A recent article  proposes that certain experiences—specifically “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations”—create dissonance with an individual’s moral and ethical beliefs. A failure to resolve this dissonance can result in moral injury, a cascade of negative changes in beliefs about self and the world, emotions such as shame and guilt, self-blame or lack of forgiveness, and PTSD symptoms as well as self-harm and demoralization.

The concept of moral injury can help patients gain a new way of understanding themselves and their symptoms. Treatment includes: (1) strong working alliance; (2) psychoeducation about moral injury and development of a collaborative plan for addressing it; (3) exposure-based processing; (4) directed examination of the implications of the trauma for self- and other schemas; (5) an imaginary dialogue with a respected moral authority; (6) fostering reparation and self-forgiveness; (7) fostering reconnection with important communities; and (8) assessment of goals and values.

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