Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT): treatment protocol description and a case study

Abstract

Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as 'the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.' These events can provoke emotions such as remorse, guilt and shame, and affects someone's self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion:The case of Dusan has shown it is worthwhile to address moral trauma and BEP-MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT. Psicoterapia ecléctica breve para el trauma moral (BEP-MT): Descripción del protocolo de tratamiento y un estudio de casoAntecedentes: Los eventos traumáticos pueden estar relacionados con transgresiones graves o violaciones de los límites morales. El daño moral (DM) se ha descrito como 'el impacto duradero psicológico, biológico, espiritual, conductual y social de perpetrar, fallar en prevenir o testificar actos que transgreden creencias y expectativas morales profundamente sostenidas'. Estos eventos pueden provocar emociones como remordimiento, culpa y vergüenza, y afectan la autoimagen y la identidad de una persona. Objetivo: El objetivo del estudio es evaluar un protocolo de tratamiento que aborde las características específicas del trauma moral en el tratamiento del TEPT, junto a la ansiedad. Método: La psicoterapia ecléctica breve para el trauma moral (BEP-MT) es una adaptación de la psicoterapia ecléctica breve basada en la evidencia para el TEPT (BEPP). La BEP-MT integra componentes de psicoterapia cognitivo-conductual, psicodinámica, constructivista y sistémica. En el estudio actual, se monitoreó el progreso del tratamiento de un refugiado, Dusan. Antes y después del tratamiento, se aplicó la Escala de TEPT para el DSM-5 administrada por clínicos, la Lista de chequeo de TEPT (PC...

Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review

“…Evidence to date is restricted to a single case study of a male refugee with PTSD and history of military service in his home country. The case study reported improvements in PTSD and MI appraisals after completing the intervention (de la Rie et al, 2021 ).…”

Profiles of posttraumatic stress disorder and negative world assumptions in treatment-seeking refugees

“…dysfunctional core beliefs and cognitions. Lastly, a recently developed intervention targeting trauma-related emotions and cognitions with regard to guilt or shame, Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT), could prove valuable in treating such dysfunctional and rigid feelings and beliefs (de la Rie et al, 2021 ).…”

Moral injury appraisals and posttraumatic stress symptoms in trauma-exposed police officers: a latent class analysis

“…While trauma-focused therapy may be adequate for certain individuals, others may require targeted interventions specifically addressing MI to attain optimal outcomes. The past years there is a growing number of treatment interventions targeting MI, such as Adaptive Disclosure (Litz et al, 2016 ), Trauma-Informed Guilt Reduction Therapy (Norman, 2022 ), or Brief Eclectic Psychotherapy for moral trauma (BEP-MT) (de la Rie et al, 2021 ) and can be added to regular trauma focused therapies. Subsequent research endeavours should point out the potential requirement for distinct adaptations within MI treatment protocols, given that self- and other-transgressions may vary in their clinical outcomes.…”