Perceived perpetration during traumatic events: Clinical suggestions from experts in Prolonged Exposure therapy
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Standard evidence-based PTSD interventions show only modest symptom reduction among individuals exposed to morally injurious events.
“Standard evidence-based interventions for posttraumatic stress disorder (PTSD) have shown, across case studies and secondary analyses, only modest symptom reduction among individuals exposed to morally injurious events (24–26).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [25]
Cites
Moral Emotions and Moral Behavior
Tangney, J. P., Stuewig, J., & Mashek, D. J. (2007) · Annual Review of Psychology · doi:10.1146/annurev.psych.56.091103.070145 · Cited by 3,222 · see citing works
Moral injury and moral repair in war veterans: A preliminary model and intervention strategy
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.07.003 · Cited by 2,738 · see citing works
Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.4.867 · Cited by 1,294 · see citing works
Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., Resick, P. A., Thurston, V., Orsillo, S. M., Haug, R., et al. (2007) · JAMA · doi:10.1001/jama.297.8.820 · Cited by 813 · cited 1× · see citing works
“…as depression, anger, and guilt (Cahill, Rauch, Hembree, & Foa, 2003; Foa et al., 1999; Foa et al., 2005; Hembree et al., 2005; Paunovic & Öst, 2001; Rauch, et al., 2009; Resick, Nishith, Weaver, Astin, & Feuer, 2002; Rothbaum, Astin, & Marsteller, 2005; Schnurr et al., 2007; Tuerk et al., 2011).”
Emotional Processing Theory (EPT) and Exposure Therapy for PTSD
Rauch, S., & Foa, E. (2006) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-006-9008-y · Cited by 300 · see citing works
Self-citationZoellner, L. A., Feeny, N. C., Bittinger, J. N., Bedard-Gilligan, M. A., Slagle, D. M., Post, L. M., & Chen, J. A. (2011) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/a0024642 · Cited by 52 · see citing works
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Moral Injury: An Integrative Review
Griffin, B. J., Purcell, N., Burkman, K., Litz, B. T., Bryan, C. J., Schmitz, M., Villierme, C., Walsh, J., & Maguen, S. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22362 · Cited by 752 · see citing works
Defining and assessing moral injury: A syndrome perspective
Jinkerson, J. D. (2016) · Traumatology · doi:10.1037/trm0000069 · Cited by 381 · see citing works
A functional approach to understanding and treating military-related moral injury
Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.07.003 · Cited by 226 · see citing works
Held, P., Klassen, B. J., Brennan, M. B., & Zalta, A. K. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.09.003 · Cited by 82 · see citing works
Held, P., Klassen, B. J., Hall, J. M., Friese, T. R., Bertsch-Gout, M. M., Zalta, A. K., & Pollack, M. H. (2019) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000364 · Cited by 52 · see citing works
Fleming, W. H. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1701564
- Authors
- Smith, E. R., Duax, J. M., & Rauch, S. A. M.
- Affiliations
- University of Michigan (US)
- VA Ann Arbor Healthcare System (US)
- Corresponding author
- Smith, Erin R.
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 20
- Issue
- 4
- Pages
- 461-470
- ISSN
- 1077-7229 (ISSN-L)
- OpenAlex
- W2047942442
- Cited by
- 87
- References
- 6
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 7 · 2022: 3 · 2021: 6 · 2020: 19 · 2019: 21 · 2018: 6 · 2017: 7 · 2016: 5 · 2015: 3 · 2014: 2 · 2013: 4
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cognitive and Behavioral Practice (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- prolonged exposure therapy, post-traumatic stress disorder, war injuries, guilt, shame, trauma survivors, lethal force, use of violence, clinical evaluation, trauma-related guilt
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