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Shira Maguen - One of the best experts on this subject based on the ideXlab platform.
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Trajectories of functioning in a population-based sample of veterans: contributions of Moral Injury, PTSD, and depression.
Psychological medicine, 2020Co-Authors: Shira Maguen, Brandon J. Griffin, Cameron B. Richardson, Daniel F. Perkins, Laurel A Copeland, Erin P Finley, Dawne VogtAbstract:Although research has shown that exposure to potentially traumatic and Morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral Injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and Moral Injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, Moral Injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Moral Injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and Moral Injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.
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trajectories of functioning in a population based sample of veterans contributions of Moral Injury ptsd and depression
Psychological Medicine, 2020Co-Authors: Shira Maguen, Brandon J. Griffin, Cameron B. Richardson, Daniel F. Perkins, Laurel A Copeland, Erin P Finley, Dawne VogtAbstract:BACKGROUND Although research has shown that exposure to potentially traumatic and Morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. METHODS A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral Injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. RESULTS Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and Moral Injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, Moral Injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. CONCLUSIONS Moral Injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and Moral Injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.
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Moral Injury: An Integrative Review
Journal of traumatic stress, 2019Co-Authors: Brandon J. Griffin, Natalie Purcell, Kristine Burkman, Brett T. Litz, Craig J. Bryan, Martha Schmitz, Claudia Villierme, Jessica Walsh, Shira MaguenAbstract:Individuals who are exposed to traumatic events that violate their Moral values may experience severe distress and functional impairments known as "Moral injuries." Over the last decade, Moral Injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about Moral Injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about Moral Injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially Morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how Moral Injury might and might not respond to evidence-based treatments for posttraumatic stress disorder (PTSD) whereas others identified new treatment models to directly address Moral repair. Limitations of the literature included variable definitions of potentially Morally injurious events, the absence of a consensus definition and gold-standard measure of Moral Injury as an outcome, scant study of Moral Injury outside of military-related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect. We conclude our review by summarizing lessons from the literature and offering recommendations for future research.
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Sources of Moral Injury among war veterans: A qualitative evaluation
Journal of clinical psychology, 2018Co-Authors: Yonit Schorr, Shira Maguen, Nathan R. Stein, J. Ben Barnes, Jeane Bosch, Brett T. LitzAbstract:OBJECTIVE Service members deployed to war are at risk for Moral Injury, but the potential sources of Moral Injury are poorly understood. The aim of this qualitative study was to explore the types of events that veterans perceive as Morally injurious and to use those events to develop a categorization scheme for combat-related Morally injurious events. METHOD Six focus groups with US war veterans were conducted. RESULTS Analysis based on Grounded Theory yielded two categories (and eight subcategories) of events that putatively cause Moral Injury. The two categories were defined by the focal attribution of responsibility for the event: Personal Responsibility (veteran's reported distress is related to his own behavior) versus Responsibility of Others (veteran's distress is related to actions taken by others). Examples of each type of Morally injurious event are provided. CONCLUSIONS Implications for the further development of the Moral Injury construct and treatment are discussed.
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Self-Forgiveness and Military Service: Equipping Warriors to Combat Moral Injury
Handbook of the Psychology of Self-Forgiveness, 2017Co-Authors: Brandon J. Griffin, Shira Maguen, Everett L. Worthington, Steven J. Danish, John Donovan, Caroline R. Lavelock, Laurel Shaler, Robert F. Dees, Don E. DavisAbstract:Self-perceived violation of a socio-Moral standard can cause military service members to experience Moral Injury. Sustaining a Moral Injury is associated with stress-related problems including physiological, psychological, social, and spiritual distress. By applying a stress-and-coping model, we adduce evidence to suggest that clinical application of self-forgiveness promotes the well-being of active duty personnel and military veterans who bear the burden of self-condemnation secondary to Moral conflict. While self-forgiveness may be applicable to many military health issues, we explore protective effects of self-forgiveness for personnel at risk of suicide. Implications for future research and clinical practice are discussed.
Brett T. Litz - One of the best experts on this subject based on the ideXlab platform.
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Response to Zalta and Held's "Commentary on the special issue on Moral Injury: leveraging existing constructs to test the heuristic model of Moral Injury"
Journal of traumatic stress, 2020Co-Authors: Brett T. LitzAbstract:Zalta and Held (2020) generated some interesting and potentially useful principles to distinguish Moral distress and Moral Injury, leveraging ideas from our introduction to the Journal of Traumatic Stress special issue on Moral Injury. In this response, I provide feedback and commentary about the principles generated by Zalta and Held. I also attempt to modify and expand the various principles to accommodate any Moral emotion and all possible dimensions of response to exposure to potentially Morally injurious experiences.
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Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium.
Journal of traumatic stress, 2019Co-Authors: Julie D. Yeterian, Danielle S. Berke, Jessica R. Carney, Alexandra Mcintyre-smith, Kate St. Cyr, Lisa King, Nora K. Kline, Andrea Phelps, Brett T. LitzAbstract:In the current paper, we first describe the rationale for and methodology employed by an international research consortium, the Moral Injury Outcome Scale (MIOS) Consortium, the aim of which is to develop and validate a content-valid measure of Moral Injury as a multidimensional outcome. The MIOS Consortium comprises researchers and clinicians who work with active duty military service members and veterans in the United States, the United Kingdom, the Netherlands, Australia, and Canada. We describe the multiphase psychometric development process being conducted by the Consortium, which will gather phenomenological data from service members, veterans, and clinicians to operationalize subdomains of impact and to generate content for a new measure of Moral Injury. Second, to illustrate the methodology being employed by the Consortium in the first phase of measure development, we present a small subset of preliminary results from semistructured interviews and questionnaires conducted with care providers (N = 26) at three of the 10 study sites. The themes derived from these initial preliminary clinician interviews suggest that exposure to potentially Morally injurious events is associated with broad psychological/behavioral, social, and spiritual/existential impacts. The early findings also suggest that the outcomes associated with acts of commission or omission and events involving others' transgressions may overlap. These results will be combined with data derived from other clinicians, service members, and veterans to generate the MIOS.
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Moral Injury: An Integrative Review
Journal of traumatic stress, 2019Co-Authors: Brandon J. Griffin, Natalie Purcell, Kristine Burkman, Brett T. Litz, Craig J. Bryan, Martha Schmitz, Claudia Villierme, Jessica Walsh, Shira MaguenAbstract:Individuals who are exposed to traumatic events that violate their Moral values may experience severe distress and functional impairments known as "Moral injuries." Over the last decade, Moral Injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about Moral Injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about Moral Injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially Morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how Moral Injury might and might not respond to evidence-based treatments for posttraumatic stress disorder (PTSD) whereas others identified new treatment models to directly address Moral repair. Limitations of the literature included variable definitions of potentially Morally injurious events, the absence of a consensus definition and gold-standard measure of Moral Injury as an outcome, scant study of Moral Injury outside of military-related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect. We conclude our review by summarizing lessons from the literature and offering recommendations for future research.
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Sources of Moral Injury among war veterans: A qualitative evaluation
Journal of clinical psychology, 2018Co-Authors: Yonit Schorr, Shira Maguen, Nathan R. Stein, J. Ben Barnes, Jeane Bosch, Brett T. LitzAbstract:OBJECTIVE Service members deployed to war are at risk for Moral Injury, but the potential sources of Moral Injury are poorly understood. The aim of this qualitative study was to explore the types of events that veterans perceive as Morally injurious and to use those events to develop a categorization scheme for combat-related Morally injurious events. METHOD Six focus groups with US war veterans were conducted. RESULTS Analysis based on Grounded Theory yielded two categories (and eight subcategories) of events that putatively cause Moral Injury. The two categories were defined by the focal attribution of responsibility for the event: Personal Responsibility (veteran's reported distress is related to his own behavior) versus Responsibility of Others (veteran's distress is related to actions taken by others). Examples of each type of Morally injurious event are provided. CONCLUSIONS Implications for the further development of the Moral Injury construct and treatment are discussed.
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Treating War-Related Moral Injury and Loss with Adaptive Disclosure: A Case Study
Posttraumatic Stress Disorder and Related Diseases in Combat Veterans, 2015Co-Authors: Alexandra L. Laifer, Amy D. Amidon, Ariel J. Lang, Brett T. LitzAbstract:Existing evidence-based treatments for posttraumatic stress disorder (PTSD), while effective for many fear-based traumas, do not sufficiently target the unique phenomenology of psychological wounds stemming from combat, specifically, Moral Injury and traumatic loss. The experience of Moral Injury and loss cause deeply complex challenges across multiple domains—behavioral, biological, cognitive, social, and spiritual—in ways that are significantly different from danger-based harms. Adaptive disclosure, a new psychotherapy, was specifically designed to address this gap in treatment and help service members and veterans begin the process of healing from combat stress and trauma. This chapter presents the conceptual foundation and change agents for adaptive disclosure along with the case of a new veteran whose principal harm was Moral Injury complicated by loss. The patient in this case made modest gains in PTSD symptom severity alongside authentic cognitive and behavioral signs of increased agency, proactivity, hopefulness, and vitality that were clear departures from Moral Injury, suggesting the utility of this treatment approach in addressing the psychological wounds of war.
Timothy J. Hodgson - One of the best experts on this subject based on the ideXlab platform.
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Chaplaincy, Spiritual Care and Moral Injury: Considerations Regarding Screening and Treatment
Frontiers in psychiatry, 2018Co-Authors: Lindsay B. Carey, Timothy J. HodgsonAbstract:Moral Injury is a complex trauma related syndrome involving a correlation of biological, psychological, social, and spiritual symptoms that can have substantial impact upon health and well-being. This paper argues for a holistic bio-psycho-social-spiritual approach to Moral Injury, by including chaplaincy in the screening and treatment of Moral Injury among actively serving military members and retired veterans. As part of the Moral Injury treatment process, and in alignment with the World Health Organization's Spiritual Intervention Codings, a new technique is proposed, "Pastoral Narrative Disclosure" (PND), as a guide for chaplains and others trained in spiritual care to assist those suffering from Moral Injury.
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Moral Injury and Definitional Clarity: Betrayal, Spirituality and the Role of Chaplains
Journal of religion and health, 2017Co-Authors: Timothy J. Hodgson, Lindsay B. CareyAbstract:This article explores the developing definition of Moral Injury within the current key literature. Building on the previous literature regarding 'Moral Injury, Spiritual Care and the role of Chaplains' (Carey et al. in JORH 55(4):1218-1245, 2016b. doi: 10.1007/s10943-016-0231-x ), this article notes the complexity that has developed due to definitional variations regarding Moral Injury-particularly with respect to the concepts of 'betrayal' and 'spirituality'. Given the increasing recognition of Moral Injury and noting the relevance and importance of utilizing a bio-psycho-social-spiritual model, this article argues that betrayal and spirituality should be core components for understanding, defining and addressing Moral Injury. It also supports the role of chaplains being involved in the holistic care and rehabilitation of those affected by Moral Injury.
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Moral Injury, Spiritual Care and the Role of Chaplains: An Exploratory Scoping Review of Literature and Resources
Journal of Religion and Health, 2016Co-Authors: Lindsay B. Carey, Timothy J. Hodgson, Lillian Krikheli, Annie-rose Armour, Taranjeet K. Singh, Cassandra G. ImpiombatoAbstract:This scoping review considered the role of chaplains with regard to ‘Moral Injury’. Moral Injury is gaining increasing notoriety. This is due to greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the ‘soul’ that are far more difficult to heal—if at all. As part of a larger research program exploring Moral Injury, a scoping review of literature and other resources was implemented utilising Arksey and O’Malley’s scoping method (Int J Soc Res Methodol 8(1):19–32, 2005 ) to focus upon Moral Injury, spirituality (including religion) and chaplaincy. Of the total number of articles and/or resources noting the term ‘Moral Injury’ in relation to spiritual/religious issues ( n = 482), the results revealed 60 resources that specifically noted Moral Injury and chaplains (or other similar bestowed title). The majority of these resources were clearly positive about the role (or the potential role) of chaplains with regard to mental health issues and/or Moral Injury. The World Health Organization International Classification of Diseases: Australian Modification of Health Interventions to the International Statistical Classification of Diseases and related Health problems (10th revision, vol 3—WHO ICD-10-AM, Geneva, 2002 ), was utilised as a coding framework to classify and identify distinct chaplaincy roles and interventions with regard to assisting people with Moral Injury. Several recommendations are made concerning Moral Injury and chaplaincy, most particularly the need for greater research to be conducted.
Brandon J. Griffin - One of the best experts on this subject based on the ideXlab platform.
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Trajectories of functioning in a population-based sample of veterans: contributions of Moral Injury, PTSD, and depression.
Psychological medicine, 2020Co-Authors: Shira Maguen, Brandon J. Griffin, Cameron B. Richardson, Daniel F. Perkins, Laurel A Copeland, Erin P Finley, Dawne VogtAbstract:Although research has shown that exposure to potentially traumatic and Morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral Injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and Moral Injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, Moral Injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Moral Injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and Moral Injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.
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trajectories of functioning in a population based sample of veterans contributions of Moral Injury ptsd and depression
Psychological Medicine, 2020Co-Authors: Shira Maguen, Brandon J. Griffin, Cameron B. Richardson, Daniel F. Perkins, Laurel A Copeland, Erin P Finley, Dawne VogtAbstract:BACKGROUND Although research has shown that exposure to potentially traumatic and Morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. METHODS A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral Injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. RESULTS Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and Moral Injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, Moral Injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. CONCLUSIONS Moral Injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and Moral Injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.
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Psychospiritual Developmental Risk Factors for Moral Injury
Religions, 2020Co-Authors: Timothy Usset, Brandon J. Griffin, M Kopacz, Erika Gray, Joseph M. Currier, John H. Wilhelm, J. Irene HarrisAbstract:There is increasing theoretical, clinical, and empirical support for the hypothesis that psychospiritual development, and more specifically, postconventional religious reasoning, may be related to Moral Injury. In this study, we assessed the contributions of exposure to potentially Morally injurious events, posttraumatic stress symptoms, and psychospiritual development to Moral Injury symptoms in a sample of military veterans (N = 212). Psychospiritual development was measured as four dimensions, based on Wulff’s theory juxtaposing conventional vs. postconventional levels of religious reasoning, with decisions to be an adherent or a disaffiliate of faith. After controlling for exposure to potentially Morally injurious events and severity of posttraumatic stress symptoms, veterans who were conventional disaffiliates reported higher scores on the Moral Injury Questionnaire than conventional adherents, postconventional adherents, or postconventional disaffiliates. We conclude that the role of psychospiritual development offers a theoretical approach to Moral Injury that invites collaboration between social scientists, philosophers, theologians, and medical professionals.
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Moral Injury: An Integrative Review
Journal of traumatic stress, 2019Co-Authors: Brandon J. Griffin, Natalie Purcell, Kristine Burkman, Brett T. Litz, Craig J. Bryan, Martha Schmitz, Claudia Villierme, Jessica Walsh, Shira MaguenAbstract:Individuals who are exposed to traumatic events that violate their Moral values may experience severe distress and functional impairments known as "Moral injuries." Over the last decade, Moral Injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about Moral Injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about Moral Injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially Morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how Moral Injury might and might not respond to evidence-based treatments for posttraumatic stress disorder (PTSD) whereas others identified new treatment models to directly address Moral repair. Limitations of the literature included variable definitions of potentially Morally injurious events, the absence of a consensus definition and gold-standard measure of Moral Injury as an outcome, scant study of Moral Injury outside of military-related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect. We conclude our review by summarizing lessons from the literature and offering recommendations for future research.
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Self-Forgiveness and Military Service: Equipping Warriors to Combat Moral Injury
Handbook of the Psychology of Self-Forgiveness, 2017Co-Authors: Brandon J. Griffin, Shira Maguen, Everett L. Worthington, Steven J. Danish, John Donovan, Caroline R. Lavelock, Laurel Shaler, Robert F. Dees, Don E. DavisAbstract:Self-perceived violation of a socio-Moral standard can cause military service members to experience Moral Injury. Sustaining a Moral Injury is associated with stress-related problems including physiological, psychological, social, and spiritual distress. By applying a stress-and-coping model, we adduce evidence to suggest that clinical application of self-forgiveness promotes the well-being of active duty personnel and military veterans who bear the burden of self-condemnation secondary to Moral conflict. While self-forgiveness may be applicable to many military health issues, we explore protective effects of self-forgiveness for personnel at risk of suicide. Implications for future research and clinical practice are discussed.
Jacob K. Farnsworth - One of the best experts on this subject based on the ideXlab platform.
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A commentary on Moral Injury among health care providers during the COVID-19 pandemic.
Psychological trauma : theory research practice and policy, 2020Co-Authors: Lauren M. Borges, Jacob K. Farnsworth, Nazanin H. Bahraini, Sean M. Barnes, Lisa A. BrennerAbstract:Although little is known about Moral Injury in nonmilitary populations, the COVID-19 pandemic has made it clear that Moral Injury's relevance extends beyond the battlefield. Health care providers are experiencing potentially Morally injurious events that may violate their Moral code or values, yet almost no research has been conducted on Moral Injury among health care providers to date. The purpose of this commentary is to describe the relevance of Moral Injury to health care providers and to spark a dialogue that motivates future research, prevention, and intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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moving Moral Injury into the future with functional contextualism a response to nash s unpacking two models for understanding Moral Injury 2019
Journal of Traumatic Stress, 2019Co-Authors: Jacob K. Farnsworth, Lauren M. Borges, Robyn D. WalserAbstract:In his commentary on the Journal of Traumatic Stress special issue on Moral Injury (Vol. 32, Issue 3), Nash (2019) critiques both Farnsworth's (2019) descriptive-prescriptive framework for differentiating posttraumatic stress disorder (PTSD) from Moral Injury and Farnsworth, Drescher, Evans, and Walser's (2017) functional contextual definition of Moral Injury and related concepts. To make his arguments, Nash contrasts these two frameworks with the Navy and Marine Corps Combat Operational Stress Control (COSC) model wherein Moral stressors are presumed to cause literal damage to intrapsychic structures. Unfortunately, in drawing his comparisons, Nash makes several misstatements that we feel are important to clarify. We respond to Nash's commentary by first identifying the proper sources for the critiqued frameworks and correctly locate Farnsworth et al.'s functional contextual definition of Moral Injury within the domain of third-wave cognitive behavioral therapies. We go on to compare and contrast the respective origins of the COSC and functional contextual models, noting important differences in their intended purposes. Next, we defend our model against Nash's critiques by highlighting how a functional contextual approach to Moral Injury (a) links with evolutionary science, (b) captures multiple levels of analysis, (c) is parsimonious, (d) serves diverse populations, (e) directly informs interventions, (f) promotes Moral humility, and (g) decreases stigma while preserving client autonomy. In our conclusion, we recognize the value of the COSC model for its intended purposes while also encouraging deep and respectful dialogue among researchers and clinicians regarding the proposed benefits of the functional contextual model of Moral Injury.
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Moving Moral Injury Into the Future With Functional Contextualism: A Response to Nash's “Unpacking Two Models for Understanding Moral Injury” (2019)
Journal of traumatic stress, 2019Co-Authors: Jacob K. Farnsworth, Lauren M. Borges, Robyn D. WalserAbstract:In his commentary on the Journal of Traumatic Stress special issue on Moral Injury (Vol. 32, Issue 3), Nash (2019) critiques both Farnsworth's (2019) descriptive-prescriptive framework for differentiating posttraumatic stress disorder (PTSD) from Moral Injury and Farnsworth, Drescher, Evans, and Walser's (2017) functional contextual definition of Moral Injury and related concepts. To make his arguments, Nash contrasts these two frameworks with the Navy and Marine Corps Combat Operational Stress Control (COSC) model wherein Moral stressors are presumed to cause literal damage to intrapsychic structures. Unfortunately, in drawing his comparisons, Nash makes several misstatements that we feel are important to clarify. We respond to Nash's commentary by first identifying the proper sources for the critiqued frameworks and correctly locate Farnsworth et al.'s functional contextual definition of Moral Injury within the domain of third-wave cognitive behavioral therapies. We go on to compare and contrast the respective origins of the COSC and functional contextual models, noting important differences in their intended purposes. Next, we defend our model against Nash's critiques by highlighting how a functional contextual approach to Moral Injury (a) links with evolutionary science, (b) captures multiple levels of analysis, (c) is parsimonious, (d) serves diverse populations, (e) directly informs interventions, (f) promotes Moral humility, and (g) decreases stigma while preserving client autonomy. In our conclusion, we recognize the value of the COSC model for its intended purposes while also encouraging deep and respectful dialogue among researchers and clinicians regarding the proposed benefits of the functional contextual model of Moral Injury.
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Is and Ought: Descriptive and Prescriptive Cognitions in Military-Related Moral Injury.
Journal of traumatic stress, 2019Co-Authors: Jacob K. FarnsworthAbstract:Debate exists regarding the most appropriate way to address Moral injuries that stem from involvement in war and other military conflicts. In recent years, some researchers have suggested that existing treatments for trauma may be inadequate to address Moral Injury and have thus proposed novel interventions to help mitigate these concerns. In response, advocates of more traditional approaches have argued that standard trauma interventions are generally sufficient for Moral Injury, and investment in new interventions may be premature. This conceptual article draws from research findings and current theories of Moral Injury to demonstrate that there is merit on both sides of this debate, and further clarifying the types of cognitions involved in Moral Injury can guide effective treatment planning. In particular, the most recent diagnostic criteria for posttraumatic stress disorder is used to distinguish the objectively falsifiable descriptive cognitions often associated with trauma from the subjectively determined prescriptive cognitions that characterize Moral Injury. Scenarios from war zone deployments have been used to highlight the relevance of this distinction for Moral Injury, and a general treatment framework that shows how existing and novel interventions may complement one another is presented. Research suggestions for assessing descriptive and prescriptive cognitions in Moral Injury and empirically validating this treatment framework are discussed.
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A functional approach to understanding and treating military-related Moral Injury
Journal of Contextual Behavioral Science, 2017Co-Authors: Jacob K. Farnsworth, Kent Drescher, Wyatt Evans, Robyn D. WalserAbstract:Abstract The term Moral Injury has been coined to describe the suffering that may develop following a violation of deeply held Moral beliefs and values and subsequent difficulties in functioning. Yet despite an increase in research and intervention approaches for this topic, the relationship between Moral Injury and mental health diagnoses such as Posttraumatic Stress Disorder (PTSD) remains unclear and concern exists that, in some cases, Moral Injury might be used to unnecessarily pathologize Moral processes. With the goal of further refining the construct, we argue that Moral Injury is a condition distinct from PTSD and other disorders and, using a functional approach, propose enhanced definitions for the terms, Morally injurious event , Moral pain , Moral Injury, and Moral healing . Consistent with these new definitions, we then argue for Acceptance and Commitment Therapy (ACT) as a feasible and promising treatment for Moral Injury and present initial qualitative data supporting the intervention.