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Guilt, Distress and Ways of Coping with Guilty Thoughts in a Clinical Sample
[Thesis]. Manchester, UK: The University of Manchester; 2013.
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Abstract
This thesis explores the role of guilt in post-traumatic stress disorder (PTSD) and ways of coping with guilt-related thoughts in a clinical sample. The thesis is presented as three papers that include a review of the literature, an empirical research study and critical appraisal of the research process.In the first paper, the author provides a systematic review of 27 studies to determine whether an association exists between guilt and symptoms of post-traumatic stress. Guilt remains an associated feature of PTSD; however, how these two constructs might be linked is not fully understood. Therefore the current review further evaluated the evidence for four competing models conceptualising the guilt-PTSD relationship. Overall, trauma-related guilt was positively related to PTSD symptomology even when controlling for depression. Guilt cognitions reflecting self-blame, perceived responsibility and wrongdoing were frequently associated with PTSD symptoms. Few studies found guilt was no longer related to PTSD symptomology when controlling for shame. Future studies ought to control for overlapping or confounding variables and further explore factors that may mediate the guilt-PTSD relationship such as coping.The second paper provided preliminary validation of a newly developed and unique measure of coping with guilty thoughts (GLAMS) in a clinical sample. A total of 67 participants from primary care services completed the GLAMS and measures of distress, guilt, coping and thought control. Eighteen completed the GLAMS and distress measure two weeks later. Overall the GLAMS evidenced moderate to high internal consistency and acceptable to good concurrent validity. Maladaptive subscales were found to be reliable over time. Higher self-punishment was related to greater guilt and distress and more mindful coping was related to a reduction in guilt supporting construct validity. Future research is required to test the stability of the GLAMS factor structure in a larger clinical sample. The GLAMS may have clinical utility in guiding psychological intervention towards more adaptive ways of coping with guilt. It may also provide a suitable outcome measure by monitoring the frequency in which clients engage in maladaptive ways of coping.The final paper provided a critical evaluation and reflection on the research process. Particular reference was made to the research rationale, methodological and ethical issues and considerations were given for future research and clinical practice. Conclusions drawn from this thesis are limited largely by the cross-sectional nature of most of the studies reviewed in paper 1 and insufficient numbers for the empirical study, which due to methodological and service-related constraints, limited further exploration of the data. Factor analysis and subsequent validation of the GLAMS in a larger sample is required to further support inferences drawn.