Table 1.

Overview of the treatment components and exercises covered at each session of a value-based cognitive-behavioral group therapy to treat war-related shame.

Sessions	Topics	Exemplarly guiding questions	Optional exercises
1–3	Psychoeducation on the topics of war trauma and affect regulation, Identification of everyday destructive behaviors toward others (e.g., aggressive social interaction) and oneself (e.g., excessive exercise, unhealthy eating habits)	How are one’s own needs and resources dealt with? Are self-forgiveness and self-consolation possible in stressful conflict situations? How are conflicts managed and frustration coped with?	Compassion-focused imagery guided breathing exercises Trauma-releasing exercises (TRE)
4–5	Improvement of social competencies and interactions, identification of personal resources	What do you genuinely care about? What do you want your life to stand for?	Meditation Mindful walking
6–7	The importance of value orientations in daily life and the advantages and disadvantages deriving therefrom	What are values and why are value orientations important for individuals? What consequences can rigid, uncompromising values have?	Group discussion
8–9	Contextualisation of values and belief systems and deployment-related changes	How did participation in the deployment affect personal value orientations? What are the advantages and disadvantages associated with changed values and belief systems in the areas of perception of service and private life?	Imaginative value affirmation (imaginative description of a future characteristic scene representing the desirable new values (“Me in 10 years”))
10–13	Moral Injury (MI) resulting from the moral misconduct of others	Why did the perpetrator commit his actions? Therapists may adopt a judgmental position in order to be authentically perceptible for the participants (“…that was a terrible offence…”), if necessary, this should also be put into perspective: (“Was the perpetrator perhaps overtaxed himself?”). What consequences does anger have for the relationships with their close relatives (e.g., bitterness, relationship conflicts, separation…)? Is anger still “attractive” when these changes are taken into account?	e.g.,Thought-stopping techniques, compassionate imagination and developing potential healing cognitions
14–17	MI resulting from one’s own moral misconduct	Why did the person act in that way in that situation? What consequences did the behavior lead to for themselves and for others? What personal value orientations and moral standards might be in conflict with such behaviors? Accordingly, what thoughts, feelings or symptoms might have developed?	Inner judge or trainer, imaginary dialogue with a benevolent moral authority practice of forgiveness using compassionate imagery
18–20	Integration of solutions to moral conflicts into daily life	How does shame affect self-esteem? What are the consequences of shame for dealing with oneself? Can shame also have advantages? What does the fact that feelings of guilt and shame have arisen at all in the face of the traumatic situation say about those affected? How can meaningful and supportive personal social relationships be resumed?	Group discussions and role play