do you have any info on service dogs? How to qualify for service dog? Who to contact? Where or what va organization to work with? Documents required to be apart of service dog program?


  3. John Boles    

    What about Veterans Suffering from MST related PTSD??

  4. Richard G Kensinger    

    I applaud this clinical intervention and ensuing research. I am a former AF medic during the Vietnam Conflict and i am a retired BHC clinician and psychology professor. I myself am researching combat trauma; and i have 3 published article on Brain Blogger in this regard. In addition to PTSD and SUD it is my clinical premise that those in combat also experience what I refer to as “compacted grief”.
    Keep up the great work!

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