Responsibility Pie Chart

Feelings of guilt are often associated with the belief that one should have acted, thought, or felt differently. They can be helpful when they motivate pro-social behaviors, such as apologizing or making amends, but sometimes people feel guilt or shame because they are blaming themselves inappropriately or feeling overly responsible for events. This is especially apparent in survivors of trauma.

Feeling guilty is not always an accurate signal of responsibility. Cognitive biases that are known to contribute to excessive guilt and inaccurate attributions for events include:

• Hindsight bias, where the individual conflates an outcome with what they knew at the time (Fischoff, 1975).
• Black and white thinking, where the individual does not appreciate the multitude of factors that contributed to an event.
• Personalizing, where the individual falsely assumes that situations or outcomes are related to themselves (particularly negative ones).

Regarding responsibility, several cognitive processes may account for the excessive and inappropriate guilt observed in clinical groups (Kubany & Watson, 2003: Young et al, 2021). They include situations where the individual:

• Overestimates their personal responsibility for negative events, and underestimates the responsibility of others.
• Believes there was insufficient justification for acting as they did.
• Believes that their actions violated their values.
• Believes that the negative outcome was foreseeable and preventable (hindsight bias can increase this impression).
• Has gaps in their memory of the event and so assumes that they are responsible for what happened.

Cognitive techniques for working with beliefs about personal responsibility have been described by multiple authors:

• In the context of working with depression, Beck and colleagues (1979) use the term “de-responsibilitizing” to describe a reattribution technique for clients who are excessively self-blaming or assume too much responsibility. They describe a process involving, “(a) reviewing the ‘facts’ of the events which result in self-criticism…; (b) demonstrating the different criteria for assigning responsibility applied by the patient to his own behavior as compared to the behavior of others (double standard); or (c) challenging the belief that the patient is ‘100 percent’ responsible for any negative consequences”.
• Scurfield (1994) describes an intervention in which clients are helped to generate a list of the factors that could have contributed to an event and then assign a percentage responsibility to each item. In later publications describing their work with veterans, Scurfield and Platoni (2013) elaborate this technique to encompass additional steps such as, “[challenging] the veteran’s exclusion or minimization of the role of others who were at the immediate scene of the trauma” and “[challenging] the veteran to consider if he or she has been “punished enough” for his or her share of the (recalculated) responsibility for what happened”.
• Following a long programme of research with veterans and survivors of domestic violence, Kubany and Manke (1995) describe a programme for working effectively with self-blame. Their approach includes: “(a) making sure that clients understand the distinction between causation and ‘blame’; (b) helping clients generate a comprehensive listing of people and factors that contributed to the event’s occurrence; (c) asking clients to assess the degree of responsibility of each external source of causation by assigning a percentage (of responsibility) to each source; and (d) asking clients to reappraise their degree of personal responsibility in light of their appraisals of external sources of causation.”

Padesky and Greenberger (1995) describe a variant of these approaches and were the first to display ‘shares’ of responsibility using pie charts. In this exercise, clients create a list of factors which might have contributed to a negative event and assign a ‘slice’ of a pie chart to each one, the size corresponding to the degree of responsibility each factor deserves. Crucially, they recommend that clients add the slice of the pie representing their own contribution last, thus ensuring they do not “prematurely assign too much responsibility” to themselves.

The uses of responsibility pie charts have been described in multiple clinical reports. A notable example is Grey and colleagues’ (2002) paper, which describes a (then) novel technique in cognitive therapy for PTSD. They describe the ‘off-line’ cognitive restructuring of a peritraumatic hotspot associated with guilt (i.e., outside of imaginal reliving); learning from a responsibility pie chart is subsequently incorporated into the trauma memory during a (hot) reliving session.

Responsibility pie charts and related approaches have been applied in work with a variety of clinical presentations, including:

• PTSD and associated guilt, shame, and anger (Grey, Young & Holmes, 2005; Murray & Ehlers, 2021; Young et al., 2021; Wild, Duffy & Ehlers, 2023).
• OCD (Williams & Shafran, 2015; Jassi et al., 2020; Chatburn, Millar, Ryan, 2020).
• GAD (Gústavsson, Salkovskis, Sigurðsson, 2022).
• Hoarding disorder (Dozier et al., 2022).
• Self-critical thoughts and related negative emotions (Arimitsu & Hoffman, 2015).
• Social anxiety (Jones, & Rakovshik, 2019).
• Coaching (O’Moore, 2011).

It sounds as though you feel very responsible for what happened. Would you be willing to explore that more with me?

1. Identify the situation, event, outcome, or consequence about which the client feels a strong sense of responsibility, or where they feel a strong sense of guilt or shame. Scurfield (1994) recommends that clients be asked to give a “clear explication of the event and the survivor’s perception and rationale for the degree of self-responsibility assumed”, that “hazy or unclear descriptions must be clarified”, or a determination made that the client’s recollection is unclear. Suggested questions include:
   • "What situation, event, or outcome do you feel responsible / ashamed / guilty for?"
   • "Can you describe what it is that you feel guilty about or responsible for?"
   • "Specifically, what are you blaming yourself for?"
2. Assess the client’s perceived degree of responsibility. Prompts might include:
   • "How responsible do you feel for what happened?"
   • "Can you rate how responsible you believe you are on a 0-100% scale, where 100% means 'I am completely responsible'?"
3. Ask the client to list all the possible contributing factors to the situation, outcome, or event, no matter how small or significant they might seem. Clients should be helped to consider every possible factor which might have had a bearing upon the outcome. These factors might include other people, organizations, or contextual factors which were present before, during, or after the event in question. It can also be helpful to consider factors that may have indirectly contributed responsibility due to their absence, such as an absence of authorities or people who ‘should’ have been present (Scurfield, 1994). Clients will normally emphasize their role in what happened, but should add themselves to this list if they fail to do so. In the context of working with military veterans, Scurfield and Platoni (2013) propose telling clients that every traumatic event can have a total of 100 percent shared responsibility, and that responsibility is partly shared by every individual or factor related to the event. Consider asking:
   • "Can we make a list of all the things that might have contributed to what happened, even if they seem unlikely?"
   • "Who else was present that day? What role did they play?"
   • "Was there anyone who was not present but should have been?"
   • "Can we open up the timeline? Was there anything that happened (or were any decisions made) before, during, or after the event which contributed to the outcome?"
   • "Can we think more broadly? Were there any political / social / organizational / policy / environmental / seasonal factors which might have influenced the outcome?"
   • "Do intentions have any bearing on how responsible you feel? For example, did you intend for this outcome to happen? Did anyone else intend for this outcome to happen?"
4. Assign percentage responsibilities to each item on the list by placing them on the pie chart. Once a list has been generated, the client should assign a proportion of responsibility to each item by drawing it on the pie chart. Crucially, in order to avoid any self-referential bias clients should be instructed to add their slice last. Suggested instruction:
   • "Divide up your pie chart up so that each item on your list has a slice. A larger slice would mean that the item played a bigger role in what happened. To avoid over-emphasizing your responsibility, add your own contribution to the pie chart last."
5. Reflect on the process. Once the pie chart has been completed, clients should be encouraged to reflect on the process. They can be encouraged to consider whether they think their assignment for each slice is fair, whether they want to make any adjustments, and what the exercise has done for any feelings of guilt. Suggested questions might include:
   1. "If you had to sum things up now, what would be a fair and accurate explanation for what happened?"
   2. "How do you feel about the outcome now? What has happened to your feelings of guilt?"
6. Re-rate the client’s perceived degree of responsibility:
   • "Can you re-rate how responsible you now feel for what happened on a 0–100% scale, where 100% means 'I am completely responsible'?"
7. Additional steps. Scurfield (1994) recommends an additional homework assignment so the client can “reflect and reframe… refine and calculate the set of percentages of responsibility that add up to 100 percent and truly take into account the full circle of persons and circumstances; and to develop an initial longer-range plan”. Clients can be encouraged to take the list and pie chart home, to add any additional factors which they think of, and to redraw the pie chart. Some individuals may also want to make amends for their (albeit reduced) contribution to negative events. Indeed, making amends can play an important role in reducing guilt and preoccupation, and support self-forgiveness (Litz et al., 2016). This might entail making a list of individuals who were hurt by the transgression, brainstorming methods to make amends, and (if appropriate) making a detailed plan to implement one of these for homework (Litz et al., 2016). Therapists should ensure that these actions are positive, life-sustaining, and proactive: making amends should not be conceptualized as a form of punishment, as a means to “fix” past events that cannot be undone, or be taken to an extreme (Scurfield, 1994).

• Beck, A. T. (Ed.). (1979). Cognitive therapy of depression. Guilford press.
• Chatburn, E., Millar, J., & Ryan, J. (2020). Extended formulation in cognitive behavioural therapy for OCD: a single case experimental design. the Cognitive Behaviour Therapist, 13, e38. DOI: 10.1017/S1754470X20000367.
• Dozier, M. E., Nix, C. A., Taylor, C., Pyles, K., Mejia, N., & Kalchbrenner, R. (2022). Perceived locus of control for clutter: Reported reasons for clutter in adults with and without hoarding symptoms. British Journal of Clinical Psychology, 61, 306-312. DOI: 10.1111/bjc.12332.
• Fischhoff, B. (1975). Hindsight is not equal to foresight: The effect of outcome knowledge on judgment under uncertainty. Journal of Experimental Psychology: Human Perception and Performance, 1, 288–299. DOI: 10.1037/0096-1523.1.3.288.
• Greenberger, D., & Padesky, C. A. (1995). Mind over Mood: A cognitive therapy treatment manual for clients. Guilford Press.
• Jassi, A., Shahriyarmolki, K., Taylor, T., Peile, L., Challacombe, F., Clark, B., & Veale, D. (2020). OCD and COVID-19: a new frontier. The Cognitive Behaviour Therapist, 13, e27. DOI: 10.1017/S1754470X20000318.
• Jones, M., & Rakovshik, S. (2019). Inflated sense of responsibility, explanatory style and the cognitive model of social anxiety disorder: a brief report of a case control study. the Cognitive Behaviour Therapist, 12, e19. DOI: 10.1017/S1754470X19000047.
• Kubany, E. S., & Manke, F. P. (1995). Cognitive therapy for trauma-related guilt: Conceptual bases and treatment outlines. Cognitive and Behavioral Practice, 2, 27-61. DOI: 10.1016/S1077-7229(05)80004-5.
• Litz, B. T., Lebowitz, Gray, M. J., & Nash, W. P. (2016). Adpative disclosure: A new treatment for military trauma, loss, and moral injury. Guilford Press.
• Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695-706. DOI: 10.1016/j.cpr.2009.07.003.
• Scurfield, R. M. (1994). “War-Related Trauma: An Integrative Experiential, Cognitive and Spiritual Approach. In M. B. Williams & J. F. Sommer (Eds.), Handbook of Post-Traumatic Therapy (pp. 180–204). Greenwood Press.
• Scurfield, R. M., Platoni, K. T. (2013). Resolving combat-related guilt and responsibility issues. In R. M. Scurfield & K. T. Platoni (Eds.), Healing War Trauma: A Handbook of Creative Approaches (pp.253-272). Routledge.
• Wild, J., Duffy, M., & Ehlers, A. (2023). Moving forward with the loss of a loved one: treating PTSD following traumatic bereavement with cognitive therapy. the Cognitive Behaviour Therapist, 16, e12. DOI: 10.1017/S1754470X23000041.