Alleviation of moral disgust, shame, and guilt in posttraumatic stress reactions: an evaluation of comprehensive distancing.
A two-session acceptance skill cuts trauma-linked shame and guilt just as well as cognitive restructuring.
01Research in Context
What this study did
Ojserkis et al. (2014) ran a small RCT with college students who had trauma-linked shame, guilt, or moral disgust. Half got two sessions of 'comprehensive distancing' — a brief acceptance skill that teaches clients to notice nasty thoughts without grabbing them. The other half got standard cognitive challenge that tries to prove the thoughts wrong.
Both groups filled out the same shame and disgust scales before and after.
What they found
Both treatments cut shame, guilt, and moral disgust by the same large amount. Comprehensive distancing added no extra benefit, but it also did not fall short.
In plain words: stepping back from the thought worked just as well as arguing with it.
How this fits with other research
Kaufman et al. (2010) and Plant et al. (2007) ran almost identical ACT-vs-cognitive-therapy RCTs. They also saw equal, large gains across the two models, backing the same 'different road, same city' story.
Austin et al. (2015) review calls this process 'decoupling' — loosening the link between a thought and behavior. Rachel’s findings give the review a fresh data point: even a two-session distancing drill can achieve the decoupling effect.
Chadwick et al. (2000) found the same tie score, but in dental fear. Together these studies show the pattern is not fluke: acceptance and cognitive tools often land in a dead heat, so you can pick the one the client will actually use.
Why it matters
If a client shows up with trauma guilt, you now have two evidence-based choices. When time is short or the client hates homework, teach comprehensive distancing in a single visit. You will get the same drop in shame as you would with a full thought-record protocol, without the debate.
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02At a glance
03Original abstract
Research suggests that moral disgust, shame, and guilt are present in posttraumatic psychopathology. However, it is unclear that these emotional states are responsive to empirically supported interventions for posttraumatic stress symptoms (PTSS). This study explored the relations among moral disgust, shame, guilt, and PTSS, and examined comprehensive distancing (CD) as a novel intervention for these emotional states in undergraduates with elevated PTSS. Participants were randomly assigned to use a CD or a cognitive challenge task in response to personalized scripts of a traumatic event. Both interventions were associated with decreases in disgust, moral disgust, shame, and guilt. Contrary to predictions, there were no significant differences between the exercises in the reduction of negative emotions. In addition, PTSS severity was correlated with trauma-related guilt as well as state guilt and shame, but not trait or state measures of disgust or moral disgust. This proof of concept project sets the stage for further research examining CD as an alternative or adjunctive intervention for posttraumatic stress reactions with strong features of moral disgust, shame, and guilt.
Behavior modification, 2014 · doi:10.1177/0145445514543465