Effects of Resilience Strength Training on Constructs Associated with Moral Injury among Veterans

Timothy M Barth,Charles G Lord,Rita N Brock,Vishal J Thakkar

doi:10.21061/jvs.v6i2.199

Timothy M Barth, Charles G Lord + Show 2 more

Open Access

https://doi.org/10.21061/jvs.v6i2.199

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Abstract

Resilience Strength Training (RST) is a peer specialist program that incorporates a military squad model of group trust and bonding to address problems specific to moral injury (typically involving collapse of meaning or faith, loss of trust, self-isolation, and the failure of relationships). The training program was offered to 97 male and female veterans (ages 24–73) at two Volunteers of America (VOA) affiliates. The veterans completed measures related to moral injury prior to RST training, immediately upon completion, and 6 months after the training. RST significantly improved their reported post-traumatic growth, perceived meaning in life, propensity to trust, dispositional optimism, positive attitudes toward themselves, personal self-esteem, and sleep quality, while decreasing their dependence on both alcohol and sleep medications. These improvements were more pronounced immediately after RST but remained significant on most measures 6 months after training had ended. The results are interpreted as supportive of RST as a vehicle for addressing moral injury in veterans through development of self-calming strategies, communication skills, and self-esteem, as well as development of a peer-supported community with shared experiences.

Highlights

In late 2009, a team of Veterans Affairs (VA) clinicians (Litz et al, 2009) published a conceptual essay about moral injury in military veterans, based on observations they were seeing in their clinical work that were not adequately captured by the post-traumatic stress disorder (PTSD) framework
We interpreted scales that loaded on the first factor as reflecting positive orientations toward one’s social environment, and scales that loaded on the second factor as reflecting positive orientations toward oneself
The positive results found in the data for Resilience Strength Training (RST) indicate that it is successful in mitigating the negative impacts of moral injury in veterans

Summary

Introduction

In late 2009, a team of Veterans Affairs (VA) clinicians (Litz et al, 2009) published a conceptual essay about moral injury in military veterans, based on observations they were seeing in their clinical work that were not adequately captured by the post-traumatic stress disorder (PTSD) framework They defined moral injury as: Perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations. The first use of the term “moral injury” appeared in 1994 in psychiatrist Jonathan Shay’s book, Achilles in Vietnam: Combat trauma and the undoing of character, based on his salient clinical observations of veterans of the war in Vietnam (Shay, 1994) He later summarized his definition as “a betrayal of what’s right, by someone who holds legitimate authority (e.g., in the military, a leader), in a high stakes situation. A psychometric survey, the Moral Injury Events Scale (MIES), measures levels of exposure to events that are identified as morally injurious, using definitions by Litz and colleagues (2009) and Shay (1994), and it can be used to evaluate experiences that are a “necessary precursor to evaluating the biological, psychological, social, and spiritual consequences of moral injury” (Nash et al, 2013)

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