Healing Moral Injury: The Trauma Resiliency Protocol (TRP) and Cognitive Approaches to Recovery

Abstract

Moral injury is a deeply impactful psychological condition, especially common among military personnel, first responders, and healthcare workers. This article explores the concept of moral injury, its effects, and effective methods for recovery. We focus on the Trauma Resiliency Protocol (TRP) as a therapeutic process for healing traumatic emotional wounds and restoring resilience, as well as additional cognitive-based therapies like cognitive-behavioral therapy (CBT) and cognitive processing therapy (CPT). Highlighting the personal story of a Medevac pilot who experienced moral injury while serving in Afghanistan, this article demonstrates the potential for recovery through these methods.

Table of Contents

1. Introduction to Moral Injury
2. The Trauma Resiliency Protocol (TRP) for Healing
3. Story of a Medevac Pilot: A Case of Moral Injury
4. Cognitive Therapies for Moral Injury Recovery
5. Integrating TRP with Cognitive-Based Methods for Long-Term Healing
6. Conclusion
7. References

Moral injury is a profound and often overlooked aspect of the combat experience that can have lasting effects on the mental health and well-being of veterans. In this article, we’ll explore the concept of moral injury among combat veterans, its causes, impacts, and strategies for healing, drawing on research and expert insights.

Introduction to Moral Injury

Moral injury occurs when an individual engages in, witnesses, or is unable to prevent actions that violate their deeply held moral beliefs, leading to profound psychological distress (Litz et al., 2009). Often observed in military and emergency service contexts, moral injury is associated with emotional responses such as guilt, shame, and spiritual distress that stem from ethical conflicts rather than fear-based trauma (Griffin et al., 2019).

Symptoms and Consequences

Individuals with moral injury experience unique symptoms, including:

• Guilt and Shame: Intense self-blame related to actions or decisions made in the line of duty.
• Loss of Trust: Feelings of betrayal by oneself, one’s organization, or societal values.
• Spiritual and Existential Crisis: A profound questioning of one’s beliefs and purpose.
• Social Isolation: Withdrawal from others due to feelings of guilt or alienation.

Moral injury is distinct from post-traumatic stress disorder (PTSD), which involves a fear-based response to trauma. Instead, moral injury centers on conflicts with personal morals or ethics, leaving an emotional scar that can last a lifetime without proper healing.

The Trauma Resiliency Protocol (TRP) for Healing

Overview of TRP

The Trauma Resiliency Protocol (TRP) is a therapeutic approach designed to address the emotional effects of moral injury and other trauma by targeting the core of the individual’s distress. TRP, developed as a holistic protocol, supports individuals in processing their traumatic emotions and rebuilding psychological resilience, particularly when conventional therapies have limited effectiveness (Jarvis, 2018).

Components of TRP

TRP involves several essential components that facilitate emotional healing from moral injury:

• Processing Traumatic Emotions: TRP provides structured methods for individuals to safely confront and release their traumatic emotions.
• Forgiveness and Self-Compassion: The protocol encourages individuals to approach their experiences with compassion, working toward self-forgiveness.
• Mindfulness and Self-Reflection: TRP incorporates mindfulness practices to heighten emotional awareness and resilience, allowing individuals to regain control over their internal experiences.
• Reclaiming Moral Identity: The protocol helps individuals realign with their core values and principles, restoring a sense of moral balance.

Why TRP Works for Moral Injury

TRP is highly effective for moral injury because it addresses the root of the emotional conflict, allowing individuals to process their distress without judgment. By tackling these emotions directly, TRP helps individuals reconcile their actions or decisions with their deeply held values, making it an ideal protocol for those struggling with moral injury.

Story of a Medevac Pilot: A Case of Moral Injury

The Pilot’s Experience in Afghanistan

*John, a Medevac pilot serving in Afghanistan, recalls the harrowing day when he witnessed Afghan soldiers die in his helicopter, just outside a U.S. military hospital. Despite the soldiers’ dire need for medical attention, policies prevented them from being treated at the U.S. facility. John was forced to watch helplessly as the soldiers succumbed to their injuries, unable to intervene in a way that aligned with his values as both a soldier and a caretaker.

The Emotional Toll

This was not an isolated incident. On multiple occasions, John’s Medevac unit was delayed or prevented from engaging when the casualties were exclusively Afghan soldiers. Each time, he felt a profound sense of guilt and disillusionment, as his duty to save lives was restricted by rules beyond his control. These experiences left John with a deep moral injury, questioning the ethics of his role and feeling responsible for lives he was unable to save.

*Note: Pseudonym used to protect privacy.

Cognitive Therapies for Moral Injury Recovery

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is a widely used, evidence-based approach for treating various mental health conditions, including those related to moral injury. CBT focuses on identifying and restructuring negative thoughts and beliefs, enabling individuals to develop healthier perspectives on their experiences (Beck, 2011).

Cognitive Processing Therapy (CPT)

Cognitive processing therapy (CPT) is a structured therapeutic approach that helps individuals re-evaluate harmful beliefs and assumptions related to trauma. Initially developed for PTSD, CPT has shown significant effectiveness for moral injury by helping individuals make sense of their experiences and reduce self-blame (Resick et al., 2008).

Applying CBT and CPT to Moral Injury

CBT and CPT offer targeted methods for addressing the cognitive aspects of moral injury:

Enhancing Self-Forgiveness: Both CBT and CPT promote self-forgiveness by providing tools to manage guilt and encourage empathy for oneself.

Reframing Self-Blame: These therapies enable individuals to contextualize their actions within the larger environment, helping to release inappropriate self-blame.

Developing Balanced Perspectives: Clients work on reshaping harmful beliefs and developing more constructive interpretations of their experiences.

Integrating TRP with Cognitive-Based Methods for Long-Term Healing

Integrative Approach: TRP with CBT and CPT

Combining the Trauma Resiliency Protocol with cognitive-based therapies like CBT and CPT provides a comprehensive approach to healing moral injury. TRP serves as the foundational therapeutic process for addressing the emotional wounds, while CBT and CPT offer additional support by addressing cognitive distortions and fostering long-term psychological resilience.

Benefits of an Integrated Treatment Plan

An integrated treatment plan that incorporates TRP with cognitive therapies offers numerous benefits:

• TRP for Emotional Healing: TRP focuses on the core traumatic emotions, helping individuals process and release moral injury without judgment.
• CBT and CPT for Cognitive Restructuring: These therapies add cognitive techniques to challenge and reframe harmful beliefs.
• Sustainable Healing: Together, these approaches provide tools for long-term healing, allowing individuals to find peace with their experiences and regain their sense of moral identity.

Success Stories and Clinical Outcomes

Research indicates that veterans and first responders who participate in an integrated approach to therapy report significant reductions in feelings of shame, improved self-forgiveness, and increased emotional resilience (Currier et al., 2015). By using TRP alongside cognitive therapies, individuals like John are able to confront their traumatic emotions and rebuild their trust in themselves and others. http://www.healingthehro.org

Peer Support: Connecting veterans with peers who have shared similar experiences can provide validation, understanding, and mutual support in navigating moral injury.

Spiritual Care: Providing access to chaplaincy services, spiritual counseling, and faith-based support groups can address veterans’ spiritual distress and help restore a sense of meaning and purpose.

Community Reintegration: Supporting veterans in reintegrating into civilian life through employment assistance, education opportunities, and community engagement can promote social connection and belonging.

Policy and Leadership: Implementing policies and practices within military and veteran support systems that promote ethical leadership, moral resilience, and accountability can help prevent moral injury and support those affected.

Conclusion

Moral injury is a complex and deeply impactful condition that often requires an integrative approach for healing. The Trauma Resiliency Protocol, combined with cognitive-based therapies like CBT and CPT, provides a robust framework for those suffering from moral injury. This comprehensive approach allows individuals to process their traumatic emotions, reshape harmful beliefs, and ultimately restore a sense of moral and psychological well-being. By acknowledging the challenges faced by veterans and providing comprehensive support that addresses their moral, psychological, and spiritual needs, we can honor their sacrifices and promote healing and resilience in the aftermath of war.

As we continue to raise awareness, invest in research, and advocate for improved mental health care for combat veterans, we reaffirm our commitment to supporting those who have served and ensuring their well-being and dignity in the journey toward healing.

Anyone wishing to participate in a University study of TRP with QEEG please connect with the following link. https://tacticalresiliencyusa.com/research/

References:

Beck, A. T. (2011). Cognitive Therapy and the Emotional Disorders. Penguin.

Currier, J. M., Holland, J. M., & Malott, J. (2015). Moral injury, meaning making, and mental health in returning veterans. Journal of Clinical Psychology, 71(3), 229–240.

Griffin, B. J., Purcell, N., Burkman, K., Litz, B. T., Bryan, C. J., Schmitz, M., … & Maguen, S. (2019). Moral injury: An integrative review. Journal of Traumatic Stress, 32(3), 350–362.

Jarvis, D. (2018). The Trauma Resiliency Protocol: Healing Moral Injuries Through Resiliency Training. [Unpublished manuscript].

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706.

Resick, P. A., Monson, C. M., & Chard, K. M. (2008). Cognitive Processing Therapy: Veteran/Military Version. U.S. Department of Veterans Affairs.