scholarly journals Moral injury in a context of trauma

2020 ◽  
Vol 216 (3) ◽  
pp. 127-128 ◽  
Author(s):  
Edgar Jones
Keyword(s):  
Moral Philosophy ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Rating Scales ◽  
Stress Disorder ◽  
Moral Injury ◽  
Ethical Behaviour ◽  
Post Traumatic Stress ◽  
Effective Interventions ◽  
Post Traumatic

SummaryMoral injury, characterised by guilt, shame and self-condemnation, is conceptualised either as an adjunct to post-traumatic stress disorder or as a new syndrome. Studies of symptoms and potentially morally injurious events have produced a possible definition and informed the design of rating scales. The current challenge remains the design of effective interventions. Because moral injury relates to ethical behaviour, the meaning attached to events and perceptions of the self, moral philosophy and spirituality could contribute to the design of treatments.

Trauma―Focused Treatment for PTSD With Comorbid Psychosis: A Case Report

2020 ◽  
pp. 153465012098006
Author(s):  
Stephanie Cherestal ◽  
Kate L. Herts
Keyword(s):  
Case Report ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Rating Scales ◽  
Stress Disorder ◽  
Prolonged Exposure ◽  
Psychotic Symptoms ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Treatment Targeting

Post-traumatic stress disorder is often a condition left untreated in patients also meeting criteria for psychotic disorders. While many clinicians who treat patients with these co-occurring conditions choose to avoid treatment targeting symptoms of PTSD for fear of de-stabilizing these individuals or exacerbating psychotic symptomatology, little is currently known about how patients respond to treatment for PTSD in the context of ongoing psychotic symptoms. Additionally, research is scarce regarding the clinical profile of individuals who develop psychotic symptoms secondary to a traumatic stressor, in the absence of any premorbid symptomatology. The purpose of this case report is to outline the case of an individual, “Mary” who developed psychotic symptoms secondary to a traumatic stressor in her middle age and to describe her response to treatment targeting her symptoms of PTSD. Mary presented with core symptoms of PTSD that emerged following a traumatic car crash. She developed psychotic symptoms (auditory and visual hallucinations) several weeks later. Mary underwent a treatment course of Prolonged Exposure targeting her symptoms of PTSD, with careful work done to monitor any changes in psychotic symptomatology while engaging in this treatment. Standardized measures such as the Post-traumatic Stress Disorder Checklist-5 (PCL-5) and the Psychotic Symptom Rating Scales were administered to assess Mary’s progress throughout treatment. This case report provides a comprehensive summary of Mary’s 16-week course of Prolonged Exposure therapy, which resulted in a significant reduction in PTSD symptomatology as demonstrated by a 72% decrease in scores on the PCL-5 from the initiation to the conclusion of treatment.

Assessment of a new self-rating scale for post-traumatic stress disorder

1997 ◽  
Vol 27 (1) ◽  
pp. 153-160 ◽  
Author(s):  
J. R. T. DAVIDSON ◽  
S. W. BOOK ◽  
J. T. COLKET ◽  
L. A. TUPLER ◽  
S. ROTH ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Treatment Effects ◽  
Rating Scales ◽  
Rating Scale ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Event Scale ◽  
Self Rating ◽  
Post Traumatic

Background. In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage.Methods. Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R.Results. The scale demonstrated good test–retest reliability (r = 0·86), internal consistency (r = 0·99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects.Conclusions. The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.

scholarly journals To Understand and Support Contemporary Veterans Utilizing Biblical Combat Veteran Types

2018 ◽  
Vol 72 (4) ◽  
pp. 232-240 ◽  
Author(s):  
Jan Grimell
Keyword(s):  
Pastoral Care ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Combat Veterans ◽  
Stress Disorder ◽  
Real Life ◽  
Moral Injury ◽  
Post Traumatic Stress ◽  
Combat Veteran ◽  
Post Traumatic

This article continues to build on the biblical combat veteran types (BCVTs) which were recently presented as a tool to describe and understand biblical combat veterans through the lenses of post-traumatic stress disorder and moral injury. The purpose of this article is to connect the BCVTs with real-life cases so as to show the potential usefulness of the biblical types. This article further develops a model for pastoral care which integrates this tool.

scholarly journals Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

2021 ◽  
pp. oemed-2020-107276
Author(s):  
Danielle Lamb ◽  
Sam Gnanapragasam ◽  
Neil Greenberg ◽  
Rupa Bhundia ◽  
Ewan Carr ◽  
...  
Keyword(s):  
Mental Health ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Healthcare Workers ◽  
Alcohol Misuse ◽  
Stress Disorder ◽  
Moral Injury ◽  
Health Questionnaire ◽  
Post Traumatic Stress ◽  
Post Traumatic

ObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April–June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale.ResultsAnalyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

scholarly journals Spiritually Integrated Cognitive Processing Therapy: A New Treatment for Post-traumatic Stress Disorder That Targets Moral Injury

2018 ◽  
Vol 7 ◽  
pp. 216495611875993 ◽  
Author(s):  
Michelle Pearce ◽  
Kerry Haynes ◽  
Natalia R Rivera ◽  
Harold G. Koenig
Keyword(s):  
Cognitive Processing ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Moral Injury ◽  
Cognitive Processing Therapy ◽  
Post Traumatic Stress ◽  
Spiritual Beliefs ◽  
Post Traumatic ◽  
Spiritual Resources

Background Post-traumatic stress disorder (PTSD) is a debilitating disorder, and current treatments leave the majority of patients with unresolved symptoms. Moral injury (MI) may be one of the barriers that interfere with recovery from PTSD, particularly among current or former military service members. Objective Given the psychological and spiritual aspects of MI, an intervention that addresses MI using spiritual resources in addition to psychological resources may be particularly effective in treating PTSD. To date, there are no existing empirically based individual treatments for PTSD and MI that make explicit use of a patient’s spiritual resources, despite the evidence that spiritual beliefs/activities predict faster recovery from PTSD. Method To address this gap, we adapted Cognitive Processing Therapy (CPT), an empirically validated treatment for PTSD, to integrate clients’ spiritual beliefs, practices, values, and motivations. We call this treatment Spiritually Integrated CPT (SICPT). Results This article describes this novel manualized therapeutic approach for treating MI in the setting of PTSD for spiritual/religious clients. We provide a description of SICPT and a brief summary of the 12 sessions. Then, we describe a case study in which the therapist helps a client use his spiritual resources to resolve MI and assist in the recovery from PTSD. Conclusion SICPT may be a helpful way to reduce PTSD by targeting MI, addressing spiritual distress, and using a client’s spiritual resources. In addition to the spiritual version (applicable for those of any religion and those who do not identify as religious), we have also developed 5 religion-specific manuals (Christianity, Judaism, Islam, Buddhism, and Hinduism) for clients who desire a more religion-specific approach.

scholarly journals Understanding Language and Speech in the Voice of Collective Trauma

2020 ◽  
Vol 15 ◽  
pp. 84-88
Author(s):  
Larysa Zasiekina ◽  
Tetyana Hordovskya ◽  
Mariia Kozihora
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Moral Injury ◽  
Collective Trauma ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Constructing Meaning ◽  
The Voice

The study aims to examine lexicon of collective trauma and compare it with concepts of post-traumatic stress disorder (PTSD), moral injury and continuous traumatic stress (CTS). The role of language and speech in disintegrating and constructing meaning as a result of collective trauma has been explored.

Challenging the Hegemony of the Symptom: Reclaiming Context in PTSD and Moral Injury

2020 ◽  
Vol 45 (6) ◽  
pp. 644-662 ◽  
Author(s):  
Warren Kinghorn
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Moral Injury ◽  
Post Traumatic Stress ◽  
Therapeutic Approaches ◽  
Vietnam Era ◽  
Vietnam Syndrome ◽  
Contemporary Work ◽  
Post Traumatic

Abstract Although post-traumatic stress disorder (PTSD) is now constituted by a set of characteristic symptoms, its roots lie in Post-Vietnam Syndrome, a label generated by a Vietnam-era advocacy movement that focused not on symptoms but on war’s traumatic context. When Post-Vietnam Syndrome was subsumed into the abstract, individualistic, symptom-centered language of DSM-III and rendered as PTSD, it not only lost this focus on context but also neglected the experiences of veterans who suffer from things done or witnessed, not primarily from what was done to them, in war. This agent-related trauma has been rediscovered in contemporary work on moral injury, but moral injury too is increasingly subjected to the hegemony of the symptom. Focusing on symptoms, however, unhelpfully pathologizes and individualizes trauma, neglects traumatic context, and legitimates problematic therapeutic approaches. Trauma researchers and clinicians should decenter the language of symptoms and focus instead on context and on alternative accounts of trauma.

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