Cognitive processing therapy (CPT) is a first-line treatment for posttraumatic stress disorder (PTSD). The primary goals of CPT are to identify and challenge dysfunctional cognitions resulting from the trauma to promote a more balanced set of beliefs and reduce manufactured emotions; encouraging expression of natural emotions further promotes symptom improvement. Between-session assignments (homework) are an integral part of learning and practicing the skills developed during CPT, and these assignments are theorized to reinforce the proposed mechanisms of symptom change. This article begins with a brief description of the theoretical foundations of CPT and an overview of the session content of the CPT protocol, followed by a case study illustrating the use of CPT with the written account (CPT + A) with a survivor of childhood sexual assault. Although the client demonstrated some avoidance, her successful completion of practice assignments throughout treatment allowed her to identify and examine thoughts contributing to feelings of guilt and self-blame as well as negative beliefs about the world. She was able to reduce her assimilated and overaccommodated stuck points to form a more balanced view of the trauma, and also process her natural emotions, resulting in a significant reduction of PTSD symptoms. The role of homework at each session and how the assignments addressed the proposed mechanisms of change in CPT are discussed, and recommendations to increase clients\' engagement in practice assignments in CPT are provided.

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.

Psychosocial and cultural factors play an important, but often neglected, role in depression in young individuals. In this article, we present two cases of young, educated males with major depressive disorder and prominent themes of guilt and spiritual distress. We explore the relationship between moral incongruence, spiritual distress, and feelings of guilt with major depressive episodes by presenting two cases of depression in young individuals who were high-achieving students. Both cases presented with low mood, psychomotor slowing, and selective mutism. Upon detailed history, spiritual distress and feelings of guilt due to internet pornographic use (IPU) and the resulting self-perceived addiction and moral incongruence were linked to the initiation and progression of major depressive episodes. The severity of the depressive episode was measured using the Hamilton Depression Scale (HAM-D). Themes of guilt and shame were measured using the State of Guilt and Shame Scale (SSGS). High expectations from the family were also a source of stress. Hence, it is important to keep these factors in mind while managing mental health problems in young individuals. Late adolescence and early adulthood are periods of high stress and vulnerabe to mental illness. Psychosocial determinants of depression in this age group generally go unexplored and unaddressed leading to suboptimal treatment, particularly in developing countries. Further research is needed to assess the importance of these factors and to determine ways to mitigate them.

Reports of sexual offences have increased in recent years, with many cases involving allegations against high-status individuals (e.g., Harvey Weinstein, Bill Cosby). In addition, many of these cases have involved allegations against the defendant from multiple victims, with long delays in reporting of the alleged assault. The purpose of this study was to examine the influence of defendant occupational status (low vs. high), defendant race (White, Black), number of allegations (one vs. five victims), and the length of reporting delay (5, 20, or 35 years) on mock-juror decision-making. Mock-jurors (N = 752) read a mock-trial transcript describing a sexual assault case. After reading the trial transcript, mock-jurors were asked to provide dichotomous and continuous guilt ratings, as well as ratings regarding their perceptions of the defendant and victim. Results revealed that mock-jurors rendered more guilty verdicts, assigned higher guilt ratings, and perceived the defendant less favorably and the victim more favorably, when the defendant was White (as opposed to Black) and when there were multiple allegations against the defendant. The current findings suggest that defendant race and the number of allegations are highly influential in the context of a sexual assault case.

In the Netherlands, in approximately 30% of the more serious criminal cases, a pretrial forensic mental health report (FMHR) is requested to inform the court whether a mental disorder was present at the time of alleged crime, whether this disorder affected behavior and decision-making at the time of the offense and how this disorder may affect future (criminal) behavior. While informative for sentencing decisions, information about mental disorders or risk is irrelevant for the question whether the defendant committed the alleged crime. Yet based on cognitive psychological theory of evidence evaluation and integration, we hypothesized that information in an FMHR would affect the evaluation of evidence as well as the ultimate decision about guilt. Using an experimental vignette study among 200 law and criminology students with manipulation of the presence and content of an FMHR, we found a main effect of the presence of an FMHR report on decisions about guilt. The proportion of guilty verdicts increased with almost 20% when an FMHR was present compared to when this report was absent, irrespective of the type of disorder (schizophrenia or personality disorder) or level of recidivism risk (low or high) present in the report. We did not find support for our hypothesis that this effect could be explained by assimilation of other available evidence. Implications for further research and practice are discussed.

Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as \'the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.\' These events can provoke emotions such as remorse, guilt and shame, and affects someone\'s self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion: The case of Dusan has shown it is worthwhile to address moral trauma and BEP- MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT.
Antecedentes: Los eventos traumáticos pueden estar relacionados con transgresiones graves o violaciones de los límites morales. El daño moral (DM) se ha descrito como ‘el impacto duradero psicológico, biológico, espiritual, conductual y social de perpetrar, fallar en prevenir o testificar actos que transgreden creencias y expectativas morales profundamente sostenidas’. Estos eventos pueden provocar emociones como remordimiento, culpa y vergüenza, y afectan la autoimagen y la identidad de una persona.Objetivo: El objetivo del estudio es evaluar un protocolo de tratamiento que aborde las características específicas del trauma moral en el tratamiento del TEPT, junto a la ansiedad.Método: La psicoterapia ecléctica breve para el trauma moral (BEP-MT) es una adaptación de la psicoterapia ecléctica breve basada en la evidencia para el TEPT (BEPP). La BEP-MT integra componentes de psicoterapia cognitivo-conductual, psicodinámica, constructivista y sistémica. En el estudio actual, se monitoreó el progreso del tratamiento de un refugiado, Dusan. Antes y después del tratamiento, se aplicó la Escala de TEPT para el DSM-5 administrada por clínicos, la Lista de chequeo de TEPT (PCL-5, por su sigla en inglés), el Inventario breve de síntomas (BSI, por su sigla en inglés) y la Escala de evaluación de lesiones morales (MIAS, por su sigla en inglés). En cada sesión, las emociones morales se evaluaron en una escala Likert.Resultados: Mientras que las quejas de TEPT y los fuertes sentimientos de culpa y vergüenza se manifestaron antes del tratamiento, durante BEP-MT se encontró una disminución gradual en la intensidad de las emociones morales. Después de BEP-MT, Dusan dejo de cumplir los criterios para el trastorno de estrés postraumático y sus quejas psicológicas disminuyeron.Conclusiones: El Caso de Dusan ha demostrado que vale la pena abordar el trauma moral y BEP-MT es un protocolo prometedor para los pacientes que sufren de trastorno de estrés postraumático después de un trauma moral. Se necesitan más investigaciones para examinar la eficacia de BEP-MT.
背景: 创伤事件可能与严重违法或违反道德界限有关。道德伤害（MI）被描述为“犯下、未能预防或见证违背深层道德观念和期望行为的持久心理、生物、精神、行为和社会影响。”这些事件会激起诸如悔恨、内疚和羞耻的情绪，并影响某人的自我形象和身份。目的: 研究的旨在评估一种治疗方案，该方案致力于PTSD治疗中有别于焦虑的特定道德创伤性创伤特征。方法: 道德创伤的简明折衷心理疗法（BEP-MT）是针对PTSD询证简明折衷心理疗法的改编（BEPP, Gersons et al, 2000; Gersons & Olff, 2005; Gersons & Schnyder, 2013）。BEP-MT整合了认知行为、心理动力、建构主义和系统性心理治疗的组成部分。在本研究中，监测了难民杜尚的治疗进度。在治疗前后，都要使用DSM-5临床用PTSD量表、PTSD清单（PCL-5）、简要症状量表（BSI）和道德损伤评估量表（MIAS）。每次治疗的道德情感都用李克特量表进行评估。结果: 尽管在治疗前出现了 PTSD 抱怨以及强烈的内疚和羞耻感，在 BEP MT 期间发现道德情感的强度逐渐下降。 在 BEP-MT 之后，杜尚不再符合 PTSD 的标准后，他的心理抱怨也减少了。结论: 杜尚的案例表明，解决道德创伤是值得的，而 BEPMT 是一个对于道德创伤后 PTSD 患者有前景的治疗方案。 需要进一步研究来考查 BEP-MT 的有效性。.

The worldwide spread of the novel coronavirus (SARS-CoV-2) has exposed healthcare workers (HCWs) to physical and mental disorders both directly and indirectly related to the pandemic. Italy was the first European country affected by the SARS-CoV-2 pandemic, and Italian HCWs have presented adverse psychological outcomes related to work and emotional overload and the fears of becoming infected and infecting others, particularly loved ones.
We report the case of a 61-year-old HCW who likely infected her husband with SARS-CoV-2, leading to his death. We assessed the depressive and anxious symptoms that the patient experienced after the death of her husband, which were characterized by a deep sense of guilt, psychological pain, and thoughts of death.
In our opinion, our case emphasizes the fact that HCWs need greater mental health assistance, particularly those who are heavily involved in the care of patients and who have possible risk factors for psychiatric symptoms.

OBJECTIVE: Criticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results.
METHODS: After monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to 3 months. Indexes of OCD, depression, anxiety, disgust, and fear of guilt were collected.
RESULTS: Patients reported a significant decrease in OCD symptoms. The mean value on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the 3-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety.
CONCLUSIONS: Our findings suggest that after ImRs intervention focusing on patients\' early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD.

Scholars have long investigated how perceptions of the victim affect judgments in a sexual assault case, but little research has investigated perceptions of the perpetrator. Participants (N = 322) read a scenario about an alleged sexual assault that manipulated victim behavior (speed of reporting) and perpetrator characteristics (athlete status and celebrity status) and then made judgments about the victim and perpetrator. Results showed that victim behavior was the most important factor in judgments. Furthermore, significant three-way interactions suggested that participants may attend to perpetrator characteristics but only when the victim\'s behavior is consistent with stereotypes about sexual assault victims.

Grief, death, bereavement, and loss do not discriminate based on gender identity or sexual orientation. Limited attention has been given to the bereaved partners of transgender and gender non-conforming persons (TGNC). Despite recent efforts to protect the rights of TGNC persons, the death of a TGNC partner is often complicated, marked by family members and friends who might never have known or refused to acknowledge the deceased in his, her, or their preferred gender. The present study adopted a single case study design to examine the death of a TGNC spouse through the unique lens of a bereaved partner.