Jacob Farnsworth | University of North Texas (original) (raw)

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The term moral injury has been coined to describe the suffering that may develop following a viol... more The term moral injury has been coined to describe the suffering that may develop following a violation of deeply held moral beliefs and values and subsequent difficulties in functioning. Yet despite an increase in research and intervention approaches for this topic, the relationship between moral injury and mental health diagnoses such as Posttraumatic Stress Disorder (PTSD) remains unclear and concern exists that, in some cases, moral injury might be used to unnecessarily pathologize moral processes. With the goal of further refining the construct, we argue that moral injury is a condition distinct from PTSD and other disorders and, using a functional approach, propose enhanced definitions for the terms, morally injurious event, moral
pain, moral injury, and moral healing. Consistent with these new definitions, we then argue for Acceptance and Commitment Therapy (ACT) as a feasible and promising treatment for moral injury and present initial qualitative data supporting the intervention.

Moral injury and acceptance and commitment therapy (ACT) are both topics that have only quite rec... more Moral injury and acceptance and commitment therapy (ACT) are both topics that have only
quite recently been introduced into the mental health literature. Although inquiries into these two
domains have been advanced independent from one another, both challenge various aspects of the
traditional medical model for diagnosing, understanding, and treating psychiatric problems. This
article explores complementary possibilities for using ACT to approach the care of persons with moral
injury. Descriptions of moral injury and ACT are provided along with an overview of the developmental histories and
relevant research literature in each of these domains. Specific possibilities for attending to moral injury are explored via
examination of each of the six core processes in ACT: acceptance; cognitive defusion; contact with the present moment;
self-as-context; values; and committed action. It is suggested that ACT has unique potential as an evidence-based
psychotherapy for approaching numerous moral injury related issues. These include: understanding human suffering as
normative, expectable, and potentially meaningful; balancing both verbal and experiential understandings of morality;
fostering forgiveness in a manner that is not dismissive of guilt but employs it to orient towards values; holding and
honoring morally injurious experiences in a way that respects and empathizes with ongoing suffering; identifying a sense
of self from which to behaviorally enact valued actions; and inviting engagement from care providers and communities
outside of the traditional mental health care system. Future conceptual and empirical work is needed, including studies
examining the efficacy and effectiveness of ACT for moral injury.

Moral injury, a term coined to represent the potential negative outcomes following transgression ... more Moral injury, a term coined to represent the potential negative outcomes following transgression of deeply held moral values and beliefs, has recently gained increased recognition as a major concern among military service members exposed to trauma. However, working definitions of moral injury have not yet fully clarified the mechanisms whereby violations of conscience result in these outcomes or their co-occurrence with posttraumatic stress disorder (PTSD). In this paper, advances from the field of moral psychology are used to integrate cognitive, affective, and social dimensions of the emerging moral injury construct, while also pointing to new possibilities for clinical intervention. After reviewing the salience of moral injury for military and veteran populations, the presence of negative moral emotions (e.g., guilt, anger, disgust) are examined within the context of trauma and military-related PTSD. Next, social functionalist accounts of moral emotions are used to explain the development of moral injury and are linked to potential etiologies of PTSD that emphasize both fear and nonfear emotions. Finally, the clinical importance of positive moral emotions for existing and emerging trauma-focused interventions is discussed. Future directions for research and clinical interventions are identified highlighting the importance of utilizing community support.

In recent years, greater attention has been provided to military-related moral injury as an impor... more In recent years, greater attention has been provided to military-related moral injury as an important risk factor for the mental health of Veterans. As research into moral injury is still in its nascent stages, this area of inquiry would be bolstered by additional theoretical accounts of moral injury's detrimental effects on psychological well-being. To this end, Hubert Hermans' theory of the dialogical self is applied to moral injury in male Veterans with an emphasis on understanding how the interplay of cultural myths and masculine identities may combine to make Servicemen deployed in the theatre of war more vulnerable to moral injury. Specific emphasis is given in reviewing how the mythological figure of the hero informs both military culture and hegemonic masculine ideals and fuses them into the westernized soldier-hero figure. It is argued that male Veterans who identify strongly with this soldier-hero figure may be ill equipped to face the moral uncertainties presented by war. Quotations of Veterans from published empirical and clinical sources are then used to demonstrate how identification with the soldier-hero figure may put male Veterans at risk for moral injury. Finally, clinical recommendations are provided for clinicians seeking to assist Veterans recovering from combat-related moral injury.

Despite high levels of exposure to stress, questions remain regarding how social interactions and... more Despite high levels of exposure to stress, questions remain regarding how social interactions and beliefs about emotion interact to influence posttraumatic stress disorder (PTSD) in firefighters. United States urban firefighters (N = 225) completed the Interpersonal Support Evaluation List, the Unsupportive Social Interactions Inventory, the Affective Control Scale, and the Posttraumatic Stress Disorder Checklist. Each independent variable predicted PTSD beyond variance accounted for by demographic variables. Additionally, fear of emotion emerged as the strongest individual predictor of PTSD and a moderator of the relation between social interactions and PTSD symptoms. These findings emphasize the importance of beliefs about emotion both in how these beliefs might influence the expression of PTSD symptoms, and in how the social networks of trauma survivors might buffer distress.

Despite longstanding acknowledgment that values are intrinsic to the process of psychotherapy, th... more Despite longstanding acknowledgment that values are intrinsic to the process of psychotherapy, the field of psychology has been hesitant to explore the implications of values for the client-clinician relationship. One important issue concerns disagreement between the treatment goals of the client and the personal values of the trainee clinician (referred to here as client-clinician value conflict). In this article, the theoretical and practical importance of values for psychotherapy outcomes is briefly reviewed, with an emphasis on the normative and unavoidable nature of value conflicts between clients and their trainee clinicians. A model for addressing client-clinician value conflict is then presented along with case examples and practical recommendations for professional clinicians, supervisors, and trainees. General guidelines for the application of the model are then discussed in more detail with specific warnings regarding the potential for misuse. It is argued that because value conflicts are an inescapable element of psychotherapy, the best protection that can be afforded to clients is for all trainee clinicians to develop greater personal and professional awareness of their own values and recognize the impact that those values have on the services they provide.

Journal of Constructivist Psychology, 2012

Although conceptualizations of human emotions in personal construct psychology have differed, mos... more Although conceptualizations of human emotions in personal construct psychology have differed, most have agreed that emotion is a fundamental aspect of human experience. However, notwithstanding their fundamental nature, personal attitudes and beliefs about emotion take form against the larger background of culture and its associated values, stereotypes, and ideals. In Western culture, individual constructions of emotion are likely to be housed in frameworks that resemble the structure of Western beliefs and attitudes. This article examines the relations between Western constructions of identity and the core processes of emotion—particularly, how conflict between these can generate fear of emotion. To this end, principles of personal construct psychology will be used to describe how emotion may come to be construed as being incompatible with the self, a state that we refer to as emotion-threat. The implications of this construct will then be elaborated in regard to psychological health and treatment.

Journal of Constructivist Psychology, 2012