What is moral injury and how can we treat it?



Hi all, this video discusses different types of moral injury and the many ways it would be addressed during cognitive trauma therapy. I hope you enjoy it!

Website: avamason.com
Proofreading services/collaboration email: neuropsych@avamason.com
Creds to Jayan for the intro music

0:00 Intro
0:26 Moral injury intro
0:51 Moral injury types & examples
05:00 Cognitive therapy trauma model
05:25 PTSD short intro
07:28 Cognitive moral injury model intro
10:21 Psychoeducation & normalisation
10:56 Individual case formulation
11:10 Rebuilding your life
11:45 Updating trauma memory
12:33 Working on trauma meanings (pie charts, contextualisation, thinking errors, cost & benefits, making amends)
18:47 Trigger discrimination
19:18 Site visits
19:30 Addressing behaviour & coping strategies
20:01 Limitations of cognitive therapy
21:14 Summary

Paper discussed: Murray, H., & Ehlers, A. (2021). Cognitive therapy for moral injury in post-traumatic stress disorder. the Cognitive Behaviour Therapist, 14.

Ehlers et al. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345

Litz et al. (2009). Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychology Review, 29, 695–706.

Williamson et al. (2018). Occupational moral injury and mental health: systematic review and meta-analysis. British Journal of Psychiatry, 212, 339–346

American Psychological Association (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. 

Backholm et al. (2015). Ethical dilemmas, work-related guilt, and posttraumatic stress reactions of news journalists covering the terror attack in Norway in 2011. Journal of Traumatic Stress, 28, 142–148.

Browne et al. (2012). Trauma-related guilt and posttraumatic stress among journalists. Journal of Traumatic Stress, 25, 207–210.

Currier et al. (2015). How do morally injurious events occur? A qualitative analysis of perspectives of Veterans with PTSD. Traumatology, 21, 106–116.

Ehlers et al. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.

Ehlers et al. (2014). A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. American Journal of Psychiatry, 171, 294–304.

Ehlers et al. (2000). PTSD following political imprisonment: the role of mental defeat, alienation, and permanent change. Journal of Abnormal Psychology, 109, 45–55.

Evans et al.  (2007). Intrusive memories and ruminations related to violent crime among young offenders: phenomenological characteristics. Journal of Traumatic Stress, 20, 183–196

Foa et al. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences: Therapist Guide. Oxford University Press.

Gray et al. (2012). Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries. Behavior Therapy, 43, 407–415.

Haight et al.  (2017). Moral injury among child protection professionals: implications for the ethical treatment and retention of workers. Children and Youth Services Review, 82, 27–41.

Haney et al. (1973). Study of prisoners and guards in a simulated prison. Naval Research Reviews, 26, 1–17.

Held et al. (2018). Using prolonged exposure and cognitive processing therapy to treat veterans with moral injury-based PTSD: two case examples. Cognitive and Behavioral Practice, 25, 377–390.

Komarovskaya et al. (2011). The impact of killing and injuring others on mental health symptoms among police officers. Journal of Psychiatric Research, 45, 1332–1336.

Litz et al.  (2009). Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychology Review, 29, 695–706.

Milgram, S. (1963). Behavioral study of obedience. Journal of Abnormal and Social Psychology, 67, 371–378.

Murray et al. 2018). Are medical students in prehospital care at risk of moral injury? Emergency Medicine Journal, 35, 590–594.

Murray et al.  (2015). Returning to the scene of the trauma in PTSD treatment – why, how and when?. The Cognitive Behaviour Therapist, 8.

National Institute for Health and Care Excellence (2018). Post-Traumatic Stress Disorder (NICE Guideline NG116). 

Steenkamp et al. (2011). A brief exposure-based intervention for service members with PTSD. Cognitive and Behavioral Practice, 18, 98–107

Thomas et al. (2020). Care fit for carers: ensuring the safety and welfare of NHS and social care workers during and after COVID-19. Institute for Public Policy Research. 

Williamson et al. (2020). COVID-19 and experiences of moral injury in front-line key workers. Occupational Medicine, 70, 317–319. 

Williamson et al.(2018). Occupational moral injury and mental health: systematic review and meta-analysis. British Journal of Psychiatry, 212, 339–346.

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