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Research Proposal
3
Moral Injury in the Military:
prevalence of betrayal-related moral struggles and a suggested treatment focus
Connie Gustafson, Adler University
Introduction
- Topic introduction
- A research proposal on the investigation of determining whether a forgiveness-based therapy could be critically utilized as a form of recovery from betrayal-related moral injury such as with toxic leadership w/i the military
- see 1st box below
- Subjects & Instruments
- Discussion
- Summary of salience
Introduction
Civilian-related contribution to understanding moral Injury
- From cognitive dissonance & psychosocial dysfunction, plus other psychological stressors & personal suffering, positive emotions are only made real through relationships found in caring communities (Shay, 1994).
Civilian-related contribution to understanding moral injury
- back one slide
Proposed contribution to understanding moral Injury
- 2 points of focus for this proposed study
- to conduct an exploratory investigation in order to re-enforce the knowledge of existing prevalence of betrayal-related moral injury
- specifically toxic leadership within the military
- also use as a prediction that might suggest the need for a very practical, interpersonal forgiveness-focused therapy similar to the practical group recovery program done within the civilian healthcare industry
- salience of this topic is to avoid the worst case for moral injury which, in that service members with moral injury suffer in isolation, feeling helpless and hopeless having chronic collateral manifestations (Litz, 2009)
Contribution to understanding moral injury
Subjects & Instruments
- based on a Litz et al. study (2009) see Fig.1 below
Subjects & Instruments
Fig. 1. MORAL INJURY CAUSATION LOOP BY LITZ & TEAM: expectations of being
tainted by moral transgression and being unworthy of [self]forgiveness can
come full circle (this feedback loop is depicted)
Subjects
- Population
- approx. 350 military veterans or current service members
- Target population
- those that have experienced dysfunctional features as a result of toxic leadership
- Sample population
- randomly select 10% of the target population and elicit follow-on interviews from the survey as well as allow subjective sharing of their experience
Survey Topics Examples
Assess for having corrective features
1. ability to relive & re-experience (may indicate breaking through avoidance)
- management & challenging negative beliefs & expectations about self
2. possible exposure to corrective life experience (entails increased access of pos.judgements about self)
3. if ever confronted with countervailing exp where someone needed their forgiveness or a soldier having same issue needed their advise
Survey Topics (inspired by Litz (2009)
Analysis for a descriptive study
Analysis
- Using the communication mechanisms, both quantitative & qualitative data collection would be used
- mixed methods approaches are credible esp. w advanced cpu-based technologies
- Computer Assisted Qualitative Data Analysis Software (CAQDAS)
- theoretical contribution for mixed methods approaches would fall within pragmatic methodology
Discussion
- Currently MORAL INJURY literature tends to conceptualize the lasting potentially damaging exposures in war through the lens of direct life-threat and personal loss (Litz et al., 2009) rather than on betrayal such as toxic leadership
- Currently MORAL INJURY literature also does not focus on the military setting
- toxic leadership w/i the military is different
- culture teaches toleration
- seeking resolve does not mean separation from the wrong-doer
- only resolve is PCSing or moving on from assignment but rarely/never for declining inter-professional relations
- Topic of overcoming toxic leadership requires more scholarly evidence & trials done that are parallel to civilian tx models to be tried within the military or Litz's Adaptive CBT (for interpersonal forgiveness not just self-forgiveness)
- belief in the need to focus on interpersonal forgiveness
Discussion
Limitations
Currently MORAL INJURY tends to conceptualize the lasting potentially damaging exposures in war through the lens of direct life-threat and personal loss (Litz et al., 2009) rather than on betrayal such as toxic leadership
WAY AHEAD
Limitations within topic
Highly reputable author drafts a model focusing on self-forgiveness (Fig. 1)
- topic lacks interpersonal forgiveness-focused tx
Limitations
tx models have to saturate the academic base surrounding as a pre-req. for good tx
Lack of military evidence for effective tx for toxic leadership
Summary
- Contribute to pool of scholarly data regarding military-related moral injury, specifically reinforcing the prevalence and suggestive need for a group-setting, forgiveness-focused treatment (Morris et al., 2018)
- Summary of salience
- salience of this topic is to avoid having service members suffer with a moral injury
- in isolation
- feeling helpless and hopeless
- having chronic collateral manifestations
- self-harming behaviors, such as poor self-care, alcohol & drug abuse, severe recklessness, & para-suicidal behavior
- self-handicapping behaviors, such as retreating in the face of success or good feelings
- demoralization, which may entail confusion, bewilderment, futility, hopelessness, & self-loathing.
- Most damaging is the possibility of enduring changes in self & other beliefs that reflect
regressive over-accommodation of moral
violation, culpability, or expectations of
injustice
Summary
Literature Review
Literature Review/ References
Litz, B., Stein, N., Delaney, E., Lebowitz, L., Nash, W., Silva, C., Maguen, S., (2009). Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychology Review 29
Litz, B., Lebowitz, L., Gray, M., & Nash, W. (2016). Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury
Matthews, M. D. (2018). Moral Injury: toxic leadership, maleficent organizations, and psychology distress. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/head-strong/201803/moral-injury
Morris-Singer, A., Pollack, S., Lewis, M. (2018). Healing the ‘moral injury’ of clinicians will take a village. First Opinion. Retrieved from https://www.statnews.com/2018/08/21/moral-injury-clinicians-healing/
Nash, W., Marino Carper, T., Mills, M., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178, 646–652. 10.7205/MILMED-D-13-00017
Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Atheneum Publishers/Macmillan Publishing Co.