Held Philip, Klassen Brian J, Brennan Michael B, Zalta Alyson K
Department of Psychiatry, Rush University Medical Center.
Department of Behavioral Sciences, Rush University Medical Center.
Cogn Behav Pract. 2018 Aug;25(3):377-390. doi: 10.1016/j.cbpra.2017.09.003. Epub 2017 Oct 13.
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 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 posttraumatic stress disorder (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 manuscript 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 manuscript concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.
道德伤害是指违反个人道德或伦理标准的作为或不作为行为。道德伤害事件通常与心理创伤同义，尤其是在战斗情况下；因此，道德伤害事件常被认为与军人和退伍军人创伤后应激障碍（PTSD）的发生有关。尽管延长暴露疗法（PE）和认知加工疗法（CPT）已被确认为治疗患有创伤后应激障碍（PTSD）退伍军人的有效疗法，但有人认为，这两种循证疗法可能不足以治疗因道德伤害事件导致PTSD的退伍军人。本文的目的是详细说明PE和CPT的基础理论如何解释基于道德伤害的PTSD，并描述两名因道德伤害事件而患有PTSD的退伍军人通过PE和CPT成功治疗的案例。本文最后总结了临床医生在使用PE或CPT治疗因道德伤害导致PTSD的退伍军人时可能面临的挑战。
