Moral injury prevention and intervention
Open accessAbstract
Background: Those working in high-risk occupations may often face ethical dilemmas that violate their moral code which can lead to moral injury (MI). While research into the impact of MI is growing, evidence for effective treatment interventions and prevention approaches remains limited.Objective: To review recent developments in treatment and prevention approaches for MI-related mental health difficulties.Method: We synthesised emerging treatments, including trauma focused therapies and spiritual approaches, as well as possible prevention strategies.Results: Conventional treatments for post-traumatic stress disorder (PTSD) (e.g. prolonged exposure) often inadequately address MI and may exacerbate symptoms. Adapted or novel approaches, including Impact of Killing, Adaptive Disclosure, and Restore and Rebuild, show promise, particularly when co-produced with patients and clinicians. Spiritual interventions demonstrate mixed outcomes. Prevention research remains very limited but highlights the potential of systemic reforms, leadership fostering psychological safety, preparedness training, structured reflection, and peer support. Evidence remains constrained by small samples, military-focused populations, and inconsistent measurement of MI.Conclusions: While no gold-standard intervention exists, values-based and compassion-focused approaches appear promising. Prevention strategies targeting organisational culture and fostering preparedness are urgently needed, particularly for civilian and diverse occupational groups, to better support and protect those exposed to potentially morally injurious events.
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Current treatment models seek to restore moral and relational functioning, rebuild trust and belonging, cultivate restorative moral and social experiences, and foster acceptance, forgiveness, self-reorientation, and renewed engagement with moral communities.
“Current treatment models therefore seek to restore moral and relational functioning, rebuild trust and belonging, cultivate restorative moral and social experiences, and foster acceptance, forgiveness, self-reorientation, and renewed engagement with moral communities (13, 53, 54)—core therapeutic aims that require broadened awareness and reduced self-focus.”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [54]
The treatment section and Table 1 (page unavailable) describe interventions aimed at repairing social bonds, strengthening connections, reconnecting with values, and fostering acceptance and forgiveness. They do not clearly identify rebuilding trust and belonging or renewed engagement with moral communities as treatment aims; the discussion of trust appears in a separate prevention section. The citing authors’ statement about broadened awareness and reduced self-focus follows the citations and is not assessed here. (LLM, conf=0.82)
Experimental — accuracy not yet measuredEmerging theories on moral injury treatment frame moral injury as a multidimensional phenomenon encompassing interlocking self-focus, relational, and meaning-making processes.
“Consistent with these views, emerging theories on MI treatment increasingly frame moral injury as a multidimensional phenomenon—encompassing interlocking self-focus, relational, and meaning-making processes—and have informed the development of interventions that prioritize identity-level disruptions and maladaptive meaning-making over symptom reduction alone (13, 53, 54).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [54]
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- Authors
- Williamson, V., Kothari, R., Bonson, A., Campbell, G., Greenberg, N., Murphy, D., & Lamb, D.
- Affiliations
- King's College London (GB)
- King's College Hospital NHS Foundation Trust (GB)
- Combat Stress
- National Institute for Health and Care Research (GB)
- Corresponding author
- Williamson, Victoria
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2025-10-21
- Volume
- 16
- Issue
- 1
- Pages
- 2567721-2567721
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC12541919
- OpenAlex
- W4415400132
- Cited by
- 16
- References
- 50
- Citations by year
- 2026: 16
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Forces in Mind Trust
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Social Sciences › Decision Sciences › Information Systems and Management › Ethics in Business and Education
- Keywords
- moral injury, high-risk occupations, military personnel, post-traumatic stress disorder, trauma-focused psychotherapy, spiritual intervention, compassion-focused therapy, values-based intervention, psychological safety, peer support, organizational culture, co-production
- MeSH terms
- Humans, Morals, Stress Disorders, Post-Traumatic
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