Building Resilience from Survivor Guilt After a Traumatic Event
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Vol. I., No. 1
April 2019
Building Resilience from Survivor Guilt After a Traumatic Event
Veronica Powell, PhD
Measures4Success, LLC
Monique Swift, PsyD
Swift Solutions Consulting Services, LLC
Please address correspondence to:
Veronica Powell, PhD, LPC, Measures4Success, LLC, 1629 K St NW Suite
300 Washington, DC 20006 (drvdpowell@measures4success.com)
Monique Swift, PsyD, LPC,
Swift Solutions Consultant Services, LLC, 362 Albermarle St., Rahway, NJ 07065
(moniqueswift19@yahoo.com)
The authors have no conflicts of interest to declare as it pertains to this article.
Abstract: Not a year goes by without media coverage of causalities involving mass violence or
natural disasters. Those affected directly or indirectly are left to pick up the pieces and establish a
“new norm” for navigating the life that was lost pre-tragedy. Those who physically survived the
trauma of mass casualties are challenged to reconcile various emotional reactions such as guilt
from the tragedy. The emotions of guilt take on a transformative quality, moving from healthy guilt
to unhealthy guilt, such as survivor guilt. With guilt itself being a powerful emotion, those plagued
by the grips of survivor guilt may be limited in their ability to recognize the role of resiliency to
assist in their recovery and healing from the trauma. Additionally, practitioners may be challenged
to assist trauma survivors with complex guilt reactions. This paper examines the etiology, symptoms,
and intervention strategies for survivor guilt and its impact on trauma survivors and provides
strategies to assist trauma survivors in harnessing the power of resilience to move through the
barriers of survivor guilt post-tragedy.
Keywords: guilt, survivor guilt, PTSD, prosocial behavior, protective factors, resilience
The experience of guilt after a traumatic depression), decreased self-esteem, or limited
event is not a new phenomenon. In general, social support (Good Therapy, 2018). These
guilt represents a form of judgment that may be factors are noted to increase the trauma
based on one’s belief system, such as remorse survivor’s susceptibility to developing survivor
from something that is believed to be bad, guilt.
wrong, or a biblical sin (Fink, 2016). The destructive impact of a traumatic
Unfortunately, the unprecedented rise of experience on a trauma survivor depends on
natural disasters and mass violence has created factors such as characteristics of the individual,
a paradigm shift in how survivors of a traumatic the type of event(s), developmental processes,
event process the emotion of guilt. Although a the significance of the trauma, and
traumatic event may affect people differently, sociocultural factors (SAMSHA, 2014). For
some trauma survivors may display increased example, a CNN interview of a trauma survivor
vulnerability to the impact of guilt, whereas from the 2017 Las Vegas massacre described
others may exhibit more resilient responses to the guilt of surviving the massacre “unscathed”
the trauma. An individual’s vulnerability to and not knowing if they “Did enough?” or if
guilt may be related to factors such as a history they “Helped enough people?” (Ellefson,
of trauma, mood related disorders, (i.e., 2017). The survivor presented a classic case of
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CSHR Vol. I, No. 1 April 2019
14Building Resilience from Survivor Guilt After a Traumatic Event
what is known as survivor guilt. I too [VP] can instinctual survival drives and pleasures in a
attest to the experience of survivor guilt. When prosocial direction. Valent further noted that
I was 14 years old (1984 Easter weekend), a guilt is one of three moral judgments, with the
tornado in my rural Mississippi community other two being shame (e.g., judgment of an
killed a family who lived approximately one individual’s worth) and justice (e.g., judgment
mile from my home. I reflect on my own of fairness).
experience of survivor guilt after surviving the Fundamentally, guilt has prosocial
storm. I was left with many questions such as attributes in that it judges an individual’s
“How come my family didn’t die from the actions as good or bad and can strengthen
storm?” “How did the tornado sideswipe my interpersonal relationships (Valent, 1998;
house (without destroying it) and then Baumeister, 1997). However, for those who
miraculously go back in the air, only to touch have experienced a traumatic event there is a
down and destroy the house and the family potential for the individual to feel excessive or
down the road from us?” “Why them and not irrational guilt over surviving the trauma.
us?” “How did we escape and not them?” Kubany and Manke (1995) identified four
“What could we have done to warn the family cognitive factors of guilt related to survivors of
down the road?” “What was my purpose for traumatic events as identified in traumatized
living?” (Powell, 2019). individuals: (1) a violation personal standard
This article expands the general related to right or wrong; (2) perceived
understanding of survivor guilt and its ownership/responsibility or preventability of
differentiating factors from what represents a the event; (3) perceived lack of justification for
healthy response to guilt versus unhealthy guilt. acting; and (4) false beliefs regarding pre-
Further examination of survivor guilt includes outcome knowledge or hindsight bias. Guilt
a review of the literature on (a) its etiology, that is associated with an individual surviving
symptoms, and intervention strategies; (b) the or being uninjured in circumstances whereby
impact on trauma survivors; (c) postvention another person died or was physically or
treatment strategies; and how the power of psychologically injured is known as survivor
resilience is leveraged to move through the guilt (Hutson, Hall & Pack, 2015).
barriers of survivor guilt post tragedy. A
contextualization of guilt is presented as a Etiology, Symptoms, and Intervention
baseline to understanding survivor guilt.
for Survivor Guilt
Survivor guilt as an unintended
Contextualizing Guilt consequence of a traumatic experience has
A review of the literature identifies several been recognized as a shared phenomenon by
definitions associated with the concept of guilt. trauma survivors. For example, Neiderland
Guilt is generally defined as a fact or state of (1961) introduced the concept of survivor guilt
having committed an offense, crime, violation based on his work with Holocaust patients.
or wrong that goes against a moral standard or Through his observations, Neiderland
penal law (as cited in Elliot, 2018). It is further described a psychological state that was
defined as a cognitive or emotional experience common among survivors from World War II
occurring when an individual believes or concentration camps. He noted that survivors
realizes that they have compromised their own displayed feelings of intense guilt for surviving
standard of conduct or violated a universal loved ones who were killed in the concentration
moral standard and feel significantly camps and would behave as if they were dead
responsible for the violation. Tilghman- themselves (O’Connor, Berry, Weiss, Bush, &
Osborne, Cole, and Felton (2010) expand the Sampson, 1997). The concept of survivor guilt
definition of guilt as representing “moral was further expanded to include all trauma-
transgressions (real or imagined) in which related events, be they natural or manmade.
people believe that their action (or inaction)
According to Modell (1971), survivor guilt
contributed to negative outcomes” (p. 546).
can include more subtle forms such as
Valent (1998, 2000), described guilt as an
inhibiting oneself from success, engaging in
internal moral judgment that aims to modify
self-destructive behavior, or over-identifying
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CSHR Vol. I, No. 1 April 2019
15Building Resilience from Survivor Guilt After a Traumatic Event
with one’s suffering. Valent (2000) identified trauma-related symptoms. Furthermore,
the following eight survival behaviors that are symptoms of survivor guilt are often related to
associated with survivor guilt: those of anxiety and depression.
1. Rescue/caretaking mode involves agonizing over Symptoms experienced may range from
guilt due to neglectfulness and self-concerning mild to severe, and may impact physical being,
behavior that caused harm, suffering, or death to thoughts, feelings, and behaviors. A few
others, particularly those for whom they bore examples of symptoms are presented in Table
responsibility. Individuals operating in 1 (adapted from Weaver, 2011, p. 15;
rescue/caretaking mode will blame themselves for E4Health, 2012).
not saving those for whom they felt a sense of The noted symptoms experienced by a
responsibility. trauma survivor indicate that intervention is
2. Attachment consist of guilt that is experienced as warranted to mitigate the long-term negative
bad, sinful, or disobedient. The individual believes consequences of psychological trauma. When
that they are the cause of the catastrophe and by working with trauma survivors, it is important
abandoning the situation, must be punished for to validate their experience of the trauma by
their badness. acknowledging the normalcy of their response
3. Goal achievement represents guilt that is or reaction to an abnormal situation. There are
associated with failure, feelings of inadequacy, or several crisis intervention models designed to
incompetence. Individuals may also view assist trauma survivors in navigating their path
themselves as being stupid, clumsy, or lazy. to healing from the trauma. For example,
4. Goal surrender occurs when an individual feels Mitchell’s (1983) Critical Incident Stress
guilty over giving up, giving in, feeling despair, or Debriefing (CISD) model is a precise, 7-phase,
attempting suicide. small group, supportive crisis intervention
5. Fight is described as a self-defense or defense of process designed to facilitate reduction in
others mechanism. However, when it involves distress, restore group cohesion and unit
mistaken causing of damage or death, one’s guilt performance. CISD is a psycho-educational
reaction invokes horror or dismay. Valent notes process and is not considered to be a form of
that the individual may feel like a wicked psychological therapy. Psychological first aid
murderer. is an evidence-informed model that is
6. Flight evokes guilt from having left others behind, employed in disaster response assisting those
evading responsibility, acting cowardly, lacking impacted in the hours and early days following
moral character, or engaging in bystander apathy. an emergency, disaster, or terroristic act
7. Competition consists of priority guilt, whereby (Uhernik & Husson, 2009). The authors note
there is a belief that people undeservedly survived that psychological first aid has emerged as a
at the expense of others and that really, they should preferred response for disaster emergencies.
have died instead of the ones who perished. After the initial phase of trauma response
8. Cooperation evokes betrayal guilt whereby there is interventions, attention can be turned to
a sense of cheating, lying, exploitation or hurt of postvention strategies.
partners.
Survivors of a traumatic event who Postvention Strategies for Survivor
display survivor guilt are at risk of developing
what Lee, Scragg, and Turner (2001) described
Guilt
as guilt-based post-traumatic stress disorder Postvention is a concept that originated
(PTSD). The researchers noted that the from the field of suicidology and was first
personalization of the traumatic event by the coined by Shneidman (1981). The basic
individual may significantly influence the premise of postvention is a strategy that occurs
development of PTSD. For example, Bub and after the traumatic incident and offers crisis
Lommen (2017) noted that pre-trauma schemas intervention, support, and assistance for those
that an individual had of themselves activate or impacted by trauma related injury. Postvention
confirm underlying guilt-associated beliefs principles are transferable to non-suicide
about the self. The increased vulnerability to related traumas. When working with trauma
guilt-based PTSD consequently yields various survivors’ post-tragedy, emphasis is placed
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CSHR Vol. I, No. 1 April 2019
16Building Resilience from Survivor Guilt After a Traumatic Event
Table 1. Symptoms related to survivor guilt
(Adapted with permission)
Thoughts Feelings Physical/ Behavioral
Recurring dreams or Numbness, withdrawn, or Overprotective of your
nightmares about the disaster disconnected and your family's safety
Reconstructing the events Fear and anxiety when Isolation from others
surrounding the disaster in your reminded of the disaster such as
mind, in an effort to make it come sights, sounds, and smells
out differently
Recurring dreams or Feeling depressed Hypervigilant and easily
nightmares about the disaster startled
Reconstructing the events Anger outburst or intense Challenges getting to
surrounding the disaster in your irritability sleep or staying asleep
mind, in an effort to make it come
out differently
Difficulty concentrating or Emptiness or hopelessness Avoidance of activities,
remembering things about the future people, places or things that
are reminders of the disaster
Poor attention span Feelings of sadness Increased conflict with
family members, significant
other, friends, etc.
Questioning one's spiritual Feelings of shock/startled Excessively busy to avoid
or religious beliefs thinking about the disaster and
what has happened to you
Ruminating thoughts or Feelings of grief Increased alcohol
memories of the disaster, or of consumption or illicit drug use
individuals who died in the disaster
Suicidal thinking Feelings of guilt Crying spells for no
apparent reason
Delay in processing Feeling lost Nausea, upset stomach,
information or thinking diarrhea, chills, sweating
Difficulty in problem solving Feeling abandoned Tremors/ poor
coordination.
Increased blood pressure /
headaches
Disorientation (particularly to Feelings of irritability Rapid heartbeat,
time) breathing, muscle aches and
cramps
Challenges in naming Feelings of isolation.
common objects
on (a) processes that facilitate the grief or adjustment reduction for further traumatization (Higher
process; (b) stabilization of the trauma survivor Education Mental Health Alliance [HEMA], 2014).
environment; (c) risk reduction of negative behaviors Further goals for postvention efforts include the
such those associated with survivor guilt; and (d) risk following noted in Table 2:
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CSHR Vol. I, No. 1 April 2019
17Building Resilience from Survivor Guilt After a Traumatic Event
Building resilience from survivor
Table 2. Postvention Goals (HEMA, 2014) guilt
Unbeknownst to most trauma survivors is
their resilient ability to navigate through
Postvention Goals traumatic experiences. A basic definition of
resilience is an individual’s ability to develop
a. To provide assistance to trauma survivors psychological and emotional skills, as well as
impacted by the traumatic event and its the ability to use familial, social, and other
associated negative responses by reducing external protective support to navigate through
the intensity of the individual's or group's
emotional, mental, physical and behavioral
stressful life events or experiences (Suri, 2018).
reactions to the trauma; Resiliency also represents the ability to adapt
b. To facilitate restoration of some semblance
and overcome adversity. In building resiliency
of order and routine by assisting trauma from survivor guilt through therapeutic
survivors to return to their pre-trauma level of intervention, trauma survivors can experience
functioning; post-traumatic growth, which involves positive
c. To prevent or minimize risk of further trauma changes that individuals experience after
related injury; challenges encountered with a major life crisis
d. To create and provide a safe space where or traumatic event (Lucario, 2018). Protective
trauma survivors can process what factors, which refers to characteristics that
happened, express difficult emotions and
understand the impact of the trauma event; prevent or reduce vulnerability for the
development of maladaptive behavior or
e. To avoid memorializing grief and its
associated emotions that prevent disorders, may contribute to post-traumatic
remembrance of life prior to the traumatic growth as well. Additionally, protective factors
event; and include strengths or assets that assist
f. To educate trauma survivors on how to utilize individuals to maintain mental health well-
protective factors to build resiliency from the being and resilience at the individual level and
impact of trauma related injury. other supportive resources (i.e., family, peers,
school/work, and community) (MindMatter,
2008). For example, protective factors that
Postvention strategies for managing promote resiliency from survivor guilt may
survivor guilt allow trauma survivors the include one’s ability to (1) regulate emotions;
opportunity to leverage resources designed to (2) demonstrate effective coping and problem-
promote and foster healing post-tragedy. solving skills; (3) display optimism towards
Valent (2000) noted that protocols for the life; and (4) have a positive attitude in seeking
treatment of survivor guilt involve assisting and receiving help.
trauma survivors in (1) delineating perceptions Other resiliency strategies to curtail the
of responsibility as it related to what could impact of survivor guilt are teaching trauma
feasibly be done under the presented survivors self-care, including how to recognize
circumstances; (2) mitigating compassion behaviors that contribute to self-neglect. Some
fatigue; and (3) engagement of early debriefing examples of self-care include regular exercise,
to ameliorate survivor guilt. Through fact- healthy nutritional and sleep hygiene,
finding efforts, individuals working with engagement in physical care and grooming, and
trauma survivors can facilitate movement rest and relaxation (GoodTherapy, 2018). A
toward accepting that their best was done and solid support system is another critical aspect
using the strength of resilience to navigate the of building resiliency from survivor guilt.
adversity. Most often trauma survivors are Support networks that foster trusting and
unable to immediately recognize or supportive relationships are beneficial for
acknowledge their resilient ability along with trauma survivors. Through these relationships,
protective factors as a source of strength in trauma survivors are able to (1) vocalize their
reconciling their response to guilt. experiences of living with the guilt and connect
with those who shared the experience; (2)
participate in support groups; (3) build a
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CSHR Vol. I, No. 1 April 2019
18Building Resilience from Survivor Guilt After a Traumatic Event
community that represents their new norm Bub, K., & Lommen, M. J. J. (2017). The role of guilt
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support system that cares. Ultimately through
Center for Substance Abuse Treatment. (2014).
each intervention the trauma survivor is put
Trauma-informed care in behavioral health
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services. Rockville (MD): Substance Abuse and
of a life that was (pre-trauma) to a life of what
Mental Health Services Administration (US);
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