Introduction
Moral injury is theorized to be
the consequence of events that are perpetration-based (e.g., injuring a
noncombatant, witnessing cruel behavior but doing nothing to stop it) or
betrayal-based (e.g., betrayal by peers, leadership) that transgress
one’s deeply held morals and values (Flipse Vargas et al., 2013; Litz et
al., 2009; Shay, 1991). When service members cannot reconcile their
experiences with their moral values and beliefs, the dissonance that
results may cause a range of negative emotions, cognitions, and
attributions (e.g., anger, guilt, shame, loss of trust, lack of
forgiveness, self-condemnation, hostility toward authority). These
experiences are collectively known as moral injury (Litz et al., 2009).
Moral injury symptoms are associated with depression, suicidality, and
substance misuse (Bravo et al., 2020; Bryan et al., 2014; Forkus et al.,
2021; Kelley, Chae et al., 2021). Consistent with ‘whole person
approaches’ to care (U.S. Department of Veterans Affairs, 2020), there
is growing interest in developing flexible mind-body approaches for
addressing moral injury (Kopacz et al., 2016; Walser & Wharton, 2021)
that address the unique experiences of veterans. In this paper, we
present findings on feasibility, satisfaction, and preliminary changes
in moral injury outcomes from a small, randomized controlled trial of
Mindfulness to Manage Moral Injury (MMMI), a live facilitated web-based
7-week mindfulness-based program for veterans targeting moral injury
symptoms.