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Cited by 143Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsMigration, Health and Trauma

Impact of killing in war: A randomized, controlled pilot trial

Maguen, Shira, Burkman, Kristine, Madden, Erin, Dinh, Julie, Bosch, Jeane, Keyser, Jessica, Schmitz, Martha, Neylan, Thomas C.·2017·Journal of Clinical Psychology
DOI 10.1002/jclp.22471
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Abstract

Objective The purpose of this pilot study was to test the effectiveness of Impact of Killing (IOK), a novel, cognitive-behavioral treatment (CBT) aimed at reducing mental health symptoms and functional impairment. Method Participants were 33 combat Veterans with a posttraumatic stress disorder (PTSD) diagnosis who had completed trauma-focused psychotherapy and reported distress regarding killing or feeling responsible for the deaths of others in war. Veterans were randomized to either IOK treatment or a 6-week waitlist condition, after which Veterans could receive IOK. IOK is a 6- to 8-session, weekly, individual, CBT, lasting 60-90 minutes, and focused on key themes, including physiology of killing responses, moral injury, self-forgiveness, spirituality, making amends, and improved functioning. Results We found that compared to controls (N = 16), the IOK group (N = 17) experienced a significant improvement in PTSD symptoms, general psychiatric symptoms, and quality of life functional measures. Veterans who received IOK reported that the treatment was acceptable and feasible. Conclusion These results provide preliminary evidence that Veterans can benefit from a treatment focused on the impact of killing after initial trauma therapy.

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  • Impact of Killing promotes structured moral reflection, identification and restructuring of maladaptive killing-related cognitions, narrative emotional processing, cultivation of self-forgiveness and self-compassion, and therapist-supported meaning-making and amends planning within a compassionate therapeutic alliance.

    “Impact of Killing (IOK), a brief cognitive-behavioral intervention for MI related to combat killing, promotes structured moral reflection, identification and restructuring of maladaptive killing-related cognitions, narrative emotional processing, cultivation of self-forgiveness and self-compassion, and therapist-supported meaning-making and amends planning within a compassionate therapeutic”

    From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [32]

  • Trials of Impact of Killing report reductions in guilt, shame, PTSD symptoms, and functional impairment, consistent with expanded moral perspective, correction of global self-condemnation, and recontextualization of morally painful experiences, though mechanisms have not been formally tested in mediation analyses.

    “Trials report reductions in guilt, shame, PTSD symptoms, and functional impairment, consistent with expanded moral perspective, correction of global self-condemnation, and recontextualization of morally painful experiences, though mechanisms have not yet been formally tested in mediation analyses (32, 92).”

    From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [32]

  • Emerging moral injury treatments frequently incorporate shifts in self-processing characterized by reduced narrative self-focus, increased decentering, broadened attentional scope, affective integration, and enhanced orientation toward meaning and connection beyond the individual self.

    “Emerging MI treatments frequently incorporate shifts in self-processing characterized by reduced narrative self-focus, increased decentering, broadened attentional scope, affective integration, and enhanced orientation toward meaning and connection beyond the individual self (29–32, 94).”

    From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [32]

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Authors
Maguen, S., Burkman, K., Madden, E., Dinh, J., Bosch, J., Keyser, J., Schmitz, M., & Neylan, T. C.
Affiliations
  • San Francisco VA Medical Center (US)
  • San Francisco VA Medical Center
Corresponding author
Maguen, Shira
ORCID
Venue
Journal of Clinical Psychology
Publisher
Wiley
Published
2017-03-10
Volume
73
Issue
9
Pages
997-1012
ISSN
0021-9762 (ISSN-L)
DOI
10.1002/jclp.22471
OpenAlex
W2592990990
Cited by
143
References
27
Citations by year
2026: 16 · 2025: 9 · 2024: 17 · 2023: 22 · 2022: 33 · 2021: 14 · 2020: 5 · 2019: 15 · 2018: 10 · 2017: 2
FWCI
10.85
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Health Services Research and Development (RRP 12-237)
  • University of California, San Francisco (REAC 525014-36248)
  • VA Health Sciences Research and Development Research Career Development (06-042)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
combat veterans, post-traumatic stress disorder, moral injury, killing in war, cognitive behavioral therapy, self-forgiveness, spirituality, making amends, functional disability, quality of life
MeSH terms
Aged, Combat Disorders, Homicide, Humans, Male, Middle Aged, Pilot Projects, Quality of Life, Stress Disorders, Post-Traumatic, United States, United States Department of Veterans Affairs, Veterans, Warfare, Cognitive Behavioral Therapy, Outcome Assessment, Health Care

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