Veteran Moral Injury
Morris, R., Rodriguez, S., & Lusk, J. (2024). ACT for Moral Injury – Healing the Harm. Department of Veterans Affairs, Portland, OR.
Morris, R., Rodriguez, S., & Lusk, J. (2024). ACT for Moral Injury – Beyond Betrayal. Department of Veterans Affairs, Portland, OR.
Smigelsky, M. A., Rodriguez, S., Lusk, J., Morris, R., Murphy, J., & Nieuwsma, J. A. (2025). Feasibility, acceptability, and preliminary effectiveness of an interdisciplinary group therapy for moral injury among veterans. Submitted for Publication.
Objective: Develop, refine, disseminate, and evaluate the Acceptance and Commitment Therapy for Moral Injury (ACT-MI) group psychospiritual intervention, specifically designed for veterans and co-facilitated by mental health professionals and chaplains.
Background: Veterans are disproportionately affected by moral injury (MI), a condition that arises from morally injurious events that violate personal moral and ethical beliefs. Recognizing the limitations of existing interventions in fully addressing MI, the ACT-MI group intervention was developed. It leverages the principles of Acceptance and Commitment Therapy (ACT) and incorporates the unique perspective of chaplaincy to address the spiritual aspects of healing.
Methodology: Over seven years, including during the COVID-19 pandemic, the ACT-MI psychospiritual group intervention was offered 25 times to hundreds of veterans in both in-person and virtual formats. The program's effectiveness was assessed through preliminary outcome data collected at a VA hospital, demonstrating statistically and clinically significant improvements in moral injury, PTSD, and depression scores. Notably, changes in psychological flexibility were identified as mediating factors for improvements in PTSD and depression.
Significance: The ACT-MI group intervention represents a significant advancement in the treatment of MI among veterans for several key reasons:
Focused Approach to MI: By integrating ACT with chaplaincy, the program addresses both the psychological and spiritual dimensions of MI, offering a comprehensive approach to healing.
Flexibility and Accessibility: The adaptation of the intervention to virtual formats highlights its potential for wide accessibility, ensuring veterans can benefit regardless of their location or circumstances.
Robust Evidence of Effectiveness: Utilizing the Moral Injury Outcome Scale, this study provides compelling evidence of the intervention's impact on key outcomes for veterans, marking a novel contribution to MI literature.
Foundation for Future Research: The findings encourage further exploration into the efficacy of the ACT-MI intervention across diverse veteran populations and care settings, as well as its delivery by various facilitators.
Conclusion: The development and refinement of the ACT-MI group intervention underscore the importance of targeted, multidimensional approaches to addressing moral injury in veterans. By combining the therapeutic strengths of ACT with the compassionate support of chaplaincy, this program not only aids in the immediate healing of veterans but also contributes valuable insights to the field of mental health interventions tailored to the veteran population.
