JMIR Publications

ABSTRACT

Background:

Veterans suffering from posttraumatic stress disorder (PTSD) and moral injury can encounter several barriers to treatment including limited access to care and low engagement with in-person therapy. Further, most approaches focus on alleviating distress rather than cultivating positive experiences that could facilitate trauma recovery. One potential way to address these areas and enhance trauma-focused treatment is through moral elevation—a distinct, positive emotional state described as feeling uplifted and inspired by others’ virtuous actions.

Objective:

The purpose of this study was to examine the feasibility and acceptability of a novel, web-based moral elevation intervention for veterans with PTSD symptoms and moral injury distress (MOVED). This mixed-methods study also examined potential changes in targeted outcomes of PTSD symptoms, moral injury distress, quality of life, and prosocial behavior.

Methods:

In this pilot trial, 48 participants were randomized to a MOVED or control condition (24 per condition). Both conditions included 8 sessions that lasted 1 month. The MOVED intervention and all components across both conditions were administered online. Participants completed self-report measures that assessed PTSD symptoms, moral injury distress, quality of life, and prosocial behavior at baseline and follow-up. Veterans in the MOVED condition also completed an individual qualitative interview at follow-up. We coded qualitative response to the follow-up interview and identified emergent themes.

Results:

Findings suggest the MOVED intervention was largely feasible with evidence for moderate-to-high levels of participation, engagement, and retention in MOVED sessions. Both quantitative and qualitative results suggest veterans found MOVED to be acceptable and satisfactory at the overall treatment level. Further, participants reported high scores for helpfulness and engagement at the session level. Veterans who completed MOVED reported a large effect size decrease in PTSD symptoms (d=1.44), nearly twice that of the control condition (d=0.78). Those in MOVED also reported medium-sized increases in physical (d=0.71) and psychological domains of quality of life (d=0.74), in contrast to no meaningful changes in the control condition. Unexpectedly, MOVED did not change in moral injury distress, whereas the control condition endorsed medium-sized decreases in subscales scores. There were no changes in self-reported prosociality for either condition. Qualitative feedback further supported high levels of perceived acceptability and satisfaction, and positive treatment outcomes across a range of domains including behaviors, cognitions, emotions, and social functioning. Veterans also recommended adaptations to enhance engagement and maximize the impact of intervention content.

Conclusions:

Overall, findings indicate that veterans with PTSD and moral injury distress are interested in an intervention that is based on exposure and engagement with experiences of moral elevation. Following further research and refinement guided by future trials, veterans may benefit from this novel approach, which may enhance treatment outcomes and increase accessibility for those in need of additional trauma-focused care. Clinical Trial: Identifier: NCT03906240; https://clinicaltrials.gov/ct2/show/NCT03906240