Treating Moral Injury in the Real World Sheila Frankfurt, PhD Postdoctoral Research Fellow VISN 17 Center of Excellence for Research on Returning War Veterans Instructor, Texas A&M University

Acknowledgements This work is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Central Texas Veterans Health Care System, and the VISN 17 Center of Excellence for Research on Returning War Veterans. Disclaimers: The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The artwork contained in this presentation is copyright protected and not free for dissemination.

Overview Introduction & Background What is Moral Injury How to Treat Moral Injury

Background Community Engagement VISN 17 Center of Excellence Develop Assessments of Moral Injury DOD: Walter Reed Army Institute of Research Moral Injury across Deployment Cycle Community Engagement Fort Hood Chaplains Heart of Texas Veterans One Stop TexVet Initiative, Texas A&M University Military Officers of America Association, Waco

Model of Moral Injury Transgressive Act Moral Dilemma Moral Injury

Working definition of “morals” DEFINITION: Commonly accepted standards of proper and improper behavior, such as is mutually expected or is an interpersonal demand Context and role dependent Working definition of “morals”

Cultural Worldview of Military Military Trains Character Values… Cultural Worldview of Military

Cultural Worldview of Military Moral Obligations The impact of law (UCMJ), politics, tribunals, & treaties Cultural Worldview of Military

Model of Moral Injury Transgressive Act Moral Dilemma Moral Injury

Cultural Worldview of Military Moral Obligations Rules of Engagement that often create Double-Binds Cultural Worldview of Military

Moral Dilemma Moral Injury

Transgressive Act Moral Injury

Transgressive Act Moral Dilemma

How to Treat Moral Injury? Reconnect with Cultural Worldview and Community Communicate with Trusted Others Give Back

Reconnection through Talking Communalize Wounds Open and Drain Wound to Heal

Whom to Talk To? Battle Buddies Veterans Spouses?

Talking about Moral Injury Prepare yourself to hear combat stories involving gruesome, troubling violence or failings WITHOUT comforting or repulsing Look for opportunities to build genuine self-empathy, self-compassion, and trust

Talking Points Self-empathy Trust Self-compassion Self-forgiveness Specifically for objectively transgressive acts Cannot rely on exposure alone

Reconnection through Giving Back Volunteering Active coping > Passive Coping Prosocial Behaviors Treat Depression Community Building Veterans Organizations Peace Groups Politics Religious or Spiritual Institutions

Thank You! Please be in touch! Sheila.frankfurt@va.gov