{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T19:33:34Z","timestamp":1783020814849,"version":"3.54.6"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH-11-2-0132"],"award-info":[{"award-number":["W81XWH-11-2-0132"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH-18-1-0464"],"award-info":[{"award-number":["W81XWH-18-1-0464"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004925","name":"Texas Health and Human Services Commission","doi-asserted-by":"publisher","award":["HHSC Contract 529-14-0084-00001"],"award-info":[{"award-number":["HHSC Contract 529-14-0084-00001"]}],"id":[{"id":"10.13039\/100004925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Identifying the role of guilt in post-traumatic stress disorder (PTSD) has important implications for understanding the development and treatment of PTSD. The present study is a secondary analysis of data collected on veterans with combat-related PTSD (N\u2009=\u200961) who enrolled in a clinical trial. Hierarchical regression analyses were used to explore associations between action- and survivor-guilt on the Clinician Administered PTSD Scale (CAPS), PTSD symptom severity on the CAPS, and depression on the Quick Inventory of Depressive Symptomatology (QIDS). Action- and survivor-guilt independently predicted PTSD total symptom severity, but in examining PTSD symptom cluster severity, only action-guilt independently predicted avoidance and numbing severity in PTSD. However, depression symptom severity on QIDS also mediated the association between action-guilt and PTSD total symptom severity and avoidance and numbing severity. Thus, action- and survivor-guilt appear to have independent contributions to PTSD symptom severity, and action-guilt, more specifically, appears to affect avoidance and numbing severity in PTSD through depression. The findings are discussed in terms of the potential role of guilt in PTSD and in relation to previous research on guilt and depression in PTSD and PTSD treatment.<\/jats:p>","DOI":"10.1371\/journal.pone.0351689","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:10:24Z","timestamp":1783015824000},"page":"e0351689","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Action-guilt, survivor-guilt, and depression in combat-related PTSD"],"prefix":"10.1371","volume":"21","author":[{"given":"Mika Allyssa","family":"Esquillo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2278-9422","authenticated-orcid":true,"given":"Riya","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Ellen","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Bass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Tillman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3919-8125","authenticated-orcid":true,"given":"John","family":"Hart Jr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6635-6948","authenticated-orcid":true,"given":"Michael A.","family":"Motes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"pone.0351689.ref001","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jad.2015.04.026","article-title":"The role of guilt in the development of post-traumatic stress disorder: A systematic review","volume":"182","author":"LR Pugh","year":"2015","journal-title":"J Affect Disord"},{"issue":"1","key":"pone.0351689.ref002","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S1077-7229(05)80004-5","article-title":"Cognitive therapy for trauma-related guilt: Conceptual bases and treatment outlines","volume":"2","author":"ES Kubany","year":"1995","journal-title":"Cogn Behav Pract"},{"issue":"23","key":"pone.0351689.ref003","doi-asserted-by":"crossref","first-page":"3610","DOI":"10.1177\/0886260516636068","article-title":"Mid-Treatment Reduction in Trauma-Related Guilt Predicts PTSD and Functioning Following Cognitive Trauma Therapy for Survivors of Intimate Partner Violence","volume":"33","author":"CB Allard","year":"2018","journal-title":"J Interpers Violence"},{"key":"pone.0351689.ref004","doi-asserted-by":"crossref","first-page":"101666","DOI":"10.1016\/j.jbtep.2021.101666","article-title":"Reductions in guilt cognitions following prolonged exposure and\/or sertraline predict subsequent improvements in PTSD and depression","volume":"73","author":"CB Allard","year":"2021","journal-title":"J Behav Ther Exp Psychiatry"},{"issue":"2","key":"pone.0351689.ref005","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S1077-7229(97)80002-8","article-title":"Application of cognitive therapy for trauma-related guilt (CT-TRG) with a Vietnam veteran troubled by multiple sources of guilt","volume":"4","author":"ES Kubany","year":"1997","journal-title":"Cogn Behav Pract"},{"key":"pone.0351689.ref006","doi-asserted-by":"crossref","first-page":"102606","DOI":"10.1016\/j.janxdis.2022.102606","article-title":"Changes in guilt cognitions in intensive PTSD treatment among veterans who experienced military sexual trauma or combat trauma","volume":"90","author":"EA Meade","year":"2022","journal-title":"J Anxiety Disord"},{"key":"pone.0351689.ref007","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jad.2005.02.013","article-title":"Resolution of trauma-related guilt following treatment of PTSD in female rape victims: a result of cognitive processing therapy targeting comorbid depression?","volume":"86","author":"P Nishith","year":"2005","journal-title":"J Affect Disord"},{"issue":"3","key":"pone.0351689.ref008","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s40501-022-00261-7","article-title":"Trauma-Informed Guilt Reduction Therapy: Overview of the Treatment and Research","volume":"9","author":"S Norman","year":"2022","journal-title":"Curr Treat Options Psychiatry"},{"key":"pone.0351689.ref009","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.jad.2017.12.046","article-title":"Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial","volume":"229","author":"FA Kozel","year":"2018","journal-title":"J Affect Disord"},{"issue":"12","key":"pone.0351689.ref010","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1017\/S0033291722001866","article-title":"The relationship of trauma-related guilt with PTSD symptoms in adult trauma survivors: a meta-analysis","volume":"52","author":"A Kip","year":"2022","journal-title":"Psychol Med"},{"key":"pone.0351689.ref011","doi-asserted-by":"crossref","first-page":"102443","DOI":"10.1016\/j.janxdis.2021.102443","article-title":"Shame, guilt, and posttraumatic stress symptoms: A three-level meta-analysis","volume":"82","author":"C Shi","year":"2021","journal-title":"J Anxiety Disord"},{"issue":"8","key":"pone.0351689.ref012","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1002\/(SICI)1097-4679(199712)53:8<801::AID-JCLP3>3.0.CO;2-I","article-title":"Combat guilt and its relationship to PTSD symptoms","volume":"53","author":"KR Henning","year":"1997","journal-title":"J Clin Psychol"},{"key":"pone.0351689.ref013","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/BF02229056","article-title":"Initial examination of a multidimensional model of trauma-related guilt: application to combat veterans and battered women","volume":"17","author":"ES Kubany","year":"1995","journal-title":"J Psychopathol Behav Assess"},{"issue":"4","key":"pone.0351689.ref014","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1037\/1040-3590.8.4.428","article-title":"Development and validation of the Trauma-Related Guilt Inventory (TRGI)","volume":"8","author":"ES Kubany","year":"1996","journal-title":"Psychological Assessment"},{"key":"pone.0351689.ref015","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"1994","edition":"4"},{"issue":"2","key":"pone.0351689.ref016","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S0020-1383(97)00131-9","article-title":"A review of post-traumatic stress disorder. Part I: Historical development and classification","volume":"29","author":"GJ Turnbull","year":"1998","journal-title":"Injury"},{"issue":"1","key":"pone.0351689.ref017","first-page":"75","article-title":"The development of a Clinician-Administered PTSD Scale","volume":"8","author":"DD Blake","year":"1995","journal-title":"J Trauma Stress"},{"issue":"2","key":"pone.0351689.ref018","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1037\/1040-3590.11.2.124","article-title":"Psychometric properties of nine scoring rules for the clinician-administered posttraumatic stress disorder scale","volume":"11","author":"FW Weathers","year":"1999","journal-title":"Psychol Assess"},{"issue":"4","key":"pone.0351689.ref019","first-page":"573","article-title":"Post\u2010traumatic stress disorder conflicts in Vietnam combat veterans: A confirmatory factor analytic study","volume":"3","author":"H Glover","year":"1990","journal-title":"Journal of Traumatic Stress"},{"key":"pone.0351689.ref020","volume-title":"Legacies of Vietnam: Vol. III. Post-war trauma: social and psychological problems of Vietnam veterans and their peers","author":"RS Laufer","year":"1981"},{"issue":"1","key":"pone.0351689.ref021","first-page":"57","article-title":"Four syndromes of post\u2010traumatic stress disorder: Stressors and conflicts of the traumatized with special focus on the Vietnam combat veteran","volume":"1","author":"H Glover","year":"1988","journal-title":"Journal of Traumatic Stress"},{"issue":"3","key":"pone.0351689.ref022","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1037\/0735-7028.20.3.159","article-title":"Taxonomy of guilt for combat veterans","volume":"20","author":"RE Opp","year":"1989","journal-title":"Professional Psychology: Research and Practice"},{"issue":"3","key":"pone.0351689.ref023","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1348\/000711299160031","article-title":"An investigation of shame and guilt in a depressed sample","volume":"72","author":"B Alexander","year":"1999","journal-title":"Br J Med Psychol"},{"issue":"1","key":"pone.0351689.ref024","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0887-6185(97)00047-9","article-title":"Posttraumatic stress disorder and comorbid major depression: is the correlation an illusion?","volume":"12","author":"EB Blanchard","year":"1998","journal-title":"J Anxiety Disord"},{"issue":"3","key":"pone.0351689.ref025","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/jts.21814","article-title":"The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis","volume":"26","author":"NK Rytwinski","year":"2013","journal-title":"J Trauma Stress"},{"issue":"6","key":"pone.0351689.ref026","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1007\/s10960-004-5795-7","article-title":"Are avoidance and numbing distinct PTSD symptom clusters?","volume":"17","author":"GJG Asmundson","year":"2004","journal-title":"J Trauma Stress"},{"issue":"3","key":"pone.0351689.ref027","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.jad.2010.10.032","article-title":"Requiring both avoidance and emotional numbing in DSM-V PTSD: will it help?","volume":"130","author":"D Forbes","year":"2011","journal-title":"J Affect Disord"},{"issue":"4","key":"pone.0351689.ref028","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1002\/jts.2490100407","article-title":"Predictors of emotional numbing in posttraumatic stress disorder","volume":"10","author":"BT Litz","year":"1997","journal-title":"J Trauma Stress"},{"issue":"3","key":"pone.0351689.ref029","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1023\/A:1007789409330","article-title":"Exploring the roles of emotional numbing, depression, and dissociation in PTSD","volume":"13","author":"NC Feeny","year":"2000","journal-title":"J Trauma Stress"},{"issue":"2","key":"pone.0351689.ref030","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1176\/appi.neuropsych.15070183","article-title":"Factors Impacting Functional Status in Veterans of Recent Conflicts With PTSD","volume":"28","author":"FA Kozel","year":"2016","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"5","key":"pone.0351689.ref031","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S0006-3223(02)01866-8","article-title":"The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression","volume":"54","author":"AJ Rush","year":"2003","journal-title":"Biol Psychiatry"},{"issue":"3","key":"pone.0351689.ref032","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1002\/da.1029","article-title":"Clinician-administered PTSD scale: a review of the first ten years of research","volume":"13","author":"FW Weathers","year":"2001","journal-title":"Depress Anxiety"},{"issue":"6","key":"pone.0351689.ref033","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations","volume":"51","author":"RM Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"issue":"2","key":"pone.0351689.ref034","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1046\/j.1440-1614.2002.01002.x","article-title":"Emotional numbing in posttraumatic stress disorder: current and future research directions","volume":"36","author":"BT Litz","year":"2002","journal-title":"Aust N Z J Psychiatry"},{"issue":"3","key":"pone.0351689.ref035","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/jts.20026","article-title":"Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence","volume":"18","author":"AE Street","year":"2005","journal-title":"J Trauma Stress"},{"issue":"3","key":"pone.0351689.ref036","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/da.20659","article-title":"Combat-related guilt mediates the relations between exposure to combat-related abusive violence and psychiatric diagnoses","volume":"27","author":"BP Marx","year":"2010","journal-title":"Depress Anxiety"},{"issue":"2","key":"pone.0351689.ref037","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1002\/jts.21999","article-title":"Trauma-related guilt: conceptual development and relationship with posttraumatic stress and depressive symptoms","volume":"28","author":"KC Browne","year":"2015","journal-title":"J Trauma Stress"},{"issue":"2","key":"pone.0351689.ref038","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1080\/10615806.2016.1230669","article-title":"Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans\u2019 involvement in wartime atrocities","volume":"30","author":"PA Dennis","year":"2017","journal-title":"Anxiety Stress Coping"},{"key":"pone.0351689.ref039","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.neubiorev.2021.10.017","article-title":"Alterations in large-scale functional networks in adult posttraumatic stress disorder: A systematic review and meta-analysis of resting-state functional connectivity studies","volume":"131","author":"W Bao","year":"2021","journal-title":"Neurosci Biobehav Rev"},{"issue":"7","key":"pone.0351689.ref040","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1002\/da.22478","article-title":"Aberrant resting-state brain activity in posttraumatic stress disorder: a meta-analysis and systematic review","volume":"33","author":"SBJ Koch","year":"2016","journal-title":"Depress Anxiety"},{"issue":"10","key":"pone.0351689.ref041","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1002\/da.23075","article-title":"Associations between resting-state functional connectivity and treatment response in a randomized clinical trial for posttraumatic stress disorder","volume":"37","author":"J Sheynin","year":"2020","journal-title":"Depress Anxiety"},{"key":"pone.0351689.ref042","doi-asserted-by":"crossref","first-page":"116287","DOI":"10.1016\/j.neuroimage.2019.116287","article-title":"Rumination and the default mode network: Meta-analysis of brain imaging studies and implications for depression","volume":"206","author":"HX Zhou","year":"2020","journal-title":"Neuroimage"},{"issue":"6","key":"pone.0351689.ref043","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jamapsychiatry.2015.0071","article-title":"Large-Scale Network Dysfunction in Major Depressive Disorder: A Meta-analysis of Resting-State Functional Connectivity","volume":"72","author":"RH Kaiser","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"pone.0351689.ref044","doi-asserted-by":"crossref","first-page":"102570","DOI":"10.1016\/j.nicl.2021.102570","article-title":"Reduced functional connectivity of default mode network subsystems in depression: Meta-analytic evidence and relationship with trait rumination","volume":"30","author":"L Tozzi","year":"2021","journal-title":"Neuroimage Clin"},{"issue":"18","key":"pone.0351689.ref045","doi-asserted-by":"crossref","first-page":"9078","DOI":"10.1073\/pnas.1900390116","article-title":"Reduced default mode network functional connectivity in patients with recurrent major depressive disorder","volume":"116","author":"CG Yan","year":"2019","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"6","key":"pone.0351689.ref046","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1073\/pnas.0812686106","article-title":"The default mode network and self-referential processes in depression","volume":"106","author":"YI Sheline","year":"2009","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pone.0351689.ref047","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jpsychires.2014.10.012","article-title":"Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model","volume":"61","author":"C Armour","year":"2015","journal-title":"J Psychiatr Res"},{"issue":"11","key":"pone.0351689.ref048","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1037\/pas0000254","article-title":"Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans","volume":"28","author":"MJ Bovin","year":"2016","journal-title":"Psychol Assess"},{"key":"pone.0351689.ref049","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1348\/014466506X171540","article-title":"The structure of PTSD symptoms: a test of alternative models using confirmatory factor analysis","volume":"46","author":"A Elklit","year":"2007","journal-title":"Br J Clin Psychol"},{"issue":"2","key":"pone.0351689.ref050","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1037\/1040-3590.10.2.90","article-title":"Confirmatory factor analysis of the clinician-administered PTSD scale: Evidence for the dimensionality of posttraumatic stress disorder","volume":"10","author":"DW King","year":"1998","journal-title":"Psychol Assess"},{"issue":"6","key":"pone.0351689.ref051","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.janxdis.2004.06.003","article-title":"Symptom structure of posttraumatic stress disorder in a nationally representative sample","volume":"19","author":"LA McWilliams","year":"2005","journal-title":"J Anxiety Disord"},{"issue":"2","key":"pone.0351689.ref052","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1002\/jts.20000","article-title":"Prediction of numbing and effortful avoidance in female rape survivors with chronic PTSD","volume":"18","author":"CA Feuer","year":"2005","journal-title":"J Trauma Stress"},{"key":"pone.0351689.ref053","unstructured":"Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keene TM. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). www.ptsd.va.gov. 2013."},{"key":"pone.0351689.ref054","volume-title":"Cognitive processing therapy: Veteran\/military version","author":"PA Resick","year":"2008"},{"key":"pone.0351689.ref055","volume-title":"Cognitive processing therapy: A comprehensive manual","author":"PA Resick","year":"2017"},{"key":"pone.0351689.ref056","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jpsychires.2018.02.003","article-title":"Trauma related guilt cognitions partially mediate the relationship between PTSD symptom severity and functioning among returning combat veterans","volume":"100","author":"SB Norman","year":"2018","journal-title":"J Psychiatr Res"},{"key":"pone.0351689.ref057","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jpsychires.2021.02.022","article-title":"Trauma-related guilt and posttraumatic stress disorder symptoms in military veterans: The role of psychological inflexibility","volume":"137","author":"LK Kachadourian","year":"2021","journal-title":"J Psychiatr Res"},{"issue":"1","key":"pone.0351689.ref058","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/da.23084","article-title":"Prior trauma-related experiences predict the development of posttraumatic stress disorder after a new traumatic event","volume":"38","author":"F Gould","year":"2021","journal-title":"Depress Anxiety"},{"issue":"1","key":"pone.0351689.ref059","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa040603","article-title":"Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care","volume":"351","author":"CW Hoge","year":"2004","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0351689.ref060","article-title":"A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans","volume":"10","author":"C Xue","year":"2015","journal-title":"PLoS One"},{"issue":"3","key":"pone.0351689.ref061","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jbct.2023.07.001","article-title":"Intelligence quotient, combat experiences, psychosocial functioning, and depressive symptoms\u2019 roles in PTSD symptom severity and treatment completion","volume":"33","author":"GD Tillman","year":"2023","journal-title":"J Behavioral Cognitive Therapy"},{"issue":"5","key":"pone.0351689.ref062","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1002\/jclp.23659","article-title":"Changes in guilt cognitions mediate the effect of trauma-informed guilt reduction therapy on PTSD and depression outcomes","volume":"80","author":"AC Kline","year":"2024","journal-title":"J Clin Psychol"},{"issue":"5","key":"pone.0351689.ref063","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1080\/10503307.2014.917217","article-title":"Trauma-related shame and guilt as time-varying predictors of posttraumatic stress disorder symptoms during imagery exposure and imagery rescripting--A randomized controlled trial","volume":"25","author":"T \u00d8ktedalen","year":"2015","journal-title":"Psychother Res"},{"key":"pone.0351689.ref064","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jad.2017.06.046","article-title":"A model comparison approach to trauma-related guilt as a mediator of the relationship between PTSD symptoms and suicidal ideation among veterans","volume":"221","author":"KC Cunningham","year":"2017","journal-title":"J Affect Disord"},{"issue":"1","key":"pone.0351689.ref065","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/sltb.12266","article-title":"Trauma-Related Guilt Mediates the Relationship between Posttraumatic Stress Disorder and Suicidal Ideation in OEF\/OIF\/OND Veterans","volume":"47","author":"JC Tripp","year":"2017","journal-title":"Suicide Life Threat Behav"},{"issue":"1","key":"pone.0351689.ref066","first-page":"3","article-title":"A cognitive model of guilt typology in combat-related PTSD","volume":"7","author":"ES Kubany","year":"1994","journal-title":"J Trauma Stress"},{"issue":"1","key":"pone.0351689.ref067","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.cbpra.2013.08.001","article-title":"Trauma informed guilt reduction therapy with combat veterans","volume":"21","author":"SB Norman","year":"2014","journal-title":"Cogn Behav Pract"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351689","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:10:44Z","timestamp":1783015844000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351689"}},"subtitle":[],"editor":[{"given":"Giuseppe","family":"Marano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":67,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351689","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}