A common assumption among clinicians and researchers is that war trauma primarily involves fear-based reactions to life-threatening situations. However, the authors believe that there are multiple types of trauma in the military context, each with unique perievent and postevent response patterns. To test this hypothesis, they reviewed structured clinical interviews of 122 active duty service members and assigned the reported index (principal, most currently distressing) events to one or more of the following categories: Life Threat to Self, Life Threat to Others, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Others. They found high interrater reliability for the coding scheme and support for the construct validity of the categorizations. In addition, they discovered that certain categories were related to psychiatric symptoms (e.g., reexperiencing of the traumatic event, guilt, anger) and negative thoughts about the world. Their study provides tentative support for use of these event categories.
"The unique nature of these conflicts—reflective of theater-specific duties and experiences—could influence symptom presentation and treatment (Tuerk, Grubaugh, Hamner, & Foa, 2009). Besides experiencing situations which may pose a threat to the life of the service member or those close to them, the experience of active duty may also include witnessing violence, experiencing a painful loss, or having one's ethical or moral standards contravened (Nash et al., 2013; Stein et al., 2012). This has given way to the idea of spiritual or moral injury in Veteran populations, conceptually defined as " perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations " (Litz et al., 2009, p. 700). "
[Show abstract][Hide abstract] ABSTRACT: In recent years, identifying ways to mitigate the risk of suicidal behavior in Veteran populations has become a major public health challenge of special significance. This has included identifying support options that can be used by Veterans in times of distress or crisis. For example, Veterans at increased risk of suicide will sometimes voice complaints indicative of a need for spiritual and pastoral care support. At U.S. Department of Veterans Affairs Medical Centers, such support is provided to Veterans by clinical chaplains. This discussion paper aims to present the contextual framework in which chaplaincy services are provided to Veterans at increased risk of suicide, better conceptualize the spiritual and pastoral care needs of at-risk Veterans who request chaplaincy services, and offer practical suggestions for framing the provision of spiritual and pastoral care services.
"However, there is growing consensus that the lasting psychic harms of combat stem from more than life-threat experiences. For example, grief and guilt that result from traumatic loss, and shame and anger that result from moral compromises, are common and arguably considerably more complex and toxic (e.g., Bryan, Morrow, Etienne, & Ray-Sannerud, 2013; Drescher et al., 2011; Maguen et al., 2011; Stein et al., 2012). Consequently, we would argue that to be clinically valid, any theory that operationalizes change agents in the treatment of combat trauma must account for how the intervention targets these nonfear emotions and disparate phenomenologies. "
[Show abstract][Hide abstract] ABSTRACT: We comment on Smith, Duax, and Rauch’s (2013--this issue) explication of their approach to treating perpetration-related guilt and shame using prolonged exposure (PE) therapy, with the aim of promoting a discourse about the mechanisms, techniques, and assumptions that underlie the treatment of moral injury in veterans and service members. We first discuss the theoretical foundation underlying PE and consider the extent to which it accounts for the phenomenology of moral injury. We then examine the treatment strategies used in the PE approach and the mechanisms by which these techniques ameliorate perpetration-related guilt and shame. We also briefly highlight points of similarity and contrast between PE and adaptive disclosure, a brief cognitive behavioral intervention targeting combat-related moral injury and traumatic loss.
Cognitive and Behavioral Practice 11/2013; 20(4):471–475. DOI:10.1016/j.cbpra.2013.05.002 · 1.33 Impact Factor
"In a pilot study of Adaptive Disclosure, a novel cognitive-behavioral therapy for combat-related PTSD that includes specific techniques for loss and moral injury, Gray et al. (2011) found that 19 of 44 participants (43 %) described index traumatic events that met the Litz et al. (2009) definition of moral injury. In a different multisite treatment outcome study, Stein et al. (2012) found that 12 % of the index traumas of 122 enrolled service members met the definition for self-perpetrated moral injury events, while 22 % described index traumas in which someone else perpetrated a morally injurious event. "
[Show abstract][Hide abstract] ABSTRACT: Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.
Clinical Child and Family Psychology Review 07/2013; 16(4). DOI:10.1007/s10567-013-0146-y · 4.75 Impact Factor
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