Trauma-Informed Guilt Reduction Therapy Compared to Prolonged Exposure

The goal of this clinical trial is to learn if receiving Trauma-Informed Guilt Reduction (TrIGR) Therapy is as effective as receiving Prolonged Exposure Therapy among veterans with PTSD and trauma related guilt. The main questions it aims to answer are: Will TrIGR be comparable to PE in terms of PTSD symptom reduction? Will it TrIGR be comparable to PE in improving functioning and reducing depression symptoms? Will it be superior in improving trauma-related guilt and shame?

Inclusion Criteria: * U.S. Veterans age 18 or older who served in the military since the start of Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF) * meets diagnostic criteria for PTSD; * a score of 2 or higher ("true" to "extremely true") on feeling trauma-related guilt much or all of the time or scoring 3 or higher ("very true" or "extremely true") on at least one guilt cognition factor (hindsight bias/responsibility, wrongdoing, or lack of justification) on the Trauma Related Guilt Inventory * not currently receiving trauma-focused treatment such as PE or CPT * willingness to attend psychotherapy and assessment sessions Exclusion Criteria: * current risk of suicidal/homicidal behavior that requires immediate intervention * current severe substance use disorder (in the past two months) based on DSM-5 criteria * current unmanaged psychosis or mania * life threatening or unstable medical illness * inability to read