How Best to Treat Deployment-Related Guilt and Shame: Commentary on Smith,Duax, and Rauch (2013)

We comment on Smith, Duax, and Rauch’s (2013--this issue) explication of their approach to treating perpetration-related guilt and shame using prolonged exposure (PE) therapy, with the aim of promoting a discourse about the mechanisms, techniques, and assumptions that underlie the treatment of moral injury in veterans and service members. We first discuss the theoretical foundation underlying PE and consider the extent to which it accounts for the phenomenology of moral injury. We then examine the treatment strategies used in the PE approach and the mechanisms by which these techniques ameliorate perpetration-related guilt and shame. We also briefly highlight points of similarity and contrast between PE and adaptive disclosure, a brief cognitive behavioral intervention targeting combat-related moral injury and traumatic loss.