Moral injury: A new challenge for complementary and alternative medicine

Kopacz, Marek S.; Connery, April L.; Bishop, Todd M.; Bryan, Craig J.; Drescher, Kent D.; Currier, Joseph M.; Pigeon, Wilfred R.

doi:10.1016/j.ctim.2015.11.003

Cited by 69 publications

(74 citation statements)

References 65 publications

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“…Concurrently, it is noteworthy that Factor 1 explained the majority of the total explained variance, suggesting that an overall MI factor could contribute to common variance among the items. In most cases, items represented prominent descriptions of emotional, cognitive, and behavioural manifestations of MI described in the literature (Farnsworth et al, ; Jinkerson, ; Kopacz et al, ; Litz et al, ; Shay, ). Namely, Self‐Directed MI items captured feelings of shame (two items) and guilt (two items) as well as beliefs/attitudes about being unlovable (one item), unforgivable (one item), incapable of moral decision making (one item), and self‐handicapping behaviours (two items) and acting out (one item) related to committing transgressive acts.…”

Section: Discussionmentioning

confidence: 99%

“…There is consensus that many military veterans and personnel experience emotional, social, and spiritual challenges that both transcend and overlap with PTSD, MDD, and other existing diagnostic constructs. Although measurement issues have limited the advancement of knowledge, MI captures an experience of suffering that might develop following the violation of deeply held moral beliefs/values and subsequent difficulties in psychosocial functioning (Farnsworth et al, ; Jinkerson, ; Kopacz et al, ; Litz et al, ; Shay, ). At present, researchers and clinicians might utilize two psychometrically validated measures for assessing exposure to PMIEs (Currier, Holland, et al, ; Nash et al, ) and an assortment of freestanding instruments to gauge different warning signs of being morally injured in their work.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, questions persist as to whether MI represents a special case of these mental health diagnoses or whether MI should be viewed as a distinct traumatic theme that can occur outside the context of existing disorders. In addition, although research has indicated incremental validity of PMIEs in predicting mental health symptoms beyond other types of military traumas (e.g., survival threat; for reviews of scientific research, see Farnsworth et al, ; Jinkerson, ; Kopacz et al, ; Litz et al, ), it is not known whether MI expressions might similarly contribute to suicidal behaviour and other pressing issues in military populations (e.g., quality of life and intimate partner violence). From a social functionist framework (Farnsworth et al, ; Hutcherson & Gross, ; Keltner et al, ), MI could serve as a key risk factor for these outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Drawing on information from empirical, theoretical, and clinical sources (Farnsworth et al, ; Jinkerson, ; Kopacz et al, ; Litz et al, ; Shay, ), EMIS‐M items capture possible cognitive and emotional consequences of MI events as well as maladaptive behaviours that often follow such moral reactions. Overall, items were divided into self‐ and other‐directed symptoms with respect to beliefs/attitudes, emotions, and behaviour (i.e., items represented six content subdomains).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Development and evaluation of the Expressions of Moral Injury Scale—Military Version

Currier

Farnsworth

Drescher

et al. 2017

Clin Psychology and Psychoth

Self Cite

142

211

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There is consensus that military personnel can encounter a far more diverse set of challenges than researchers and clinicians have historically appreciated. Moral injury (MI) represents an emerging construct to capture behavioural, social, and spiritual suffering that may transcend and overlap with mental health diagnoses (e.g., post-traumatic stress disorder and major depressive disorder). The Expressions of Moral Injury Scale-Military Version (EMIS-M) was developed to provide a reliable and valid means for assessing the warning signs of a MI in military populations. Drawing on independent samples of veterans who had served in a war-zone environment, factor analytic results revealed 2 distinct factors related to MI expressions directed at both self (9 items) and others (8 items). These subscales generated excellent internal consistency and temporal stability over a 6-month period. When compared to measures of post-traumatic stress disorder, major depressive disorder, and other theoretically relevant constructs (e.g., forgiveness, social support, moral emotions, and combat exposure), EMIS-M scores demonstrated strong convergent, divergent, and incremental validity. In addition, although structural equation modelling findings supported a possible general MI factor in Study 2, the patterns of associations for self- and other-directed expressions yielded evidence for differential validity with varying forms of forgiveness and combat exposure. As such, the EMIS-M provides a face valid, psychometrically validated tool for assessing expressions of apparent MI subtypes in research and clinical settings. Looking ahead, the EMIS-M will hopefully advance the scientific understanding of MI while supporting innovation for clinicians to tailor evidence-based treatments and/or develop novel approaches for addressing MI in their work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development and evaluation of the Expressions of Moral Injury Scale—Military Version

Currier

Farnsworth

Drescher

et al. 2017

Clin Psychology and Psychoth

Self Cite

142

211

View full text Add to dashboard Cite

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“…Depending on the backgrounds of the practitioner and the person seeking care, the practice may include anything from standard chaplain services to laying on of hands, distance healing, or energy manipulation [62], none of which are in conventional medical usage. Spiritual prayer may also form an important foundation of psychotherapies, particularly those aimed at resolving survivor's guilt and other sources of internal conflict [63]. It may also be used as a component of another modality, such as yoga or meditation [112].…”

Section: Discussionmentioning

confidence: 99%

Use of Integrative Medicine in the United States Military Health System

Madsen

Vaughan

Koehlmoos

2017

Evidence-Based Complementary and Alternative Medicine

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Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a “whole person” approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature “polytrauma triad” of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS). These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief. This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.

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Exposure to combat incidents within military and civilian populations as possible correlates of potentially morally injurious events and moral injury outcomes among Israeli combat veterans

Zerach

Levi‐Belz

2021

Clin Psychology and Psychoth

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Objectives: Exposure to potentially morally injurious events (PMIEs) is considered a necessary but insufficient determinant of moral injury (MI) outcomes. However, a question remains regarding possible acts and the necessary features of PMIEs that should be considered transgressive and might lead to MI psychopathological outcomes. We aim to examine the links between exposure to combat incidents within civilian Palestinian populations (CPPs), PMIEs and MI-related outcomes of posttraumatic stress disorder (PTSD) symptoms (PTSS), trauma-related guilt and shame. We also aim to explore the mediating roles of subjective perceptions of PMIEs in the relationship between exposure to combat incidents within CPP and MI-related outcomes among combat veterans. Method: A volunteer sample of 716 Israeli combat veterans responded to self-report questionnaires in a cross-sectional design study. Results: Exposure to combat incidents within CPP has been primarily associated with perpetration based PMIEs and MI-related guilt outcomes. Importantly, betrayal-based PMIEs mediated the association between reports of being the victim of verbal violence by militants and/or civilians and MI outcomes. Moreover, perpetration-based PMIEs mediated associations between reports of personal acts, or witnessing acts, of physical and verbal violence and degradation by militants and/or civilians, and MI outcomes. Conclusions: Military incidents within civilian populations are related to subjective perceptions of PMIEs and MI-related psychopathological outcomes. While betrayalbased experiences might serve as a mechanism to being a victim of verbal violence and MI outcomes, perpetration-based experiences might serve as mechanisms to physical, verbal and degradation incidents and MI outcomes.

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Moral injury: A new challenge for complementary and alternative medicine

Cited by 69 publications

References 65 publications

Development and evaluation of the Expressions of Moral Injury Scale—Military Version

Development and evaluation of the Expressions of Moral Injury Scale—Military Version

Use of Integrative Medicine in the United States Military Health System

Exposure to combat incidents within military and civilian populations as possible correlates of potentially morally injurious events and moral injury outcomes among Israeli combat veterans

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