Using Prolonged Exposure and Cognitive Processing Therapy to treat veterans with moral injury-based PTSD: Two case examples
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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.
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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 [24]
The Discussion (page unavailable) reports significant PTSD and depression symptom reductions in both veterans treated with PE or CPT for moral injury-based PTSD, rather than only modest reductions. The paper also says that whether frontline treatments are less successful for moral injury-based PTSD had not been explicitly tested. (LLM, conf=0.88)
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- Authors
- Held, P., Klassen, B. J., Brennan, M. B., & Zalta, A. K.
- Affiliations
- Rush University Medical Center (US)
- Corresponding author
- Held, Philip
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 25
- Issue
- 3
- Pages
- 377-390
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC6103315
- OpenAlex
- W2763686886
- Cited by
- 82
- References
- 45
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 7 · 2023: 12 · 2022: 13 · 2021: 10 · 2020: 6 · 2019: 7 · 2018: 4 · 2017: 2
- FWCI
- 6.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognitive and Behavioral Practice (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (K23MH103394)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- moral injury, post-traumatic stress disorder, veterans, prolonged exposure therapy, cognitive processing therapy, war injuries, treatment challenges, case examples
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