Cognitive processing therapy for moral injury.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…While measures to address MD have primarily focused on the preventative and supportive personal or organizational level efforts ( 16 ), insight regarding treatment may be drawn from the field of MI. Emerging approaches for the treatment of MI (e.g., Adaptive Disclosure; Acceptance and Commitment Therapy; Cognitive Processing Therapy) have tended to focus on top-down, cognitively driven approaches ( 19 , 122 – 124 ); however, our work focuses on neuroscientifically-guided treatments ( 125 ) suggests strongly that approaches that combine top-down, cognitive approaches with bottom-up, physiological and somatosensory-focused approaches, are more likely to achieve success in the prevention and treatment of MI. Accordingly, therapeutic interventions, such as deep brain re-orienting ( 126 , 127 ) and alpha-rhythm neurofeedback ( 128 , 129 ), aimed at the integration of somatosensory experience and regulation of visceral response through a combination of bottom-up and top-down mechanisms, are expected to assist in preventative and early intervention efforts for COVID-19-related MI, while also reducing distress driven by lower-level patterns of neural activation.…”

Between‐session homework and processes of change

“…First, Wachen (2023) presented the case of a female client with longstanding symptoms of posttraumatic stress disorder (PTSD) related to childhood sexual abuse and co‐occurring attention deficit hyperactivity disorder treated with cognitive‐processing therapy. The case highlights the prominent role of BSH in facilitating change within this approach to PTSD, by writing an “impact statement” on how the trauma has affected beliefs about the self, others, and the world (to identify “stuck points”), and further with the systematic and progressive use of worksheets to identify and challenge dysfunctional cognitions related to the trauma to promote a more balanced set of beliefs.…”

“…Further, any specific BSH should be framed as an opportunity to learn something new, even if the task does not go exactly as planned, and the clients' experience of engaging with BSH is always “grist for the therapeutic mill.” Perfectionism is not the goal. As emphasized in the case studies, therapists need to be attuned to the client's experience and the therapeutic process and progress, to propose BSH that is within the client's experiential and developmental grasp (e.g., Warwar, 2023) or tolerable level of anxiety (e.g., Church et al, 2023), through a scaffolding process that over time facilitates increased independence on the client (e.g., Murphy et al, 2023) and progressive internalization of new skills (Wachen, 2023). Hammersmark and colleagues (2023) also demonstrate how clients in group therapy may aid and facilitate each other in designing BSH.…”

“…Specifically, all authors noted how BSH may help clients (1) build awareness or insight (a stance of curiosity toward inner mental life; new perspective on thoughts and though processes, etc.) through specific task such as psychoeducation and sharing of rationale (Church et al, 2023; Hammersmark et al, 2023; Magistrale et al, 2023; Murphy et al, 2023; Wachen, 2023; Warwar, 2023), writing about unresolved feelings toward a significant other (Warwar, 2023), writing an impact statement (Wachen, 2023), using work‐/task sheets (McEvoy et al, 2023; Murphy et al, 2023; Wachen, 2023), experimenting with new behaviors (e.g., Magistrale et al, 2023), or experiential tasks (e.g., Hammersmark et al, 2023); as well as (2) change behaviors by extending in‐session work and (new) behaviors into clients' daily lives through the practice of new skills (e.g., exposure, activity scheduling, trying out new ways of relating, thought worksheet, etc. ; Church et al, 2023; Hammersmark et al, 2023; Magistrale et al, 2023; Murphy et al, 2023; Warwar, 2023).…”

A controlled trial of adaptive disclosure–enhanced to improve functioning and treat posttraumatic stress disorder.

“…This is followed by a focus on what can be done to heal and repair the experience to rebalance beliefs about personal (or humanity's) goodness relative to badness, which entails a flexible plan for exposure to corrective experiences in the patient's context. This is in contrast with arguably "yes-but" approaches, which use Socratic questioning, moral relativism, and contextualizing to address TL/MI (e.g., Smith et al, 2013;Wachen et al, 2021).…”