Investigating the Relationship Between Guilt and Shame Proneness and Moral Injury in Veterans That Have Experienced Active Deployment

Aldridge, Vicky; Scott, Helen; Paskell, Rachel

doi:10.1080/21635781.2019.1580641

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…Previous research has focused heavily on the role of guilt and shame in MI (e.g., Aldridge et al, 2019; Farnsworth et al, 2014; Nazarov et al, 2015). Wrongdoing naturally elicits guilt and shame, intended to prompt self‐reflection, correction, and learning (Damasio & Carvalho, 2013).…”

Section: Introductionmentioning

confidence: 99%

Shame on the brain: Neural correlates of moral injury event recall in posttraumatic stress disorder

Lloyd

Nicholson

Densmore

et al. 2020

Depression and Anxiety

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Background: Moral injury (MI) is consistently associated with adverse mental health outcomes, including the development of posttraumatic stress disorder (PTSD) and suicidality.Methods: We investigated neural activation patterns associated with MI event recall using functional magnetic resonance imaging in participants with military and public safety-related PTSD, relative to civilian MI-exposed controls. Results: MI recall in the PTSD as compared to control group was associated with increased neural activation among salience network nodes involved in viscerosensory processing and hyperarousal (right posterior insula, dorsal anterior cingulate cortex; dACC), regions involved in defensive responding (left postcentral gyrus), and areas responsible for top-down cognitive control of emotions (left dorsolateral prefrontal cortex; dlPFC). Within the PTSD group, measures of state and trait shame correlated negatively with activity among default mode network regions associated with self-related processing and moral cognition (dorsomedial prefrontal cortex; dmPFC) and salience network regions associated with viscerosensory processing (left posterior insula), respectively.Conclusions: These findings suggest that MI event processing is altered in military and public safety-related PTSD, relative to MI-exposed controls. Here, it appears probable that as individuals with PTSD recall their MI event, they experience a surge of blame-related processing of bodily sensations within salience network regions, including the right posterior insula and the dACC, which in turn, prompt regulatory strategies at the level of the left dlPFC aimed at increasing cognitive control and inhibiting emotional affect. These results are consistent with previous findings showing enhanced sensory processing and altered top-down control in PTSD samples during autobiographical memory recall.

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Section: Introductionmentioning

confidence: 99%

Shame on the brain: Neural correlates of moral injury event recall in posttraumatic stress disorder

Lloyd

Nicholson

Densmore

et al. 2020

Depression and Anxiety

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“…The PRISMA flowchart delineates the review process (see figure 1). Of the 81 full texts included in the review,6 12–21 43–112 some reported multiple studies in the same paper, so there were 88 separate studies included in the review. Of these, six reported prevalence estimates or average scores that could not be pooled, so they were included in the narrative synthesis only.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Brennan,

Roberts,

Cole

2024

BMJ Open

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ObjectivesOccupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation.DesignA systematic review and meta-analysis.Data sourcesGoogle Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022.Eligibility criteria for selecting studiesObservational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location.Data extraction and synthesisTwo independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews.ResultsIn total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%.ConclusionExposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces.PROSPERO registration numberCRD42020191766.

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“…Studies with UK military and non-military samples show that acts of commission (including injuring/killing others) are less prevalent than reported PMIE experiences of omission and betrayal. [29][30][31][32][33] Second, it is also possible that both of these treatments, which were developed and tested in US military personnel/veterans, may not entirely fit the needs of those serving in a UK military context. The US and UK militaries have different rules of engagement while on deployment and have been found to have different experiences and reactions to trauma exposure.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Restore and Rebuild (R&R): a protocol for a phase 2, randomised control trial to compare R&R as a treatment for moral injury-related mental health difficulties in UK military veterans to treatment as usual

Williamson,

Murphy,

Bonson

et al. 2024

BMJ Open

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BackgroundExposure to potentially morally injurious events is increasingly recognised as a concern across a range of occupational groups, including UK military veterans. Moral injury-related mental health difficulties can be challenging for clinicians to treat and there is currently no validated treatment available for UK veterans. We developed Restore and Rebuild (R&R) as a treatment for UK veterans struggling with moral injury-related mental health difficulties. This trial aims to examine whether it is feasible to conduct a pilot randomised controlled trial (RCT) of R&R treatment compared with a treatment-as-usual (TAU) control group.MethodsWe will use a feasibility single-blind, single-site RCT design. The target population will be UK military veterans with moral injury-related mental health difficulties. We will recruit N=46 veteran patients who will be randomly allocated to R&R (n=23) or TAU (n=23). Patients randomised to R&R will receive the 20-session one-to-one treatment, delivered online. Veterans allocated to TAU, as there are currently no manualised treatments for moral injury-related mental health problems available, will receive the one-to-one treatment (online) typically provided to veterans who enter the mental health service for moral injury-related mental health difficulties. We will collect outcome measures of moral injury, post-traumatic stress disorder (PTSD), alcohol misuse, common mental disorders and trauma memory at pretreatment baseline (before randomisation), end of treatment, 12 weeks and 24 weeks post-treatment. The primary outcome will be the proportion of patients who screen positive for PTSD and moral injury-related distress post-treatment.Ethics and disseminationThis trial will establish whether R&R is feasible, well-tolerated and beneficial treatment for veterans with moral injury-related mental health difficulties. If so, the results of the trial will be widely disseminated and R&R may improve access to effective care for those who struggle following moral injury and reduce the associated negative consequences for veterans, their families and wider society.Trial registration numberISRCTN99573523.

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Investigating the Relationship Between Guilt and Shame Proneness and Moral Injury in Veterans That Have Experienced Active Deployment

Cited by 7 publications

References 28 publications

Shame on the brain: Neural correlates of moral injury event recall in posttraumatic stress disorder

Shame on the brain: Neural correlates of moral injury event recall in posttraumatic stress disorder

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Restore and Rebuild (R&R): a protocol for a phase 2, randomised control trial to compare R&R as a treatment for moral injury-related mental health difficulties in UK military veterans to treatment as usual

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