Moral Injury, Meaning Making, and Mental Health in Returning Veterans

Currier, Joseph M.; Holland, Jason M.; Malott, Jesse

doi:10.1002/jclp.22134

Cited by 189 publications

(190 citation statements)

References 44 publications

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“…In conclusion, we feel it is important to further explore the concept of moral injury, as well as the relation between guilt and shame in military populations, and its implications for the onset, maintenance, and treatment of combat-related PTSD and other mental conditions (see also Currier et al, 2015;Yan, 2016). We reviewed and illustrated how guilt and shame can be drivers to chronicity in PTSD.…”

Section: Resultsmentioning

confidence: 99%

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A Critical Outlook on Combat-Related PTSD: Review and Case Reports of Guilt and Shame as Drivers for Moral Injury

Vermetten

Jetly

2018

Military Behavioral Health

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The model of posttraumatic stress disorder (PTSD) that has been dominant for many years has focused on fear conditioning and anxiety-related symptoms as main drivers of the pathology. Yet, the fear based conceptualization fails to consider the rules of modern combat, the culture of combatants, operational stressors and the moral dimension. Recently there is renewed interest in moral distress and moral injury with a focus on guilt, shame, and anger. Accumulating evidence suggests a link between transgression of moral values and symptoms of guilt and shame, anger, suicidal ideation, and PTSD in military servicemen and veterans. Although proper assessment is still in its infancy, there is a need to better understand how moral decisions can affect the mental health of military personnel at any point during their careers, including postrelease. The authors illustrate this with three clinical case reports. They conclude with a call for attention to the relation between the incurrence of moral injurious distress, and the role of guilt and shame as drivers for chronicity of PTSD. Identifying and addressing these issues can contribute to therapy adherence, facilitate successful progression, and contribute to healing and moral repair and reduce overall symptoms of PTSD.

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Section: Resultsmentioning

confidence: 99%

“…Inadequate measurement of combatrelated guilt may be one reason for this deficiency in the literature. Yet, despite some initial reports Campbell, 2016;Currier, Holland, & Malott, 2015), well validated instruments measuring moral injury are lacking.…”

Section: Discussionmentioning

confidence: 99%

A Critical Outlook on Combat-Related PTSD: Review and Case Reports of Guilt and Shame as Drivers for Moral Injury

Vermetten

Jetly

2018

Military Behavioral Health

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“…Although research on morally injurious events is still in its infancy, it has been observed that not all morally injurious events meet PTSD's requirements for Criterion A traumatic events as given in the fifth edition of the DSM (i.e., DSM‐5 ; Litz & Kerig, ). Furthermore, early research suggests that although MI and PTSD are intertwined, they also appear to be distinct (Bryan, Bryan, Roberge, Leifker, & Rozek, ; Currier, McDermott, Farnsworth, & Borges, ), and that morally injurious events serve as a risk factor for a range of psychological difficulties, including suicidal ideation and behavior, depression, and substance use disorders (Battles et al., ; Bryan et al., ; Currier, Holland, & Mallot, ; Kelley et al., ; Maguen et al., ). Rather than pigeon‐holing MI to solely exist within the construct of PTSD and fear‐based biological models of posttraumatic stress, the functional contextual definition approaches MI transdiagnostically, making it applicable to a much wider range of clinical conditions.…”

Section: A Functional Contextual Definition Of Moral Injurymentioning

confidence: 99%

Moving Moral Injury Into the Future With Functional Contextualism: A Response to Nash's “Unpacking Two Models for Understanding Moral Injury” (2019)

Farnsworth

Borges

Walser

2019

Journal of Traumatic Stress

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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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“…In addition to the potential impact of violations of one's moral code on functioning, MIEs have been established as a transdiagnostic risk factor for a range of psychological difficulties including posttraumatic stress disorder (PTSD), suicidal ideation and behavior, depression, and substance use (Battles et al, ; Bryan, Bryan, Roberge, Leifker, & Rosek, ; Currier, McDermott, Farnsworth, & Borges, ; Currier et al, ; Kelley, Braitman, White, & Ehlke, ; Maguen et al, ). The links between exposure to MIEs and the development of PTSD are particularly robust.…”

Section: Introductionmentioning

confidence: 99%

“…This suffering can be conceptualized as moral injury (Borges, 2019;Farnsworth, Borges, & Walser, 2019;Farnsworth et al, 2017). As evidence of the potential impact of moral injury on functioning, exposure to MIEs has been associated with relationship distress, spiritual disengagement, and workplace difficulties (Currier, Holland, & Mallot, 2014;Fontana & Rosenheck, 2004;Purcell, Koenig, Bosch, & Maguen, 2016).…”

Section: Introductionmentioning

confidence: 99%

Veterans’ perspectives on discussing moral injury in the context of evidence‐based psychotherapies for PTSD and other VA treatment

et al. 2019

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Objective We examined Veterans’ perspectives on discussing moral injury in veterans affairs (VA) evidence‐based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) and other VA treatment. Methods Fourteen male warzone veterans (ages 25–74) who completed an EBP for PTSD within the past year participated in semistructured interviews related to discussing moral injury in VA treatment (e.g., EBPs for PTSD, chaplaincy). Qualitative interviews were evaluated using a thematic analysis. Results Four themes were identified; moral injury is often not identified or discussed during therapy, therapeutic relationships can promote or inhibit discussion of moral injury, treatment has limited impact on moral injury, and it is difficult to cope with moral injury even after treatment. Conclusion The majority of Veterans interviewed identified moral injury persisting within a year of completing a PTSD EBP. These findings highlight the value of asking about, assessing, and treating moral injury in Veterans. Our results suggest the importance of developing specific moral injury interventions for warzone Veterans.

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Moral Injury, Meaning Making, and Mental Health in Returning Veterans

Cited by 189 publications

References 44 publications

A Critical Outlook on Combat-Related PTSD: Review and Case Reports of Guilt and Shame as Drivers for Moral Injury

A Critical Outlook on Combat-Related PTSD: Review and Case Reports of Guilt and Shame as Drivers for Moral Injury

Moving Moral Injury Into the Future With Functional Contextualism: A Response to Nash's “Unpacking Two Models for Understanding Moral Injury” (2019)

Veterans’ perspectives on discussing moral injury in the context of evidence‐based psychotherapies for PTSD and other VA treatment

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