Treating moral injury in veterans

A pilot trial compared two therapies designed for the lasting pain of violating one's own deepest values.

Moral injury, the lasting pain of having done, witnessed, or failed to prevent something that violates your deepest values, is common in veterans and notoriously hard to treat. This pilot trial developed and tested two therapies designed specifically for it. Seventy-four war-zone-deployed veterans were randomly assigned to either Acceptance and Commitment Therapy for Moral Injury (ACT-MI), which focuses on making room for painful thoughts while re-engaging with valued living, or Present-Centered Therapy for Moral Injury (PCT-MI), a structured comparison approach focused on current problems. Both are 15-session programs combining group and individual work. As a pilot, the goal was feasibility and acceptability rather than proving which one wins, and on that front both did well: veterans rated both therapies highly, and described ACT-MI in particular as improving daily functioning and offering alternatives to suicidal behavior and substance use. A measure of psychosocial functioning suggested larger improvement in the ACT-MI group, but the study wasn’t designed or powered to confirm that. The real significance is that both approaches proved workable and welcomed, clearing the way for a full-scale efficacy trial. For a wound medicine has struggled to reach, having credible, testable options is a meaningful step.