1 - (IOP 38) The Acceptability and Feasibility of Acceptance and Commitment Therapy for Moral Injury (ACT-MI): Results from a Randomized Controlled Pilot Trial

Across client populations, cultures, and countries, moral distress is an ever-present reality of human experience. Globalization and digital media have amplified awareness of and exposure to morally distressing situations, making these moral conflicts more pervasive and widely felt. Given this landscape, skills for working with moral distress are critical clinician competencies. High-stakes scenarios evoking moral distress, known as “potentially morally injurious events” (PMIEs) often include healthcare work, war, sexual assault, political violence, religious or ethnic persecution, school shootings, and other moral violations. After PMIE exposure, moral distress (also known as “moral pain”) is commonly felt, including painful moral emotions (e.g., guilt, shame, contempt, anger, disgust) and cognitions (e.g., self-blame or blaming others). Moral injury emerges when efforts to cope with moral pain significantly interfere with social, psychological, and spiritual functioning. These coping strategies present in a range of clinical forms, including suicidal behavior, substance use, and PTSD and depression symptoms. Consequently, flexible and culturally sensitive transdiagnostic treatments are needed to facilitate recovery from moral injury. Acceptance and Commitment Therapy for Moral Injury (ACT-MI) is an innovative 15-session hybrid group (12-sessions) and individual (3-case conceptualization sessions) psychotherapy targeting psychosocial functional impairment following moral violations (Borges et al., 2022; Borges, 2019; Farnsworth et al., 2017). We will describe the development and iterative refinement of ACT-MI in the context of a rigorous randomized controlled pilot trial (N=74 warzone Veterans) where participants were randomized to either ACT-MI or Present Centered Therapy for Moral Injury (PCT-MI). We will then present results demonstrating the acceptability of ACT-MI to warzone deployed Veterans (e.g., Client Satisfaction Questionnaire: [M = 29.53; SD=3.73; 95% CI:28.10, 30.94]) and the feasibility of implementation. Thematic analysis of qualitative interviews revealed the transdiagnostic impacts of ACT-MI (improved psychosocial functioning, and reductions in suicidal behavior and substance use) including illustrative statements such as, “I can live life again. I can go outside. I can spend time with my kids. I can be a better mom. I thank God every day that I got to be a part of this” and “I felt like the hole that was inside of me for 30 years that I’ve been throwing all kinds of substances at was filled. And I didn’t need to escape in substance anymore. I mean my entire life has changed.” Outcome data suggest ACT-MI participants experienced clinically significant change in psychosocial functioning on the Outcome Questionnaire-45 (M=-17.45; SD=19.33; 95% CI:-24.80, -10.10) whereas PCT-MI participants did not (M=-5.89, SD=15.29, 95% CI:-11.94, .16). Given the success of this trial, plans for a future large-scale study will be discussed.