Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

The Relationship Between Nonsuicidal Self‐Injury and Suicidal Ideation

This correlational study was conducted with 403 undergraduate college students from 2 universities. The authors used path analysis and bootstrap regression to analyze the relationships between variables. Locus of control and family connectedness related to current nonsuicidal self‐injury (NSSI) engagement. However, when entered into the same regression, the variables current NSSI engagement and current NSSI number of methods used mediated all other relationships with suicidal ideation. Implications to current theories and clinical practice are provided.     

Sports Media Representations of Concussions in the National Rugby League

Objective

Concussion is poorly understood by the general public who are regularly exposed to this type of injury via televised sports such as the National Rugby League (NRL). This study investigated media representations of concussion by examining the terminology used by the commentators during the 2010 and 2011 NRL seasons.

Method

Data was obtained through a surveillance design where commentary statements were recorded for each observable concussion.

Results

Dramatic terminology was the most frequently used followed by entertaining and humorous terminology. Commentators often portrayed the way the incident had occurred and the player's reaction to being concussed. However, information about a player sustaining an injury that required medical attention was rarely conveyed.

Conclusion

Media tend to trivialise concussion and this may have an impact on the public's knowledge of, and influence their response to, concussion.     

Moral injury and the priesthood of all believers1

This article proceeds from the conviction that moral injury suffered by many combat veterans is a deeply spiritual matter requiring spiritual resources for healing. The tradition of the care of souls commends itself. It takes into account that the “soul” is an expression of the whole person in all its physical, spiritual, and social realities. Moral injury affects all those dimensions of personhood or soul. Since the Reformation the care of souls has been a vocation for the ministry of the whole people of God under the theology of the priesthood of all believers. A caring community is essential to healing for many dealing with moral injury. Indeed, the veterans themselves, in sharing their stories and their pain, become part of that ministry of the priesthood of all believers and may well find healing in the meaningfulness of their mutual ministry.     

Marital Status and Adjustment 1 Year Post-Spinal-Cord-Injury

The current study employed a case-control design to examine the impact of marital status on adjustment among individuals with spinal cord injury (SCI) 1 year post-injury. Two groups of 53 individuals (i.e., single versus married individuals) were matched case-for-case on age (i.e., within 10 years), education, gender, race, and lesion level. Although not specifically matched, etiology of SCI, and number of rehospitalizations and days rehospitalized during the past year were not significantly different between groups. Outcome measures included the Satisfaction With Life Scale, the Craig Handicap Assessment and Reporting Technique (CHART), and the SF-12. Results indicated that overall self-reported QOL was significantly lower among single individuals as compared to their matched married counterparts. Similarly, self-reported handicap was significantly higher among single individuals, particularly in the areas of social integration and economic self-sufficiency. In contrast, overall physical and mental health were not different across groups.     

The role of women's self‐injury support‐groups: a grounded theory

Research evidence suggests that services are struggling to adequately address the increasing incidence of self‐injury and the needs of women who self‐injure, while national self‐injury support‐groups across the UK appear to be growing in number. Despite their reported value, evidence regarding the role of self‐injury support‐groups in women's management of their self‐injury is lacking although government policy and official guidelines are advocating the incorporation of support‐groups into self‐injury services. Seven semi‐structured interviews were conducted and analysed using Grounded Theory to investigate the role of three UK self‐injury support‐groups in women's management of self‐injury and associated difficulties. Empowerment‐as‐process emerged as the core theme of self‐injury support‐groups, mediated through experiences of belonging, sharing, autonomy, positive feeling and change. Findings are discussed in relation to relevant theory and research, followed by critical evaluation and implications of the study. Copyright © 2006 John Wiley & Sons, Ltd.     

Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms

Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients’ close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives’ physical health was predicted by relatives’ PTS symptoms (Slope=−1.76; p = .043), and mental health was predicted by both patients’ (Slope=−2.77; p = .034) and relatives’ (Slope=−6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients’ PTS symptoms (Slope=−.25; p_<.001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.     

Conceptualizing Nonsuicidal Self‐Injury as a Process Addiction: Review of Research and Implications for Counselor Training and Practice

Nonsuicidal self‐injury (NSSI) may be characterized as a process addiction for some individuals who self‐injure. The authors review findings on the addictive features of NSSI, including compulsivity, loss of control, continued use despite negative consequences, and tolerance.     

A Biopsychosocial Model for Understanding Relationship Aggression

SUMMARY

Aggression in adult, intimate relationships is a significant problem with far reaching effects on victims, perpetrators, their families, and society. Recognizing the import of the problem, the U.S. Department of Justice has established a Violence Against Women office, and many states have enacted legislation to protect victims and deal with perpetrators. It is urgent that we understand the dynamics of relationship aggression so that effective interventions and preventive programs can be developed. This article reviews the current status of research on relationship aggression and identifies several omissions, most notably, ignorance of the potential contributions of biological factors. Recent research regarding the relevance of biological factors is reviewed and a Biopsychosocial model is presented. Finally, some suggestions are made for future research.     

A Pilot Randomized Trial of an Online Parenting Skills Program for Pediatric Traumatic Brain Injury: Improvements in Parenting and Child Behavior

This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n = 20) or access to Internet resources on managing brain injury (n = 17). Parent–child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.