# Investigating the Neural Basis of Shame and Guilt in Veterans with Posttraumatic Stress Disorder

> **NIH VA I01** · DURHAM VA MEDICAL CENTER · 2021 · —

## Abstract

ABSTRACT
Abnormally regulated fear and threat perception are widely regarded as the core patho-
physiological process in posttraumatic stress disorder (PTSD). As a result, associative fear
learning models have dominated research on the neuroscience of PTSD. However, shame,
guilt, and moral injury, rather than fear, are dominant cognitive processes among individuals
with PTSD, which often develops following military combat trauma. Very little is known about
how PTSD affects the brain circuits associated with shame and guilt, in part due to the lack of
animal models. The first goal of this proposal is to develop experimental paradigms that are
suitable to the fMRI setting for investigating shame and guilt neurocircuits in PTSD. We will
begin by developing a library of short vignettes highlighting dominant themes of trauma-related
shame and guilt. Creating a trauma-relevant stimulus set to study shame and guilt will greatly
enhance our ability, and that of the broader scientific community, to investigate the
neuroscience of shame and guilt in PTSD from combat trauma. Three groups (1) patients with
PTSD having prominent shame and guilt symptoms, (2) patients with PTSD without shame or
guilt, and (3) combat-trauma exposed control subjects will be presented vignettes evocative of
shame and guilt along with matched neutral vignettes in the fMRI environment. We hypothesize
that the shame and guilt prominent PTSD group will exhibit greater activation than the other
groups in canonical shame and guilt processing brain regions (self-referential) consistent with
greater negative self-attribution. In addition, the functional organization of the brain will be
characterized from temporally correlated activity between anatomically distinct brain regions
obtained from task-related fMRI activity. We predict that self-reported shame or guilt in patients
with PTSD will be associated with a disruption of functional brain networks in prominent self-
referential brain regions. Behavioral measures of guilt and shame will be used to study whether
PTSD modulates the association between brain activity/organization and the subjective
experience of shame/guilt. The knowledge gained from the proposed research will advance the
neurobiology of PTSD, and in the future with more research, shed light on treatments that
engage neural targets implicated in shame and guilt. Transcranial magnetic stimulation (TMS),
transcranial direct current stimulation (tDCS), and real-time fMRI neurofeedback are potential
interventions that could be applied in the future to directly modulate these newly discovered
targets.

## Key facts

- **NIH application ID:** 9868198
- **Project number:** 5I01CX001783-02
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** RAJENDRA A MOREY
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9868198

## Citation

> US National Institutes of Health, RePORTER application 9868198, Investigating the Neural Basis of Shame and Guilt in Veterans with Posttraumatic Stress Disorder (5I01CX001783-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9868198. Licensed CC0.

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