ABSTRACT

Background: It has been suggested that current frontline posttraumatic stress disorder (PTSD) treatments are not effective for the treatment of moral injury and that individuals who have experienced morally injurious events may respond differently to treatment than those who have not. However, these claims have yet to be empirically tested.

Objective: This study evaluated the rates of morally injurious event exposure and morally injurious index trauma and their impact on PTSD (PCL-5) and depression symptom (PHQ-9) reductions during intensive PTSD treatment.

Method: Data from 161 USA military combat service members and veterans (91.3% male; mean age = 39.94 years) who participated in a 3-week Cognitive Processing Therapy (CPT)-based intensive PTSD treatment programme (ITP) was utilized. Morally injurious event exposure was established via the Moral Injury Event Scale (MIES). Index traumas were also coded by the treating clinician. Linear mixed effects regression analyses were conducted to examine if differences in average effects or trends over the course of treatment existed between veterans with morally injurious event exposure or index trauma and those without.

Results: Rates of morally injurious event exposure in this treatment sample were high (59.0%-75.2%). Morally injurious event exposure and the type of index trauma did not predict changes in symptom outcomes from the ITP and veterans reported large reductions in PTSD (d = 1.35–1.96) and depression symptoms (d = 0.95–1.24) from pre- to post-treatment. Non-inferiority analyses also demonstrated equivalence across those with and without morally injurious event exposure and index events. There were no significant gender differences.

Conclusions: The present study suggests that PTSD and depression in military veterans with morally injurious event exposure histories may be successfully treated via a 3-week CPT-based ITP.

摘要

背景：有人认为，当前的创伤后应激障碍（PTSD）前线治疗对于治疗道德伤害无效，并且经历过道德伤害事件的个人对治疗的反应可能与未经历过的人不同。然而，这些说法还有待实证检验。

目的：本研究评估了道德伤害事件暴露率和道德伤害指数创伤的发生率及其对 PTSD 强化治疗期间 PTSD (PCL-5) 和抑郁症状 (PHQ-9) 减少的影响。

方法：利用来自 161 名美国军事战斗人员和退伍军人（91.3% 男性；平均年龄 = 39.94 岁）的数据，他们参加了为期 3 周的基于认知处理治疗 (CPT) 的强化 PTSD 治疗计划 (ITP)。道德伤害事件暴露是通过道德伤害事件量表（MIES）确定的。治疗临床医生也对指数创伤进行编码。进行线性混合效应回归分析，以检查治疗过程中经历过道德伤害事件或指数创伤的退伍军人与没有经历过道德伤害事件或指标创伤的退伍军人之间是否存在平均效应或趋势差异。

结果：该治疗样本中道德伤害事件暴露率较高（59.0%-75.2%）。道德伤害事件暴露和指数创伤类型并不能预测 ITP 症状结果的变化，退伍军人报告，从治疗前到治疗后， PTSD（ d = 1.35-1.96）和抑郁症状（d = 0.95-1.24 ）大幅减少。治疗。非劣效性分析还证明了有或没有道德伤害事件暴露和指数事件的人之间的等效性。没有显着的性别差异。

结论：本研究表明，有道德伤害事件暴露史的退伍军人的 PTSD 和抑郁症可以通过为期 3 周的基于 CPT 的 ITP 成功治疗。