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Moral Injury and Moral Repair

Moral Injury and Moral Repair . Brett Litz National Center for PTSD VA Boston Healthcare System Boston University. Why is Unique About Modern Military / Long Wars?. Resilience resources: Pride, purposefulness, leadership, training, peer-support… Roles are motivating and reinforcing

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Moral Injury and Moral Repair

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  1. Moral Injury and Moral Repair Brett Litz National Center for PTSD VA Boston Healthcare System Boston University

  2. Why is Unique About Modern Military / Long Wars? • Resilience resources: Pride, purposefulness, leadership, training, peer-support… • Roles are motivating and reinforcing • Societal support for warriors / military • Combat and operational experiences are complex: • Deployment adversities, stressors, sacrifices take toll • Non-combat roles entail unprecedented exposure • Traumas are complex, repeated, and enduring • Loss is profound • Bearing witness to mass destruction, human depravity and evil • Destruction, killing, maiming • Military trauma has been conceptualized narrowly

  3. Current Conceptualization of PTSD • Neo-Classical Conditioning Model • Heuristic model has been useful • Excellent evidence in non-veterans • Evidence is weak for more complicated, interpersonal traumas • Trials with veterans are weak • Stress disorder and PTSD-thinking have hampered progress

  4. Assumptions • Resilience to fear-based traumatic stress • Traumatic loss and moral injury cause the most lasting scars • Loss and moral injury require different thinking • Shame and guilt thwarts motivation • Guilt, shame, sorrow, anguish are not extinguishable via repeated exposure • Reengagement, reattachment, and corrective action are pivotal (not all intrapsychic) • Societal, community, cultural, and family responses matters a great deal • Most outcomes will be delayed

  5. Most Valid Open-Ended Definition • The lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations • We do not know what “the syndrome” is • We do not know its prevalence • Betrayal has emerged as an important theme

  6. Why Has It Taken So Long To Get Serious About Moral Injury? • We have not asked the right questions • Fear-based models of care • Shame and guilt not targeted in CBT • Shame may prevent disclosure • Clinicians may feel helpless or unprepared • Clinicians may be too frightened of their own reactions • Clinicians may be judgmental

  7. Thank You

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