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Improving guilt and shame is often a goal of treatment, and providers express a desire for more strategies to manage guilt and shame for individuals with posttraumatic stress disorder (PTSD) and moral injury. Evidence\u2010based psychotherapies for PTSD, such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing therapy, have been found to improve trauma\u2010related guilt and shame among individuals with PTSD and\/or moral injury. This paper provides an overview of the assessment of trauma\u2010related guilt and shame, as well as therapist considerations for treatment, and explores each treatment, its evidence, and its approach to treating guilt and shame. Applied techniques and strategies to maximize effectiveness in addressing guilt and shame are provided for each of these treatments. Future research is needed to inform clinical decision\u2010making, the treatment of residual shame and guilt, and the assessment of trauma\u2010related shame and guilt throughout treatment.<\/jats:p>","DOI":"10.1002\/jts.70081","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:21:27Z","timestamp":1786947687000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing trauma\u2010focused treatments to address guilt and shame: Clinical considerations and strategies"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5725-7275","authenticated-orcid":false,"given":"Stephanie Y.","family":"Wells","sequence":"first","affiliation":[{"name":"Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System  Durham North Carolina USA"},{"name":"VA Mid\u2010Atlantic Mental Illness Research, Education and Clinical Center  Durham North Carolina USA"},{"name":"Durham VA Health Care System  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9145-2632","authenticated-orcid":false,"given":"Brittany C.","family":"Davis","sequence":"additional","affiliation":[{"name":"James A. Haley Veterans Hospital  Tampa Florida USA"},{"name":"Executive Division, National Center for PTSD, White River Junction  Vermont USA"},{"name":"Department of Psychiatry and Behavioral Neurosciences University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3652-5787","authenticated-orcid":false,"given":"Jennifer Schuster","family":"Wachen","sequence":"additional","affiliation":[{"name":"Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Psychiatry Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne E.","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Diego School of Medicine  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4751-1882","authenticated-orcid":false,"given":"Sonya B.","family":"Norman","sequence":"additional","affiliation":[{"name":"Executive Division, National Center for PTSD, White River Junction  Vermont USA"},{"name":"Department of Psychiatry University of California San Diego School of Medicine  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2021.101666"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0886260516636068"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1027\/1015\u20105759\/a000699"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. 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