The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial

Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase.


Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial.


Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase.


Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = −1.09), guilt (d = −2.85), shame (d = −2.14), psychopathology and self-criticism.


Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).



  • C-METTA is an intervention that addresses trauma-related guilt and shame and combines cognitive interventions with loving-kindness meditations.
  • A proof-of-concept study was conducted examining C-METTA in a wait-list randomized controlled trial
  • C-METTA led to reductions in trauma-related guilt and shame and PTSD symptoms.
Meike Müller-Engelmann, Luisa Bahnemann & Stella Kümmerle | 2024
In: European Journal of Psychotraumatology ; ISSN: 2000-8066 | 15 | 1 | february | 2308439
Adults, Germans, Guilt, Interventions, Meditation, Posttraumatic Stress Disorder, PTSD (DSM-5), PTSD (en), Randomized Clinical Trial, Shame, Statistical Analysis, Treatment