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

Borges, Lauren M.; Bahraini, Nazanin H.; Holliman, Brooke Dorsey; Gissen, Maura; Lawson, Wendy; Barnes, Sean M.

doi:10.1002/jclp.22887

Cited by 30 publications

(34 citation statements)

References 41 publications

(65 reference statements)

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“…The clinical presentation of PTSD can vary largely between patients based on heterogenous symptom profiles. In addition, specific symptoms of PTSD, such as guilt, social isolation, and trauma-related beliefs, have been posited as risk factors for suicide among military personnel and veterans (Bryan et al, 2013(Bryan et al, , 2017DeBeer et al, 2014;Legarreta et al, 2015;McLean et al, 2017;Holliday et al, 2018a;Borges et al, 2020), but were not the focus of the current review. More research is needed to understand if specific components of PTSD are more strongly related to SI and suicide among military personnel and veterans.…”

Section: Dmss Abhidementioning

confidence: 99%

Posttraumatic Stress Disorder, Suicidal Ideation, and Suicidal Self-Directed Violence Among U.S. Military Personnel and Veterans: A Systematic Review of the Literature From 2010 to 2018

et al. 2020

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Rates of suicide and posttraumatic stress disorder remain high among United States military personnel and veterans. Building upon prior work, we conducted a systematic review of research published from 2010 to 2018 regarding: (1) the prevalence of suicidal ideation, suicide attempt, and suicide among United States military personnel and veterans diagnosed with posttraumatic stress disorder; (2) whether posttraumatic stress disorder was associated with suicidal ideation, suicide attempt, and suicide among United States military personnel and veterans. 2,106 titles and abstracts were screened, with 48 articles included. Overall risk of bias was generally high for studies on suicidal ideation or suicide attempt and low for studies on suicide. Across studies, rates of suicidal ideation, suicide attempt, and suicide widely varied based on study methodology and assessment approaches. Findings regarding the association between posttraumatic stress disorder diagnosis with suicidal ideation and suicide were generally mixed, and some studies reported that posttraumatic stress disorder was associated with lower risk for suicide. In contrast, most studies reported significant associations between posttraumatic stress disorder and suicide attempt. These findings suggest complex associations between posttraumatic stress disorder and suicidal ideation, suicide attempt, and suicide, which are likely influenced by other factors (e.g., psychiatric comorbidity). In addition, most samples were comprised of veterans, rather than military personnel. Further research is warranted to elucidate associations between posttraumatic stress disorder and suicidal ideation, suicide attempt, and suicide, including identification of moderators and mediators of this relationship. Addressing this among United States military personnel, by gender, and in relation to different trauma types is also necessary.

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Section: Dmss Abhidementioning

confidence: 99%

Posttraumatic Stress Disorder, Suicidal Ideation, and Suicidal Self-Directed Violence Among U.S. Military Personnel and Veterans: A Systematic Review of the Literature From 2010 to 2018

et al. 2020

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“…The integration of spirituality into CPT was also found to be effective in one veteran's recovery from moral injury (Koenig et al., 2017). However, treatment studies indicate that guilt and moral injury are common residual symptoms after CPT or PE treatment (Borges et al., 2020; Larsen et al., 2019). Moreover, qualitative data suggests that moral injury may not always be identified or discussed in evidence‐based treatments for PTSD (Borges et al., 2020).…”

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confidence: 99%

“…However, treatment studies indicate that guilt and moral injury are common residual symptoms after CPT or PE treatment (Borges et al., 2020; Larsen et al., 2019). Moreover, qualitative data suggests that moral injury may not always be identified or discussed in evidence‐based treatments for PTSD (Borges et al., 2020). Thus, data to support the use of CPT and PE in treating moral injury are limited.…”

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confidence: 99%

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

Cenkner

Yeomans

Antal

et al. 2020

Journal of Traumatic Stress

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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.

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“…In this period there was relevant organizational changes, uncertainty about the evolution of patients, a lack of personal protective equipment and the number of professionals infected increased. It is expected that by decreasing this pressure the emotional response of the professionals will increase as they become fully aware of their experience (9,11).…”

Section: Discussionmentioning

confidence: 99%

The Acute Stress Scale in Healthcare Professionals Caring for Patients with COVID-19. Validation Study

Mira¹,

Cobos

García

et al. 2020

Preprint

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Backgroud: This study designed and validated a scale to measure acute stress experienced during the care of patients with COVID-19 (EASE scale). Methods: The COSMIN recommendations were followed in the design and validation of the EASE scale. Internal consistency was calculated using Cronbach's Alpha and McDonald's Omega. Qualitative research was conducted to assess content validity. Exploratory and Confirmatory Factorial Analysis were used to assess construct validity. Mann-Whitney-Wilcoxon test and Lineal Regression were applied to assess criterion validity. Responsiveness and interpretability were also assessed.Results: A total of 228 health professionals from the Spanish public health system responded to the ten items, of the EASE scale. Internal consistency was 0.87 (McDonald’s Omega). Two factors explaining 55% of the variance were isolated. Goodness-of-fit indices confirmed this factor structure. The highest level of stress was found among professionals working in health services who accumulated a higher number of deaths from COVID-19 (P<.05). By means of translation-counter-translation, it was adapted to Latin American Spanish, Brazilian Portuguese, and English.Conclusions: EASE gathers adequate metric properties. Its systematic use would allow the identification of professionals with a higher risk of developing affective/anxiety disorders and Moral injury that could limited that patients received safety and integrated care.

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

Cited by 30 publications

References 41 publications

Posttraumatic Stress Disorder, Suicidal Ideation, and Suicidal Self-Directed Violence Among U.S. Military Personnel and Veterans: A Systematic Review of the Literature From 2010 to 2018

Posttraumatic Stress Disorder, Suicidal Ideation, and Suicidal Self-Directed Violence Among U.S. Military Personnel and Veterans: A Systematic Review of the Literature From 2010 to 2018

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

The Acute Stress Scale in Healthcare Professionals Caring for Patients with COVID-19. Validation Study

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