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

Background: Police officers encounter various potentially traumatic events (PTEs) and may be compelled to engage in actions that contradict their moral codes. Consequently, they are at risk to develop symptoms of Posttraumatic Stress Disorder (PTSD), but also moral stress or moral injury (MI). To date, MI in police officers has received limited attention.Objective: The present study sought to identify classes of MI appraisals and PTSD symptoms among police officers exposed to PTEs, while also investigating potential clinical differences between these classes.Method: For this study, 421 trauma-exposed police officers were assessed on demographics and several clinical measurements including MI appraisals (self-directed and other-directed), PTSD severity, and general psychopathology. Latent class and regression analyses were conducted to examine the presence of different classes among trauma-exposed police officers and class differentiation in terms of demographics, general psychopathology, PTSD severity, mistrust, guilt, self-punishment, and feelings of worthlessness.Results: The following five classes were identified: (1) a 'Low MI, high PTSD class' (28%), (2) a 'High MI, low PTSD class' (11%), (3) a 'High MI, high PTSD class' (17%), (4) a 'Low MI, low PTSD class' (16%), and (5) a 'High MI-other, high PTSD class' (27%). There were significant differences between the classes in terms of age, general psychopathology, PTSD severity, mistrust, guilt, and self-punishment but no differences for gender and feelings of worthlessness.Conclusion: In conclusion, we identified five classes, each exhibiting unique patterns of cognitive MI appraisals and PTSD symptoms. This underscores the criticality of measuring and identifying MI in this particular group, as it allows for tailored treatment interventions.

This study identified classes differing in terms of endorsement of MI appraisals and posttraumatic stress disorder (PTSD) symptoms among police officers exposed to potentially traumatic events.Five classes were identified, each exhibiting unique patterns of MI appraisals and PTSD symptoms.It is important to measure the presence of MI appraisals in addition to PTSD symptoms in traumatized police officers as it can inform treatment interventions.

The impact of morally injurious events in a refugee sample: A quantitative and qualitative study.

Background: Posttraumatic Stress Disorder (PTSD) is often reported by refugees that faced violence and persecution. Some stressful events may also entail moral conflicts or dilemmas, described as "potentially morally injurious events" (PMIE). Very few studies have yet investigated the nature of these PMIEs in traumatized refugees, using both quantitative and qualitative data. Method: For this retrospective study, secondary data analysis was used to examine the traumatic events of 183 patients. Based on established definitions of a PMIE, participants were allocated to a Moral Injury (MI) group if they reported lasting distress after exposure to an event of which they indicated that it transgressed their moral beliefs. The remaining participants were allocated to the No-MI group. The type of PMIEs was categorized using qualitative analysis. The groups were compared in terms of PTSD severity, feelings of guilt, and general mental health symptoms. Results: Of the total sample, 55 participants reported one or more acts of transgression (MI group) and 128 reported no acts of transgression (No-MI group). Analyses of PMIEs revealed six themes 1) failing to prevent harm to others, 2) not giving aid to people in need, 3) leaving family members behind that consequently lead to injury or death of others, 4) making indirect and direct moral decisions leading to injury or death of others, 5) betrayal, and 6) engaging in the harm of others. No differences were found between groups on the clinical outcomes, except for feelings of guilt. Conclusion: A considerable number of traumatized refugees reported confrontation with PMIEs. Experiencing PMIEs appeared unrelated to elevated posttraumatic mental health issues.

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

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.

Antecedentes: 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 (PCL-5, por su sigla en inglés), el Inventario breve de síntomas (BSI, por su sigla en inglés) y la Escala de evaluación de lesiones morales (MIAS, por su sigla en inglés). En cada sesión, las emociones morales se evaluaron en una escala Likert.Resultados: Mientras que las quejas de TEPT y los fuertes sentimientos de culpa y vergüenza se manifestaron antes del tratamiento, durante BEP-MT se encontró una disminución gradual en la intensidad de las emociones morales. Después de BEP-MT, Dusan dejo de cumplir los criterios para el trastorno de estrés postraumático y sus quejas psicológicas disminuyeron.Conclusiones: El Caso de Dusan ha demostrado que vale la pena abordar el trauma moral y BEP-MT es un protocolo prometedor para los pacientes que sufren de trastorno de estrés postraumático después de un trauma moral. Se necesitan más investigaciones para examinar la eficacia de BEP-MT.

Vantage perspective in analogue trauma memories: an experimental study.

Vantage perspective during recall is thought to affect the emotionality and accessibility of distressing memories. This study aimed to test the effects of vantage perspective during recall on memory associated distress and intrusion development. An adapted version of the trauma film paradigm was used in an experimental design with three conditions. Participants were asked to listen to eyewitness reports of car accidents (e.g. Trauma Analogue Induction) and imagine the scenes vividly using mental imagery. Afterwards, they were asked to recall the most distressing scene from field perspective, observer perspective, or to recall a neutral image from observer perspective (control condition) (e.g. Trauma Analogue Recall). Recall from field perspective resulted in higher negative mood, state-anxiety, and a higher number of short-term intrusions compared to the observer perspective condition and control condition. Negative mood and state-anxiety were mediators in the relationship between vantage perspective and intrusions. In comparison to observer perspective, field perspective increased the amount of short-term intrusions as a result of higher levels of negative mood and state-anxiety after memory retrieval. Future research on the interaction between vantage perspective at recall and negative mood and anxiety effects is warranted.

Vantage perspective during encoding: The effects on phenomenological memory characteristics.

The vantage perspective from which a memory is retrieved influences the memory's emotional impact, intrusiveness, and phenomenological characteristics. This study tested whether similar effects are observed when participants were instructed to imagine the events from a specific perspective. Fifty student participants listened to a verbal report of car-accidents and visualized the scenery from either a field or observer perspective. There were no between-condition differences in emotionality of memories and the number of intrusions, but imagery experienced from a relative observer perspective was rated as less self-relevant. In contrast to earlier studies on memory retrieval, vantage perspective influenced phenomenological memory characteristics of the memory representation such as sensory details, and ratings of vividness and distancing of the memory. However, vantage perspective is most likely not a stable phenomenological characteristic itself. Implications and suggestions for future research are discussed.

Feeling psychologically restrained: the effect of social exclusion on tonic immobility.

BACKGROUND: A variety of studies have demonstrated posttraumatic stress disorder (PTSD) symptoms in victims of bullying. Because bullying with only relational aggression, such as social exclusion, does not involve physical aggression that could explain PTSD symptoms, it remains unclear why these relational aggression situations are also linked to PTSD symptoms. OBJECTIVE: The aim of the present study was to investigate whether the fear-response tonic immobility (Ti) can occur during social exclusion. Since Ti, as an indicator of peritraumatic dissociation, is an important predictor of PTSD symptoms, we expected that the presence of Ti during social exclusion might contribute to possible explanations of PTSD symptoms in victims of relational aggression. METHOD: Social exclusion was manipulated by a virtual Cyberball game in which participants were excluded and included by virtual confederates. During the game, Ti was measured, both physiologically (heart rate) and psychologically (subjective symptoms). Also, the underlying concepts of Ti, high levels of fear and psychological restraint (threatened sense of control), were measured. RESULTS: Excluded participants experienced higher levels of subjective and physiological Ti symptoms (lower heart rates) in comparison to social inclusion. Also, as expected, social exclusion resulted in higher levels of fear and psychological restraint in comparison to social inclusion. CONCLUSION: Social exclusion can evoke symptoms of Ti, fear, and psychological restraint, which might be important mechanisms to consider in explaining PTSD symptoms after relational forms of bullying in the absence of physical aggression. LIMITATIONS: The sample only contains healthy, female participants. Whether our results translate to bullying victims of relational aggression is therefore not known. Also, the physiological measurement of Ti (average heart rate) was rather limited and could be expanded in future studies.