Trauma-Informed Guilt Reduction

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Sonya Norman, Christy Capone, Carolyn Allard · 2019 · San Diego

What it is

Trauma-Informed Guilt Reduction Therapy (TrIGR, developed by Sonya Norman, Christy Capone, Carolyn Allard and colleagues at the VA San Diego / National Center for PTSD and Brown University / Providence VA, building on Edward Kubany's cognitive therapy for trauma-related guilt) is a brief,…

Format

• Format. Six sessions, 90 minutes each in the RCT protocol and main trial (60–90 minutes in the ISTSS description), usually weekly (the COVID-19 extension trial used six weekly sessions). Delivered individually; the book also describes a group format (Ch. 9). Each session has matching…
• Module structure. The 2019 book groups the six sessions into three modules; the trial protocol and the CDMRP summary describe four modules (Session 6 counted as its own module). Content is the same; the guide follows the book's three-module labels.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• non-completion (see 5.4).
• rising suicidal ideation or substance use (act per 5.5); flat guilt ratings after Session 4 (see 5.1).
• fear that therapy will "excuse" them, which signals that guilt has a protective function (see 4.11, 5.1).
• therapist discomfort leading to false reassurance (Young et al. 2021); disclosures that may raise legal or safeguarding duties (see 5.7).
• proposed actions that are another form of self-punishment (e.g., overwork, risky amends); actions that depend on another person's forgiveness.

Problems the guide addresses

• Client holds on to guilt ("I deserve it", stuck ratings)
• Arguing or reassurance traps
• Overwhelm or dissociation during debriefing
• Non-attendance and homework non-completion
• Suicidal ideation, self-harm and substance use
• Disclosure of serious harm done to others (moral injury, perpetration)
• Legal, safeguarding and ethical issues
• Ruptures
• Modality-specific difficulties

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.