Veterans’ Trauma-Related Guilt and Self-Stigma Affect Treatment-Seeking Behavior
References
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Association.
- Amsalem, D., Lopez-Yianilos, A., Lowell, A., Pickover, A. M., Arnon, S., Zhu, X., Suarez-Jimenez, B., Ryba, M., Bergman, M., Such, S., Zalman, H., Sanchez-Lacay, A., Lazarov, A., Markowitz, J. C., & Neria, Y. (2022). Treatment dropout among veterans and their families: Quantitative and qualitative findings. Psychological Trauma: Theory, Research, Practice, and Policy, 14(4), 578–586. 10.1037/tra0001109
- Bannister, J. A., Colvonen, P. J., Angkaw, A. C., & Norman, S. B. (2019). Differential relationships of guilt and shame on posttraumatic stress disorder among veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 35–42. 10.1037/tra0000392
- Blais, R. K., & Renshaw, K. D. (2013). Stigma and demographic correlates of help-seeking intentions in returning service members. Journal of Traumatic Stress, 26(1), 77–85. 10.1002/jts.21772
- Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. 10.1002/jts.22059
- Bonfils, K. A., Lysaker, P. H., Yanos, P. T., Siegel, A., Leonhardt, B. L., James, A. V., Brekke, J. S., Salyers, M. P., Hamm, J. A., Roe, D., Hasson-Ohayon, I., Kukla, M., Tsai, J., Oemig, C., Outcalt, S., Smith, B. N., Lickel, J. J., Cook, J., … Davis, L. W. (2018). Self-stigma in PTSD: Prevalence and correlates. Psychiatry Research, 265, 7–12. 10.1016/j.psychres.2018.04.022
- Britt, T. W., Jennings, K. S., Cheung, J. H., Pury, C. L. S., & Zinzow, H. M. (2015). The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel. Psychiatric Rehabilitation Journal, 38(2), 142–149. 10.1037/prj0000120
- Britt, T. W., Jennings, K. S., Cheung, J. H., Pury, C. L. S., Zinzow, H. M., Raymond, M. A., & McFadden, A. C. (2016). Determinants of mental health treatment seeking among soldiers who recognize their problem: Implications for high-risk occupations. Work & Stress, 30(4), 318–336. 10.1080/02678373.2016.1246490
- Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2013). Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depression and Anxiety, 30(1), 55–60. 10.1002/da.22002
- Clary, K. L., Pena, S., & Smith, D. C. (2021). Masculinity and stigma among emerging adult military members and veterans: Implications for encouraging help-seeking. Current Psychology, 42(6), 4422–4438. 10.1007/s12144-021-01768-7
- Cornish, M. A., Brenner, R. E., Vogel, D. L., & Wade, N. G. (2019). Evaluation of an online help seeking stigma-reduction intervention for military personnel. Stigma and Health, 4(4), 480–486. 10.1037/sah0000167
- Corrigan, P. W., Bink, A. B., Fokuo, J. K., & Schmidt, A. (2015). The public stigma of mental illness means a difference between you and me. Psychiatry Research, 226(1), 186–191. 10.1016/j.psychres.2014.12.047
- Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25(8), 875–884. 10.1521/jscp.2006.25.8.875
- Damron-Rodriguez, J., White-Kazemipour, W., Washington, D., Villa, V. M., Dhanani, S., & Harada, N. D. (2004). Accessibility and acceptability of the Department of Veteran Affairs Health Care: Diverse Veterans’ perspectives. Military Medicine, 169(3), 243–250. 10.7205/milmed.169.3.243
- Department of Veterans Affairs. (2022, May 03). Spotlight on Mental Health.
https://www.hsrd.research.va.gov/news/feature/mental-health.cfm - Dickstein, B. D., Vogt, D. S., Handa, S., & Litz, B. T. (2010). Targeting self-stigma in returning military personnel and veterans: A review of intervention strategies. Military Psychology, 22(2), 224–236. 10.1080/08995600903417399
- Fisher, M. L., & Exline, J. J. (2010). Moving toward self-forgiveness: Removing barriers related to shame, guilt, and Regret. Social and Personality Psychology Compass, 4(8), 548–558. 10.1111/j.1751-9004.2010.00276.x
- Fredman, S. J., Macdonald, A., Monson, C. M., Dondanville, K. A., Blount, T. H., Hall-Clark, B. N., Fina, B. A., Mintz, J., Litz, B. T., Young-McCaughan, S., Hancock, A. K., Rhoades, G. K., Yarvis, J. S., Resick, P. A., Roache, J. D., Le, Y., Wachen, J. S., Niles, B. L., McGeary, C. A., … Peterson, A. L. (2020). Intensive, multi-couple group therapy for PTSD: A nonrandomized pilot study with military and veteran dyads. Behavior Therapy, 51(5), 700–714. 10.1016/j.beth.2019.10.003
- Fung, K. M., Tsang, H. W., & Cheung, W. M. (2011). Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia. Psychiatry Research, 189(2), 208–214. 10.1016/j.psychres.2011.02.013
- Gerwell, K. (2018). Effects of self-stigma on treatment among veterans and civilians applying for disability benefits. (Publication No. 13424304) [Doctoral Dissertation, Hofstra University]. Proquest Dissertations Publishing.
- Graziano, R., & Elbogen, E. B. (2017). Improving mental health treatment utilization in military veterans: Examining the effects of perceived need for care and social support. Military Psychology, 29(5), 359–369. 10.1037/mil0000169
- Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
- Herbert, M. S., Malaktaris, A. L., Lyons, R., & Norman, S. B. (2020). Trauma-related guilt and pain among veterans with PTSD. Psychiatry Research, 285, 112820. Advance online publication. 10.1016/j.psychres.2020.112820
- Hundt, N. E., Mott, J. M., Miles, S. R., Arney, J., Cully, J. A., & Stanley, M. A. (2015). Veterans’ perspectives on initiating evidence-based psychotherapy for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 7(6), 539–546. 10.1037/tra0000035
- IBM Corporation. (2023).
IBM SPSS . Computer software, Armonk. - Kachadourian, L. K., Lyons, R., Davis, B., Haller, M., & Norman, S. (2021). TRG and posttraumatic stress disorder symptoms in military veterans: The role of psychological inflexibility. Journal of Psychiatric Research, 137, 104–110. 10.1016/j.jpsychires.2021.02.022
- Kracen, A. C., Mastnak, J. M., Loaiza, K. A., & Matthieu, M. M. (2013). Group therapy among OEF/OIF veterans: Treatment barriers and preferences. Military Medicine, 178(1), 146–149. 10.7205/milmed-d-12-00213
- Kubany, E. S., Haynes, S. N., Abueg, F. R., Manke, F. P., Brennan, J. M., & Stahura, C. (1996). Development and validation of the TRG inventory (TRGI). Psychological Assessment, 8(4), 428–444. 10.1037/1040-3590.8.4.428
- Kubany, E. S., & Manke, F. P. (1995). Cognitive therapy for trauma-related guilt: Conceptual Bases and treatment outlines. Cognitive and Behavioral Practice, 2(1), 27–61. 10.1016/s1077-7229(05)80004-5
- Kubany, E. S., & Watson, S. B. (2003). Guilt: Elaboration of a multidimensional model. The Psychological Record, 53(1), 51–90.
https://psycnet.apa.org/record/2003-01443-005 - Kube, T., Elssner, A. C., & Herzog, P. (2023). The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for a cognitive link. European Journal of Psychotraumatology, 14(1), 2165025. 10.1080/20008066.2023.2165025
- Kulesza, M., Pedersen, E. R., Corrigan, P. W., & Marshall, G. N. (2015). Help-seeking stigma and mental health treatment seeking among young adult veterans. Military Behavioral Health, 3(4), 230–239. 10.1080/21635781.2015.1055866
- Lee, D. A., Scragg, P., & Turner, S. (2001). The role of shame and guilt in traumatic events: A clinical model of shame-based and guilt-based PTSD. The British Journal of Medical Psychology, 74(4), 451–466. 10.1348/000711201161109
- Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. 10.1016/j.cpr.2009.07.003
- Lynn, B. (2014). Shared sense of purpose and well-being among veterans and non-veterans [Doctoral dissertation, North Carolina State University]. North Carolina State University.
- Lynn, B. M.-D., & Morgan, J. K. (2016). Using Amazon’s Mechanical Turk (MTurk) to recruit military veterans: Issues and suggestions. The Military Psychologist, 31(3), 10–14.
https://www.researchgate.net/publication/314113193_Using_Amazon’s_Mechanical_Turk_MTurk_to_recruit_military_Veterans_Issues_and_suggestions - Mackenzie, C. S., Knox, V. J., Gekoski, W. L., & MacAulay, H. L. (2004). An adaptation and extension of the Attitudes Toward Seeking Professional Psychological Help Scale. Journal of Applied Social Psychology, 34(11), 2410. 10.1111/j.1559-1816.2004.tb01984.x
- McCay, E., Beanlands, H., Zipursky, R., Roy, P., Leszcz, M., Landeen, J., Ryan, K., Conrad, G., Romano, D., Francis, D., Hunt, J., Costantini, L., & Chan, E. (2007). A randomised controlled trial of a group intervention to reduce engulfment and self-stigmatisation in first episode schizophrenia. Australian E-Journal for the Advancement of Mental Health, 6(3), 212–220. 10.5172/jamh.6.3.212
- McDermott, R. C., Currier, J. M., Naylor, P. D., & Kuhlman, S. T. (2017). Student veterans’ self-stigma of seeking help: Contributions of painful self-conscious emotions, traditional masculine norms, and war-zone service. Psychology of Men & Masculinity, 18(3), 226–237. 10.1037/men0000117
- McLean, C. P., Zandberg, L., Brown, L., Zang, Y., Benhamou, K., Dondanville, K. A., Yarvis, J. S., Litz, B. T., Mintz, J., Young-McCaughan, S., Peterson, A. L., & Foa, E. B. (2019). Guilt in the treatment of posttraumatic stress disorder among active duty military personnel. Journal of Traumatic Stress, 32(4), 616–624. 10.1002/jts.22416
- Meade, V. (2020). Embracing diverse women veteran narratives: Intersectionality and women veteran’s identity. Journal of Veterans Studies, 6(3), 47–53. 10.21061/jvs.v6i3.218
- Military Health System. Barriers to care (2025, August 06).
https://www.health.mil/Military-Health-Topics/Centers-of-Excellence/Psychological-Health-Center-of-Excellence/Psychological-Health-Readiness/Barriers-to-Care - Mittal, D., Drummond, K. L., Blevins, D., Curran, G., Corrigan, P., & Sullivan, G. (2013). Stigma associated with PTSD: Perceptions of treatment seeking combat veterans. Psychiatric Rehabilitation Journal, 36(2), 86–92. 10.1037/h0094976
- National Center for PTSD. (2022, September 13). How Common Is PTSD in Adults?
https://www.ptsd.va.gov/understand/common/common_adults.asp - Nazarov, A., Fikretoglu, D., Liu, A., Richardson, J. D., & Thompson, M. (2020). Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury. European Journal of Psychotraumatology, 11(1), 1–10. 10.1080/20008198.2020.1729032
- Norman, S. B., Capone, C., Panza, K. E., Haller, M., Davis, B. C., Schnurr, P. P., Allard, C. B., Brown, L. A., Moshier, S. J., Resick, P. A., Wiltsey Stirman, S., Bovin, M. J., Marx, B. P., Sloan, D. M., Bernardy, N. C., Wiltsey, C., Fredman, S. J., Keane, T. M., Street, A. E., … Angkaw, A. (2022). A clinical trial comparing trauma-informed guilt reduction therapy (TrIGR), a brief intervention for trauma-related guilt, to supportive care therapy. Depression and Anxiety, 39(4), 262–273. 10.1002/da.23241
- Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., Rodman, J. L., & Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans. JAMA, 314(5), 456–465. 10.1001/jama.2015.8361
- Randles, R., & Finnegan, A. (2021). Veteran help-seeking behaviour for mental health issues: A systematic review. BMJ Military Health, 168(1), 99–104. 10.1136/bmjmilitary-2021-001903
- Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of consulting and clinical psychology, 61(6), 984–991. 10.1037//0022-006x.61.6.984
- Seal, K. H., Abadjian, L., McCamish, N., Shi, Y., Tarasovsky, G., & Weingardt, K. (2012). A randomized controlled trial of telephone motivational interviewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans. General Hospital Psychiatry, 34(5), 450–459. 10.1016/j.genhosppsych.2012.04.007
- Shulman, G. P., Buck, B. E., Gahm, G. A., Reger, G. M., & Norr, A. M. (2019). Effectiveness of the intent to complete and intent to attend intervention to predict and prevent posttraumatic stress disorder treatment drop out among soldiers. Journal of Traumatic Stress, 32(5), 784–790. 10.1002/jts.22427
- Stecker, T., Shiner, B., Watts, B. V., Jones, M., & Conner, K. R. (2013). Treatment-seeking barriers for veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD. Psychiatric Services, 64(3), 280–283. 10.1176/appi.ps.001372012
- Sullivan, W. P., & Starnino, V. R. (2018). Moral wounds and moral repair: The dilemmas of spirituality and culturally sensitive practice. Families in Society: The Journal of Contemporary Social Services, 100(2), 139–150. 10.1177/1044389418809555
- Vogt, D., Di Leone, B. A., Wang, J. M., Sayer, N. A., Pineles, S. L., & Litz, B. T. (2014). Endorsed and Anticipated Stigma Inventory (EASI): a tool for assessing beliefs about mental illness and mental health treatment among military personnel and veterans. Psychological Services, 11(1), 105–113. 10.1037/a0032780
- Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Available from
https://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp - Weis, C. N., Webb, E. K., Stevens, S. K., Larson, C. L., & deRoon-Cassini, T. A. (2022). Scoring the Life Events Checklist: Comparison of three scoring methods. Psychological Trauma: Theory, Research, Practice, and Policy, 14(4), 714–720. 10.1037/tra0001049
- Yanos, P. T., Lucksted, A., Drapalski, A. L., Roe, D., & Lysaker, P. (2015). Interventions targeting MHSS: A review and comparison. Psychiatric Rehabilitation Journal, 38(2), 171–178. 10.1037/prj0000100
DOI: https://doi.org/10.21061/jvs.v11i2.728 | Journal eISSN: 2470-4768
Language: English
Page range: 86 - 98
Submitted on: Apr 23, 2025
Accepted on: May 19, 2025
Published on: Sep 18, 2025
Published by: Virginia Tech Publishing
In partnership with: Paradigm Publishing Services
© 2025 Elizabeth Finer, Mitchell L. Schare, G. Mitchell Mazzone, published by Virginia Tech Publishing
This work is licensed under the Creative Commons Attribution 4.0 License.