References
Bravo, A. J., Kelley, M. L., Mason, R., & Ehlke, S., Vinci, C. & Redman, J. C. (2020). Rumination as a mediator of the associations between moral injury and mental health problems in combat wounded veterans. Traumatology, 26 (1), 52-60. https://doi.org/10.1037/trm0000198
Brintz, C. E., Miller, S., Olmsted, K. R., Bartoszek, M., Cartwright, J., Kizakevich, P. N., Butler, M., Asefnia, N., Buben, A., Gaylord, S. A. (2020). Adapting mindfulness training for military service members with chronic pain. Military Medicine, 185 (3-4), 385-393. https://doi.org/10.1093/milmed/usz312
Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014). Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology, 20 (3), 154–160. https://doi.org/10.1037/h0099852
Byrd-Bredbenner, C., Wu, F., Spaccarotella, K., Quick, V., Martin-Biggers, J., & Zhang, Y. (2017). Systematic review of control groups in nutrition education intervention research. International Journal of Behavioral Nutrition and Physical Activity, 14, 91. https://doi.org/10.1186/s12966-017-0546-3
Cabrera, O. (2023, August 5). Implementation of an integrated primary prevention workforce (IPPW) for the Department of Defense. In T. Hoyt (Chair), Prevention of sexual assault & harmful behaviors in the military: Current status & future directions. American Psychological Association, Washington, DC.
Cenkner, D. P., Yeomans, P. D., Antal, C. J., & Scott, A. J. (2021). A pilot study of a moral injury group intervention co-facilitated by a chaplain and psychologist. Journal of Traumatic Stress, 34 (2), 367-374. https://doi.org/10.1002/jts.22642
Currier, J. M., Farnsworth, J. K., Drescher, K. D., McDermott, R. C., Sims, B. M., & Albright, D. L. (2018). Development and evaluation of the Expressions of Moral Injury Scale—Military Version. Clinical Psychology & Psychotherapy, 25 (3), 474-488. https://doi.org/10.1002/cpp.2170
Currier, J. M., Isaak, S. L., & McDermott, R. C. (2020). Validation of the Expressions of Moral Injury Scale‐Military Version‐Short Form. Clinical Psychology & Psychotherapy27 (1), 61-68. https://doi.org/10.1002/cpp.2407
Davies, R. L., Prince, M. A., Bravo, A. J., Kelley, M. L., & Crain, R. L. (2019). Moral injury, substance use, and PTSD symptoms among military personnel: An examination of trait mindfulness as a moderator.Journal of Traumatic Stress, 32 (3), 414-423.https://doi.org/10.1002/jts.22403
Dennis, P. A., Dennis, N. M., Van Voorhees, E. E., Calhoun, P. S., Dennis, M. F., & Beckham,
J. C. (2017). Moral transgression during the Vietnam War: A path analysis of the psychological impact of veterans’ involvement in wartime atrocities. Anxiety, Stress, & Coping, 30(2), 188-201. https://doi.org/10.1080/10615806.2016.1230669
Drescher, K. D., Foy, D. W., Kelly, C., Leshner, A., Schutz, K., & Litz, B. (2011). An exploration of the viability and usefulness of the construct of moral injury in war veterans. Traumatology, 17 (1), 8–13. https://doi.org/10.1177/1534765610395615
Evans, W. R., Stanley, M. A., Barrera, T. L., Exline, J. J., Pargament, K. I., & Teng, E. J. (2018). Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles. Psychological Trauma: Theory, Research, Practice, and Policy, 10 (3), 360–367. https://doi.org/10.1037/tra0000347
Fleming, W. H. (2021). Moral injury and the absurd: The suffering of moral paradox. Journal of Religion and Health60 (5), 3012-3033. https://doi.org/10.1007/s10943-021-01227-4
Flipse Vargas, A., Hanson, T., Kraus, D., Drescher, K., & Foy, D. (2013). Moral injury themes in combat veterans’ narrative responses from the National Vietnam Veterans’ Readjustment Study. Traumatology, 19 (3), 243-250. https://doi.org/10/1177/1534765613476099
Forkus, S. R., Schick, M. R., Goncharenko, S., Thomas, E. D., Contractor, A. A., Weiss, N. H. (2021). The moderating role of emotion dysregulation in the relation between potentially morally injurious experiences and alcohol misuse among military veterans. Military Psychology33 (1), 41-49. https://doi.org/10.1080/08995605.2020.1842640
Franklin, M., Fales, A., Akramov, B., Hintze, W., Hornbostel, M., Smith, S., & Choi, J. (2015). 2015 Wounded Warrior Project® survey: Report of findings . https://www.woundedwarriorproject.org/media/zpfjltcw/2015-wwp-alumni-survey.pdf
Goetter, E. M., Bul, E., Ojserkis, R. A., Zakarian, R. J., Brendel, R. W., & Simon, N. M. (2015). A systematic review of dropout from psychotherapy from posttraumatic stress disorder among Iraq and Afghanistan combat veterans. Journal of Traumatic Stress, 28 (5), 401-409. https://doi.org/10.1002/jts.22038
Hamrick, H. C., Ehlke, S. J., Davies, R. L., Higgins, J. M., Naylor, J., & Kelley, M. L. (2022). Moral injury as a mediator of the associations between sexual harassment and mental health symptoms and substance use among women veterans. Journal of Interpersonal Violence, 37 (11–12), NP10007–NP10035. https://doi.org/10.1177/0886260520985485
Held, P., Klassen, B. J., Brennan, M. B., & Zalta, A. K. (2018). Using prolonged exposure and cognitive processing therapy to treat veterans with moral injury-based PTSD: Two case examples. Cognitive and Behavioral Practice , 25 (3), 377-390. https://doi.org/10.1016/j.cbpra.2017.09.003
Kabat-Zinn, J. (1991). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Delacorte.
Kearney, D. J., Malte, C. A., McManua, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013). Loving-kindness meditation for posttraumatic stress disorder: A pilot study. Journal of Traumatic Stress, 26 (4), 426–434. https://doi.org/10.1002/jts.21832
Kelley, M. L., Bravo, A. J., Jinkerson, J. D., Ogle, A. D., Reichwald, R., & Rutland, J. B. (2021). Remote exposure to traumatic events and PTSD symptoms among US Air Force intelligence personnel: Moderating effects of morally injurious experiences. Psychological Trauma: Theory, Research, Practice, and Policy13 (4), 412-416. https://doi.org/10.1037/tra0000681
Kelley, M. L., Chae, J. W., Bravo, A. J., Milam, A. L., Agha, E., Vinci, C., & Currier, J. M. (2021). Own soul’s warning: Moral injury, suicidal ideation, and meaning in life. Psychological Trauma: Theory, Research, Practice, and Policy , 13 (7), 740-748. https://doi.org/10.1037/tra0001047
Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick’s four levels of training evaluation. ATD Press.
Kleiman, S. E., Bovin, M. J., Black, S. K., Rodriguez, P., Brown, L. G., Brown, M. E., Lunney, C. A., Weathers, F. W., Schurr, P. P., Spira, J., Keane, T. M., & Marx, B. P. (2020). Psychometric properties of a brief measure of posttraumatic stress disorder–related impairment: The Brief Inventory of Psychosocial Functioning. Psychological Services17 (2), 187-194. https://doi.org/10.1037/ser0000306
Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., Haynes, K., Erickson, Z. D., Arnold, I., O’Garo, K. & Pearce, M. (2018). Screening for moral injury: The Moral Injury Symptom Scale – Military Version short form. Military Medicine183 (11-12), e659-e665. https://doi.org/10.1093/milmed/usy017
Kopacz, M. S., Connery, A. L., Bishop, T. M., Bryan, C. J., Drescher, K. D., Currier, J. M., & Pigeon, W. R. (2016). Moral injury: A new challenge for complementary and alternative medicine.Complementary Therapies in Medicine, 24 , 29-33. https://doi.org/10.1016/j.ctim.2015.11.003
Lang, A. J., Malaktaris, A. L., Casmar, P., Baca, S. A., Golshan, S., Harrison, T., & Negi, L. (2019). Compassion mediation for posttraumatic stress disorder in veterans: A randomized proof of concept study.Journal of Traumatic Stress, 32 (2), 299-309. https://doi.org/10.1002/jts.22397
Lindsay, E. K. Creswell, J. D. (2017). Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT). Clinical Psychology Review, 51 , 48-59. https://doi.org/10.1016/j.cpr.2016.10.011Lindsay, E. K. & Creswell, J. D. (2019). Mindfulness, acceptance, and emotion regulation: Perspectives from monitor and acceptance theory (MAT). Current Opinions in Psychology, 28, 120-125. https://doi.org/10.1016/j.copsyc.2018.12.004
Litz, B. T., Plouffe, R. A., Nazarov, A., Murphy, D., Phelps, A., Coady, A., Houle, S. A., Dell, L., Frankfurt, S., Zerach, Levi-Belz, Y., & Moral Injury Outcome Scale Consortium. (2022). Defining and assessing the syndrome of moral injury: Initial findings of the Moral Injury Outcome Scale Consortium. Frontiers in Psychiatry , 13, 923928. https://doi.org/10.3389/fpsyt.2022.923928
Litz, B. T., Rusowicz-Orazem, L., Grunthal, B., Gray, M., Nash, W., & Lang, A. (2020). Adaptive disclosure, a combat-specific PTSD treatment, versus cognitive-processing therapy, in deployed marines and sailors: A randomized controlled non-inferiority trial. Psychiatry Research, 297 , 113761. https://doi.org/10.1016/j.psychres.2021.113761
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy, Clinical Psychology Review, 29 (8), 695-706. https://doi.org/10.1016/j.cpr.2009.07.003
Maguen S., Griffin, B. J., Copeland, L. A., Perkins, D. F., Finley, E. P. & Vogt, D. (2022). Gender differences in prevalence and outcomes of exposure to potentially morally injurious events among post-9/11 veterans. Journal of Psychiatric Research, 130, 97-103.
https://doi.org/10.1016/j.jpsychires.2020.06.020
Maguen S., Griffin, B. J., Vogt D., Hoffmire, C. A., Blosnich, J. R., Bernhard, P. A., Akhtar, F. Z., Cypel, Y. S. & Schneiderman, A. I. (2022). Moral injury and peri- and post-military suicide attempts among post-9/11 veterans. Psychological Medicine, 53 (7), 3200–3209. https://doi.org/10.1017/S0033291721005274
Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., Rodman, J. L., & Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA, 314 (5), 456 –465. https://doi.org/10.1001/jama.2015.8361
Purcell, N., Griffin, B. J., Burkman, K., & Maguen, S. (2018). “Opening a door to a new life”: The role of forgiveness in healing from moral injury. Frontiers in Psychiatry, 9 , Article 498. https://doi.org/10.3389/fpsyt.2018.00498
Richardson, J. T. (2011). Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review6 (2), 135-147. https://doi.org/10.1016/j.edurev.2010.12.001
Shay, J. (1991). Learning about combat stress from Homer’s Iliad.Journal of Traumatic Stress, 4 , 561-579. https://doi.org/10.1002/jts.2490040409
Starnino, V. R., Sullivan, W. P., Angel, C. T., & Davis, L. W. (2020). Like a blanket over a fire: Group work and spiritual repair in military trauma. Families in Society, 101 (1), 95-109. https://doi.org/10.1177/1044389419862081
Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. JAMA, 314 (5), 489-500. https://doi.org/10.1001/jama.2015.8370
ter Heide, F. J. J. (2020). Empathy is key in the development of moral injury. European Journal of Psychotraumatology, 11 (1): 1843261. doi: 10.1080/20008198.2020.1843261.
U.S. Department of Veterans Affairs. (2020, March 30). Whole health: The circle of health.https://www.va.gov/WHOLEHEALTH/circle-of-health/index.asp
Walser, R. D., & Wharton, E. (2021). Acceptance and commitment therapy: Using mindfulness and values in the treatment of moral injury. In J. M. Currier, K. D. Drescher, & J. Nieuwsma (Eds.), Addressing moral injury in clinical practice  (pp. 163–181). American Psychological Association. https://doi.org/10.1037/0000204-010
Williamson, V., Murphy, D., Stevelink, S. A. M., Allen, S., Jones, E., & Greenberg, N. (2021). The impact of moral injury on the wellbeing of UK military veterans. BMC Psychology , 9 (1), 73. https://doi.org/10.1186/s40359-021-00578-7
Varker, T, Jones, K. A., Arjmand, H.-A., Hinton, M., Hiles, S. A., Freijah, I., Forbes, D., Kartal, D., Phelps, A., Bryant, R. A., McFarlane, A., Hopwood, M., & O’Donnell, M. (2021). Dropout from guideline-recommended psychological treatments for posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 4 , 1000093, https://doi.org/10.1016/j.jadr.2021.100093
Zalta, A. K., Held, P., Smith, D. L., Klassen, B. J., Lofgreen, A. M., Normand, P. S., Brennan, M. B., Rydberg, T. S., Boley, R. A., Pollack, M. H., & Karnik, N. S. (2018). Evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD. BMC Psychiatry, 18 (242), 1-15. https://doi.org/10.1186/s12888-018-1816-6
Table 1. Mean Scores on