A functional approach to understanding and treating military-related moral injury

Farnsworth, Jacob K.; Drescher, Kent D.; Evans, Wyatt R.; Walser, Robyn D.

doi:10.1016/j.jcbs.2017.07.003

Cited by 200 publications

(295 citation statements)

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“…). In this framework, there have been attempts to distinguish moral pain from moral injury(Farnsworth, Drescher, Evans, & Walser, 2017), in which moral pain reflects a natural response to a morally injurious event, and moral injury reflects a dysfunctional attempt to cope with moral pain. However, in a moral injury context, appraisals may reflect an accurate interpretation of events.…”

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confidence: 99%

The relationship between moral injury appraisals, trauma exposure, and mental health in refugees

et al. 2018

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The relationship between moral injury appraisals, trauma exposure, and mental health in refugees

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“…While results from this study may not be generalizable to other Veterans with moral injury who have completed an EBP for PTSD, these findings support the discussion of moral injury in the context of VA care and that some Veterans still experience difficulties with moral injury following EBPs for PTSD. The results of this study suggest the importance of developing inventions that explicitly target moral injury among warzone Veterans (Borges, ; Farnsworth et al, ; Gray et al, ; Maguen et al, ; Norman, Wilkins, Myers, & Allard, ).…”

Section: Resultsmentioning

confidence: 80%

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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“…However, it is also true that Nash's commentary unfortunately includes several key misstatements that confuse the nature and sources of the Farnsworth's () original argument. In fact, rather than focusing on the descriptive–prescriptive distinction, Nash's critiques appear to be primarily directed at a mistaken conception of the functional contextual definition of MI posited by Farnsworth, Drescher, Evans, and Walser ().…”

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confidence: 99%

“…Whereas Farnsworth's () descriptive–prescriptive framework demonstrated that MI cannot be fully captured by the most recent iteration of PTSD symptom criteria (American Psychiatric Association, ), Farnsworth et al.’s () functional contextual model provided new definitions for MI and related concepts (i.e., moral pain, moral healing). In outlining these definitions, Farnsworth et al.…”

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confidence: 99%

“…In outlining these definitions, Farnsworth et al. () argued that it is natural and expected after a morally injurious event to experience moral pain, defined as “the experience of dysphoric moral emotions and cognitions (e.g., self‐condemnation) in response to a morally injurious event” (p. 392). Moral injury, in contrast, was defined by Farnsworth et al.…”

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confidence: 99%

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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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A functional approach to understanding and treating military-related moral injury

Cited by 200 publications

References 26 publications

The relationship between moral injury appraisals, trauma exposure, and mental health in refugees

The relationship between moral injury appraisals, trauma exposure, and mental health in refugees

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

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

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