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Trauma-Related Shame and Guilt as Prospective Predictors of Daily Mental Contamination and PTSD Symptoms in Survivors of Sexual Trauma

Journal of Interpersonal Violence

June 2023
38(19-20):11117-11137

DOI:10.1177/08862605231179721

Authors:

Jordyn M. Tipsword

University of Kentucky

Christal L Badour

University of Kentucky

Mental contamination (MC), the experience of dirtiness in the absence of a physical contaminant, has established links with posttraumatic stress disorder (PTSD). Shame and guilt have well-documented relationships with symptoms of PTSD and may play a role in the development and maintenance of MC. The present study examined whether trauma-related shame and guilt prospectively predicted daily MC and symptoms of PTSD among 41 women with a history of sexual trauma. Women completed baseline and twice-daily assessments of MC and symptoms of PTSD over a 2-week period and baseline measures of trauma-related shame and guilt. Two sets of hierarchical mixed linear regression models examined individual and combined fixed effects of baseline trauma-related guilt (guilt cognitions and global guilt) and shame in predicting daily trauma-related MC and symptoms of PTSD. Trauma-related shame positively predicted both daily MC and PTSD. This association remained robust even when accounting for the experience of trauma-related guilt. Neither trauma-related guilt cognitions nor global guilt predicted daily MC or PTSD. While other studies have addressed shame related to sexual assault, this is the first study to demonstrate a positive prospective relationship between shame and trauma-related MC. Findings regarding PTSD and shame are consistent with a growing literature. Further research is needed to better understand the temporal relationships between trauma-related shame, MC, and symptoms of PTSD, including how these variables interact and change over the course of PTSD treatment. A better understanding of the factors influencing the development and maintenance of MC can inform efforts to more easily target and improve MC, and subsequently PTSD.

Descriptive Data and Zero-Order Correlations for Model Variables.

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Hierarchical Linear Models of Baseline Trauma-Related Shame and Guilt Predicting Daily Mental Contamination.

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Hierarchical Linear Models of Effects of Baseline Trauma-Related Shame and Guilt Predicting Daily PTSD Symptoms.

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https://doi.org/10.1177/08862605231179721

Journal of Interpersonal Violence

2023, Vol. 38(19-20) 11117 –11137

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DOI: 10.1177/08862605231179721

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Original Research

Trauma-Related Shame

and Guilt as Prospective

Predictors of Daily

Mental Contamination

and PTSD Symptoms

in Survivors of Sexual

Trauma

Jesse P. McCann1, Jordyn M. Tipsword1, C.

Alex Brake2 and Christal L. Badour1

Abstract

Mental contamination (MC), the experience of dirtiness in the absence

of a physical contaminant, has established links with posttraumatic stress

disorder (PTSD). Shame and guilt have well-documented relationships with

symptoms of PTSD and may play a role in the development and maintenance

of MC. The present study examined whether trauma-related shame and guilt

prospectively predicted daily MC and symptoms of PTSD among 41 women

with a history of sexual trauma. Women completed baseline and twice-

daily assessments of MC and symptoms of PTSD over a 2-week period and

baseline measures of trauma-related shame and guilt. Two sets of hierarchical

mixed linear regression models examined individual and combined fixed

effects of baseline trauma-related guilt (guilt cognitions and global guilt)

and shame in predicting daily trauma-related MC and symptoms of PTSD.

Trauma-related shame positively predicted both daily MC and PTSD. This

1Department of Psychology, University of Kentucky, Lexington, KY, USA

2Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown

University, Providence, RI, USA

Corresponding Author:

Jesse P. McCann, Department of Psychology, University of Kentucky, 111-J Kastle Hall, 171

Funkhouser Drive, Lexington, KY 40506-0044, USA.

Email: jmccann@uky.edu

1179721JIVXXX10.1177/08862605231179721Journal of Interpersonal ViolenceMcCann et al.

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Mental contamination (MC)—feelings of dirtiness triggered by internal sources—is a potentially important yet understudied factor for survivors of sexual trauma. MC has been linked to disgust and other negative emotions (e.g., shame, guilt) cross-sectionally and in lab-based paradigms but not yet examined in ecological contexts. Additionally, links between MC and distinct negative emotions have not been studied systematically. The present study thus modeled relationships between MC and specific emotions both across and within days over a daily monitoring period. Forty-one females with sexual trauma history and associated MC completed twice-daily assessments of MC and seven emotions (disgust, shame, guilt, anger, hopelessness, sadness, anxiety) over two weeks via a smartphone app. Baseline MC and average daily MC were largely associated with higher daily averages of negative emotions. Concurrently, within-person changes in MC and negative emotions were also positively linked. Unexpectedly, intraindividual changes in MC were largely not associated with later negative emotions, whereas several emotions were negatively associated with later MC. Notably, MC among screened sexual trauma survivors was much more prevalent compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination are discussed.

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Background and Objectives Reduction of trauma related negative cognitions, such as guilt, is thought to be a mechanism of change within PTSD treatments like prolonged exposure (PE). Research suggests PE can directly address guilt cognitions. However, whether pharmacotherapies for PTSD can remains unclear. Methods Data from a randomized controlled trial of PE plus placebo (PE+PLB), sertraline plus enhanced medication management (SERT+EMM), and their combination (PE+SERT) in 195 Veterans from recent wars was analyzed. Results The unadjusted means and mixed-effects model showed guilt decreased significantly over the follow-up time as expected; however, contrary to our hypothesis, PE conditions were not associated with greater reductions in guilt than the SERT+EMM condition. As hypothesized, week 12 reduction in guilt predicted post-treatment (weeks 24 to 52) reduction in PTSD and depression, but not impairments in function. Limitations Generalizability of findings is limited by the sample being comprised of combat Veterans who were predominantly male, not on SSRI at study entry, willing to be randomized to therapy or medication, and reporting low levels of guilt. To reduce differences in provider attention, SERT+EMM was administered over 30 minutes to include psychoeducation and active listening; it is unknown if this contributed to effects on guilt. Conclusions PE+PLB, SERT+EMM, and PE+SERT were equally associated with reduction in trauma related guilt. Reducing trauma related guilt may be a pathway to reducing PTSD and posttraumatic depression symptoms. Further study is needed to determine how best to treat trauma related guilt and to understand the mechanisms by which guilt improves across different treatments for PTSD.

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The common approach to the multiplicity problem calls for controlling the familywise error rate (FWER). This approach, though, has faults, and we point out a few. A different approach to problems of multiple significance testing is presented. It calls for controlling the expected proportion of falsely rejected hypotheses — the false discovery rate. This error rate is equivalent to the FWER when all hypotheses are true but is smaller otherwise. Therefore, in problems where the control of the false discovery rate rather than that of the FWER is desired, there is potential for a gain in power. A simple sequential Bonferronitype procedure is proved to control the false discovery rate for independent test statistics, and a simulation study shows that the gain in power is substantial. The use of the new procedure and the appropriateness of the criterion are illustrated with examples.

Trauma-Related Shame and Guilt as Prospective Predictors of Daily Mental Contamination and PTSD Symptoms in Survivors of Sexual Trauma

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