Comparing Two Moral Injury Treatments

Summary

Purpose of this study: The purpose of this study is to evaluate the effectiveness of two psychological treatments for moral injury: Acceptance and Commitment Therapy for Moral Injury and Present Centered Therapy for Moral Injury. The main questions it aims to answer are:

1. Determine the efficacy of ACT-MI for building functional recovery among 180 warzone deployed Veterans.
2. Identify barriers and facilitators to implementing ACT-MI in VA mental health clinics or a national telehealth hub in preparation for future dissemination efforts.

Participants will be asked to:

* Complete a two to two and a half hour initial assessment session online using videoconferencing. Participants will be asked to complete surveys and questionnaires.
* Be randomized to either ACT-MI or PCT-MI
* Meet with the study clinicians for 15 virtual outpatient sessions (12-group and 3-individual sessions).
* Complete a post-treatment assessment session offered online using videoconferencing within one week of treatment completion to complete surveys and questionnaires.
* Complete one- and three-month follow-up assessments offered online using videoconferencing to complete surveys and questionnaires.

Conditions

• Moral Injury

Interventions

BEHAVIORAL

Acceptance and Commitment Therapy for Moral Injury (ACT-MI)

ACT-MI is a 15-week hybrid group (12, 90-minute group sessions) and individual (3, 30-minute case conceptualization sessions) psychotherapy offered over telehealth. The primary goal of the clinician delivering ACT-MI is to help individuals impacted by moral injury live meaningful lives even in the presence of moral pain. This means learning to experience moral pain and connecting with values simultaneously.

BEHAVIORAL

Present Centered Therapy for Moral Injury (PCT-MI)

PCT-MI is a 15-week hybrid group (12, 90-min sessions) and individual (3, 30-min sessions) psychotherapy offered over telehealth. PCT was developed as an active control in a PTSD Prolonged Exposure trial, including psychoeducation and problem-solving as the primary interventions. PCT has been used in multiple clinical trials as an active control condition for PTSD. Additionally, PCT has been used as a control condition in moral injury efficacy trials for interventions like Adaptive Disclosure and Building Spiritual Strength. However, these comparison conditions focused on the treatment of PTSD rather than moral injury. The proposed PCT-MI comparison condition has been adapted to focus specifically on moral injury. PCT-MI includes psychoeducation about moral injury and related problems and individual case conceptualization sessions that are theoretically coherent with the process-based framework and nonspecific therapeutic factors central to PCT and present in most psychotherapies.

Sponsors & Collaborators

• Denver Research Institute

  collaborator OTHER

• Northern California Institute of Research and Education

  collaborator OTHER

• Henry M. Jackson Foundation for the Advancement of Military Medicine

  collaborator OTHER

• Palo Alto Veterans Institute for Research

  collaborator OTHER

• VA Eastern Colorado Health Care System

  lead FED

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

89 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-08-31

Primary Completion

2030-09-30

Completion

2030-09-30

Countries

• United States

Study Locations