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The Status of Evidence-Based Treatments for Moral Injury Syndrome: Review and Meta-analysis of Randomized Controlled Trials

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Abstract

Purpose of review

The goals of this report were to (a) review the empirical evidence of interventions for moral injury syndrome (MIS) symptoms, (b) quantitatively synthesize these effects through a preliminary meta-analysis, and (c) provide treatment and research recommendations for MIS based on our qualitative and quantitative review.

Recent findings

Participants in MIS treatment improved on targeted MIS symptoms and general mental health, with scores decreasing across measured adverse mental health outcomes compared to control conditions. Increased scores on positive outcomes such as self-forgiveness were also reported. Meta-analysis revealed significant omnibus effects across mental health symptoms (g =  − 0.60), positive outcomes (g =  − 0.51), and hallmark MIS symptom (g =  − 0.51) domains. There were robust mixed treatment effects for PTSD (g =  − 0.61) and depression (g =  − 0.47) specific outcomes. While control samples also improved on PTSD (g =  − 0.37) and hallmark MIS symptoms (g =  − 0.34) across within-group models, stronger within-group treatment effects for these domains/subdomains (g =  − 0.71 and − 0.63, respectively) indicate that EBTs for MIS are more useful for targeting these symptoms than traditional trauma treatments or waitlist conditions.

Summary

Empirically supported treatments for MIS symptoms are effective in reducing negative impact of MIS to mental health. As EBTs for MIS treat PTSD to a comparable degree as conventional trauma treatments, and are superior in attenuating MIS symptoms, we recommend expanding access to MIS treatments.

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Authors and Affiliations

  1. Department of Mental Health, VA Maine Healthcare System, 1 VA Center, Augusta, ME, 04330, USA

    Stephen L. Aita PhD, Susannah R. Kondrath PhD & Timothy J. Usset MDiv, MA, MPH

  2. Department of Psychology, University of Maine, Orono, ME, USA

    Stephen L. Aita PhD & Susannah R. Kondrath PhD

  3. Department of Psychological Science, Texas Tech University, Lubbock, TX, USA

    Tyler Owen MA & Nicholas C. Borgogna PhD

  4. Minnesota Evidence-Based Practice Center, Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, USA

    Timothy J. Usset MDiv, MA, MPH

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Aita, S.L., Kondrath, S.R., Owen, T. et al. The Status of Evidence-Based Treatments for Moral Injury Syndrome: Review and Meta-analysis of Randomized Controlled Trials. Curr Treat Options Psych 10, 217–233 (2023). https://doi.org/10.1007/s40501-023-00292-8

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