Moral Injury 2.0: Evidence-based Treatment for Trauma, Shame and Guilt

About This Course

There is growing interest in Moral Injury (MI), defined as the internal emotional turmoil experienced by transgressing moral values. Moral Injury (MI) and its repercussions initially received attention in active-duty military and veterans following combat operations, but now has expanded to include first responders, healthcare professionals, and others exposed to severe trauma. This course is designed for mental health professionals, chaplains, community clergy and assistants, and healthcare professionals to understand the origins, prevalence, and causes of these issues. Furthermore, participants will be able to identify the distressing emotions associated with Moral Injury and the devastating consequences that can result. Treatment approaches to moral injury are described from secular, broadly spiritual, multi-religious, and specifically Christian perspectives.

Learning Objectives

Participants will…

1. Describe the moral injury spectrum, from dilemma to disorder
2. Outline the prevalence, causes, and impact of moral injury
3. Summarize the assessment and treatment of moral injury from multiple perspectives.

Lesson Titles and Summaries

MIJ 101: Definition, Moral Injury Spectrum, Symptoms, and Tools for Identifying Moral Injury
Harold G. Koenig, M.D., MHSc.

This lesson will cover the definition of moral injury, describe the moral injury spectrum, and the emotional symptoms characteristic of moral injury, such as guilt, shame, feelings of betrayal, moral concerns, loss of meaning and purpose, loss of trust, difficulty forgiving, self-condemnation, religious struggles, and loss of faith. Participants will learn the overlap with and distinction from PTSD and tools for identifying MI in various populations ranging from service members/veterans to healthcare professionals to civilians.

MIJ 102: Prevalence, Causes, Impact, Consequences, and Prevention of Moral Injury
Harold G. Koenig, M.D., MHSc.

Based on systematic quantitative research published in peer-reviewed journals, the prevalence of MI in various settings, such as active-duty military, veterans, healthcare professionals, and first responders, will be examined. Furthermore, the correlates and causes of MI, such as individual decisions and resulting behaviors, adverse childhood experiences, severe adult trauma, etc., will be explored, and factors that prevent the development of MI, such as social support, religious faith, etc.) will be described.

MIJ 103: Christian, Spiritual, and Secular Treatments for Moral Injury
Harold G. Koenig, M.D., MHSc.

Spiritually integrated cognitive processing therapy, as used by licensed professional counselors, will be outlined session by session with specific attention to various groups, such as SICPT broadly spiritual, Christian SICPT, and other religious versions of SICPT. Other spiritual forms of treatment for MI, such as Building Spiritual Strengths, Pastoral Narrative Disclosure, and Structured Pastoral Care interventions, will be described, and the evidence for their effectiveness will also be examined. Sources for therapist manuals and participant workbooks free of charge will also be provided.

Presenter

Harold G. Koenig, M.D.

Continuing Education Approval Statements

Continuing Education Accreditations applicable to this course
NBCC, IBCC, ACSI, Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, (accepted by the SOH, CSWMFTB), South Dakota Board of Examiners for Counselor & Marriage and Family Therapists , South Carolina Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, Addiction Counselors and Psycho-Educational Specialists, North Carolina Board of Licensed Mental Health Counselors

The American Association of Christian Counselors (AACC) offers some psychologists, therapists, counselors, social workers and play therapists Continuing Education (CE) credit due for good standing with certain states and a limited number of professional organizations. It remains the responsibility of each participant to be aware of state licensure and CE requirements.  

Participants should check their state and/or local regulations regarding required continuing education hours. For more information Light University Continuing Education programs, please visit: https://lightuniversity.com/continuing-education-statements/ 

Date Created: August 7th, 2024

References 

• Koenig HG, Carey, LB, Wortham, J (2023). Moral Injury: A Handbook for Military Leaders and Chaplains. Seattle, WA: Amazon/Kindle Publishing Platform. https://www.amazon.com/Moral-Injury-Handbook-Military-Chaplains/dp/B0BRJK1PVB/  

• Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., ... & Pearce, M. (2018). Screening for moral injury: the moral injury symptom scale–military version short form. Military Medicine, 183(11-12), e659-e665. https://doi.org/10.1093/milmed/usy017 

• Koenig, H. G., Boucher, N. A., Oliver, R. J. P., Youssef, N., Mooney, S. R., Currier, J. M., & Pearce, M. (2017). Rationale for spiritually oriented cognitive processing therapy for moral injury in active duty military and veterans with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 205(2), 147-153. https://doi.org/10.1097/NMD.0000000000000554  

• Koenig, H. G., Youssef, N. A., & Pearce, M. (2019). Assessment of moral injury in veterans and active duty military personnel with PTSD: A review. Frontiers in Psychiatry, 10, 443. https://doi.org/10.3389/fpsyt.2019.00443 

• Koenig, H., Ames, D., & Pearce, M. (2019). Religion and Recovery from PTSD. London: Jessica Kingsley Publishers. 

• Koenig, H. G., Youssef, N. A., Ames, D., Oliver, J. P., Teng, E. J., Haynes, K., ... & Pearce, M. (2018). Moral injury and religiosity in US veterans with posttraumatic stress disorder symptoms. Journal of Nervous and Mental Disease, 206(5), 325-331. https://doi.org/10.1097/NMD.0000000000000798 

• Koenig, H. G., Youssef, N. A., Ames, D., Teng, E. J., & Hill, T. D. (2020). Examining the overlap between moral injury and PTSD in US veterans and active duty military. Journal of Nervous and Mental Disease, 208(1), 7-12. https://doi.org/10.1097/NMD.0000000000001077  

• Mantri, S., Lawson, J. M., Wang, Z., & Koenig, H. G. (2021). Prevalence and predictors of moral injury symptoms in health care professionals. Journal of Nervous and Mental Disease, 209(3), 174-180. https://doi.org/10.1097/NMD.0000000000001277  

• Mantri, S., Song, Y. K., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Moral Injury and burnout in health care professionals during the COVID-19 Pandemic. Journal of Nervous and Mental Disease, 209(10), 720-726. https://doi.org/10.1097/NMD.0000000000001367  

• Pearce, M., Haynes, K., Rivera, N. R., & Koenig, H. G. (2018). Spiritually integrated cognitive processing therapy: A new treatment for post-traumatic stress disorder that targets moral injury. Global Advances in Health and Medicine, 7, 2164956118759939.