When someone or something violates your moral values, moral injury can occur. Veterans of war might experience moral injury as a result of witnessing or failing to prevent an event that contradicts what he or she believes during combat. Sometimes, moral injury can have lasting behavioral health effects.

Veterans of war are often at risk of moral injury, particularly if they or someone they know is participating in combat.

Unlike PTSD, moral injury cannot be diagnosed medically. Moral injury is usually identified by its symptoms, as follows: 

• Avoidance of people, places, conversations or situations that remind you of the morally injurious event
• Reliving the event through distressing memories
• Overusing drugs and alcohol to cope with lingering issues related to the event
• Feeling negative emotions such as guilt, shame, trauma or regret 

Learn more about the signs and symptoms of moral injury here. [link to blog: What is Moral Injury]

Moral Injury Treatment

Seeking treatment for moral injury may be challenging because of feelings of guilt and shame around the morally injurious events. In addition, veterans of war often have complex treatment needs that are not always met by therapies designed for the general population.

Moral injury treatment interventions emphasize the need for expansion into moral pain as a way to transcend individual experience and redefine engagement with the world in the present moment. Acceptance of moral pain can help redirect suffering to encourage well-being and living by your values.

Treatment Goals

Individuals with moral injury tend to avoid their pain. In order to recover from moral injury, they must face their suffering in order to live a life full of meaning and purpose, aiming for psychological flexibility. 

Researchers define psychological flexibility as being in contact with the present moment, fully aware of emotions, sensations, and thoughts, welcoming them, including the undesired ones, and moving in a pattern of behavior in the service of chosen values. Developing psychological flexibility allows you to “make room” for your past traumas and experiences. Ideally, you will be able to acknowledge your internal pain while pursuing a meaningful life despite those negative experiences. 

As you develop psychological flexibility through treatment, you gain the ability to:

• Feel and think openly
• Attend to your own experience of the present moment
• Move your life in directions that are important to you
• Build habits that allow you to live life in accordance with your values and aspirations

Acceptance and Commitment Therapy

Doubt, guilt or resentment may sometimes prevent us from sourcing the help we need. Acceptance and commitment therapy (ACT) may help veterans of war to challenge this tendency.

With a focus on behavioral intervention, ACT emphasizes acceptance, mindfulness, and compassion. ACT can help you reconnect with your personal values and define the discrepancy between behaviors driven by moral values versus those driven by past trauma.

Through ACT, you can learn to face stressors rather than avoid them to improve quality of life. Over time, ACT can help you develop psychological flexibility and reduce the distress you may feel when avoiding problems in your life.

ACT can help you address moral injury and restore the control over your life that you deserve.

Process-Based Treatment

Process-based treatment approaches may be effective for veterans of war who are struggling with emotional dysregulation, suicidal ideation and interpersonal concerns. These treatment strategies include:

• Arousal reduction
• Coping and emotional regulation
• Problem-solving and life skills
• Exposure strategies
• Interpersonal skills
• Cognitive defusion
• Core beliefs
• Cultivation of acceptance
• Values construction and clarification 
• Mindfulness practices

Dialectical Behavior Therapy

Unhelpful behaviors and thought patterns can sometimes derail self-confidence, personal progress, even our own identity. Through dialectical behavior therapy (DBT), veterans of war can come to terms with the thoughts and actions that stand between them and progress.

If you are a veteran of war facing moral injury, DBT can help by teaching you to confront the conflicting notions of acceptance and change. Through therapy, you’ll adapt your outlook to accommodate the change you want to experience. The following core principles can help you feel more in control of your own outcomes:

1. Distress tolerance
2. Emotional regulation
3. Interpersonal effectiveness
4. Core mindfulness

DBT allows you to embrace the moment and replace self-destructive behaviors with productive decisions for positive outcomes.

Trauma-Focused Therapy

Moral injury often co-occurs with post-traumatic stress disorder (PTSD) and may arise after traumatic events. At Pyramid Military Therapy, many of our programs are trauma-focused. In other words, each treatment modality we offer is geared toward helping veterans and active duty military personnel understand the ways that trauma has impacted their emotional and physical well-being. 

Trauma-focused treatment approaches can help you recognize the ways that trauma may have impacted your outlook, demeanor and decisions. A trauma-focused recovery program has the following objectives:

1. Realize the impact of trauma on your life and understand associated paths toward recovery.
2. Recognize the signs of trauma that might be present in your own life, and in the lives of your loved ones.
3. Respond to the situation by seeking help and integrating trauma-focused best practices.
4. Avoid re-traumatization through education and initiatives that help you own the life you live.

Veterans of war who engage in trauma-focused treatment programming can experience a number of positive outcomes. You’ll learn to develop healthy coping mechanisms and de-escalation practices useful in combating triggers and the effects of trauma. 

These tools can help decrease symptom prevalence and improve quality of life.

Pyramid Military Therapy & Recovery Programs

Pyramid Healthcare’s Military Therapy & Recovery Programs employ a treatment approach that includes ACT, DBT, and trauma-focused interventions targeting psychological inflexibility and avoidance, moral injury, and dysregulation associated with trauma. 

Our program is evidence-based for primary substance use disorder, depression, anxiety, and trauma-related conditions in addition to chronic pain and other medical issues. 

Working with our trained healthcare professionals, you’ll learn to address and embrace life’s difficult aspects, confronting reality and achieving positive outcomes. Contact us to learn more.