A communal intervention for military moral injury.

The Moral Injury Group (MIG) at the Corporal Michael J. Crescenz (Philadelphia) VA Medical Center (CMCVAMC) is an example of collaborative care between chaplains and psychologists that engages religious, academic, and not-for-profit communities, as well as the media and other organizations external to the healthcare context. The intervention is primarily informed by a unique conceptualization: the moral injury (MI) of individual veterans is rooted in the unfair distribution of appropriate moral pain and best addressed through communal intervention that facilitates broader moral engagement and responsibility. MI is a public health issue that arises from the unfair distribution of appropriate moral pain and is sourced by the sedimentary layers of structural violence in US institutions related to war, and US war-culture. Preventing veteran suicide and promoting public health requires a larger social analysis and more broad-based, collective and collaborative understanding of, and response to, US war-culture, extending responsibility for MI care and prevention beyond individual veterans in health care institutions and clinical settings to US society.

A Pilot Study of a Moral Injury Group Intervention Co-Facilitated by a Chaplain and Psychologist.

Moral injury, an experience of betrayal or transgression of moral values, continues to receive attention because of its associations with psychiatric disorders, including posttraumatic stress disorder and suicidality. There is growing recognition that moral injury may require novel interventions that involve religious or spiritual paradigms. This pilot study presents feasibility data and exploratory outcomes for 40 veteran participants across seven cohorts who participated in a novel 12-week moral injury group (MIG) over 35 months. The MIG was cofacilitated by a Veterans Affairs chaplain and psychologist and designed to reduce distress and improve functioning in individuals with histories of morally injurious experiences from military service. The intervention included a ceremony in which participants shared testimonies of their moral injury with the general public. Recruitment feasibility and retention were high, with participants completing an average of 9.45 (SD = 2.82) sessions of the 12-week group, and 32 participants (80.0%) attending nine or more sessions and the community healing ceremony. Exploratory analyses revealed medium effect sizes, ω2 = 0.05-0.08, for reductions in depressive symptoms, improvements in psychological functioning, and self-compassion after the intervention, with small effect sizes, ω2 = 0.03, in anticipated directions for personal growth and spiritual struggles. The results were not impacted by participant engagement in concurrent psychological treatments. Taken together, these findings support the feasibility of the MIG, the potential merit of an interdisciplinary approach to addressing moral injury, and justification for further research into the efficacy of this approach.

Removing Barriers in the Assessment of Combat-Related Post-traumatic Stress Disorder.

While the Veterans Health Administration continues to treat Vietnam War Veterans, approximately two million service men and women have returned from Iraq and Afghanistan. However, our treatments can only be as effective as the quality of our clinical assessment. Disclosure of trauma is facilitated when the type of trauma is present in the sociocultural environment of patient and clinician. Topics that once were deemed too shameful for inquiry, specifically, childhood abuse, domestic violence, sexual abuse, and military sexual trauma are now part of a standard assessment. Similarly, the standard clinical assessment of combat Veterans should include specific queries that address the darkest underside of wartime experiences.

A randomized trial of a reconciliation workshop with and without PTSD psychoeducation in Burundian sample.

Posttraumatic stress disorder (PTSD) psychoeducation is increasingly offered in diverse cultural settings. As the literature offers theoretical arguments for why such information might be normalizing and distress-reducing, or might risk morbid suggestion of greater vulnerability, a two-sided hypothesis was proposed to examine the specific effect of PTSD psychoeducation. Participants of a trauma healing and reconciliation intervention in Burundi were randomized to conditions with and without PTSD psychoeducation, or to a waitlist control. Both interventions reduced symptoms more than the waitlist. Participants in the condition without psychoeducation experienced a greater reduction in PTSD symptoms relative to other conditions. Findings are discussed in relationship to intervention development for traumatic stress in nonindustrialized and culturally diverse settings.

Symptom comparison across multiple solicitation methods among Burundians with traumatic event histories.

Debate continues over whether posttraumatic stress disorder (PTSD) symptoms are more biologically based and therefore relatively universal or are more culturally constructed. This study aimed to describe traumatic stress reactions in a Burundian sample and to investigate the influences of the solicitation method (open-ended questions and standardized measures) and psychoeducation (as a process of acculturation) on symptoms reported. Standardized measures showed that distress was manifested in somatization, anxiety, and depression, and less so in specific PTSD symptoms. Content analysis of open-ended questions revealed frequent material complaints. Prior exposure to Western ideas about trauma was predictive of more severe PTSD symptoms. The implications of the findings are discussed in terms of how methodological and cultural factors may influence posttraumatic reactions in nonindustrialized settings.

A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression.

Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.