Posttraumatic Growth and Shame/Guilt in Veterans: Does Time (Perspective) Really Heal All Wounds?

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Prevalence of PTSD is higher in veterans compared to the general population, with between 12 and 31% of veterans, across combat eras, developing PTSD during their lifetime, compared to 7-8% of civilians, perhaps as a result of military-related experiences (e.g., combat, sexual trauma). Such experiences contribute to the detrimental cognitive-emotional processes, including shame and guilt, which precipitate and maintain post-traumatic stress disorder. Yet, some persons experiencing trauma also experience post-traumatic growth as a result, exhibiting resiliency and, in some cases, even thriving. The mechanism of action for post-traumatic growth (PTG), which is conceptualized as a positive change following trauma (i.e., finding purpose and meaning in life), is unknown, but may involve adaptive schema restructuring (e.g., temporal shifts). Specifically, PTG may involve changes to time-perspective, or the tendency for a person to consider their life as a function of, or in the context of, the past (e.g., past trauma, nostalgia), present (e.g., positive/negative) or future (e.g., goals). The ability, for instance, to temporally transcend the past or present and focus on a more-adaptive future, may contribute to a reduction in the ruminative processes so often involved in shame and guilt, whereas maladaptive temporal views (e.g., negative past and present) may exacerbate guilt and shame. However, this premise has not been tested. We hypothesized that time perspective would mediate the association between PTG and shame/guilt, such that higher levels of PTG would be associated with higher levels of adaptive temporality/lower levels of maladaptive temporality and, in turn, to lower /higher levels of shame and guilt. Participants (N=545; 70.1% male (n=382); 86.4% Caucasian (n=469), Mean Age=49.86, SD=16.78) were community-dwelling veterans who self-identified as having experienced a trauma, and completed the PTG Inventory, Zimbardo Time Perspective Inventory, and Differential Emotions Scale-IV. Bivariate correlations and simple mediation analyses were conducted covarying age, sex, ethnicity, VHA usage, and service era. Supporting hypotheses, in simple mediation analyses (10000 bootstrapped samples), the direct effect of PTG on shame (DE=-.0134, SE=.0098, p=.1720, IE 95% CI=-.0327 to .0059) and guilt (DE=-.0085, SE=.0100, p=.3919, IE 95% CI=-.0281 to .0110) was reduced, and fell out of significance, when future time perspective was added as a mediator, indicating full mediation. The direct effects of PTG on shame and guilt were reduced, but remained significant, when present hedonistic, present fatalistic, past negative, and past positive were added as mediators, indicating partial mediation. Our results suggest that the relation between posttraumatic growth and shame/guilt may be due, in part, to changes in cognitive-emotional processing related to temporality. The PTG process may involve adaptive shifts in time perspective that, in turn, beneficially impact negative emotions associated with trauma exposure. Our findings may have clinical implications. Promotion of acceptance and meaning (e.g., via Acceptance and Commitment Therapy) to foster posttraumatic growth, and encouraging temporal holism (e.g., Cognitive Processing Therapy, Time Perspective Therapy), may reduce shame and guilt associated with trauma in the veteran population.


Johnson City, TN

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