Treatment for Moral Injury: Impact of Killing in War.
Treatment for Moral Injury: Impact of Killing in War.
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DOI：
10.1007/s40501-022-00262-6
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发表时间：
2022
影响因子：
--
通讯作者：
Maguen, Shira
中科院分区：
文献类型：
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作者：
Burkman, Kristine;Gloria, Rebecca;Mehlman, Haley;Maguen, Shira
在战争中杀人的退伍军人有可能出现负面的心理健康问题，包括道德伤害，创伤后应激障碍，精神痛苦和功能障碍。杀戮的影响（IOK）是一种新颖的，基于认知行为的治疗，旨在解决与杀戮相关的症状，重点是通过培养自我同情和观点采择练习（如写信）以及积极参与价值观驱动的行为来自我宽恕和道德修复。在一项评估IOK的试点试验中，参与者表现出多种心理健康症状的减少和生活质量指标的改善，他们报告IOK是可以接受和可行的。此外，创伤治疗师报告说，精神伤害与他们的临床工作有关，表示希望就杀戮的影响进行更多的培训，并确定了使解决临床环境中的杀戮问题具有挑战性的障碍。目前正在一项全国性的多地点试验中收集数据，以检查与对照条件相比，IOK的疗效。IOK通过直接解决与战争中的杀戮直接相关的内疚，羞耻，自我破坏行为，功能困难，自我宽恕受损以及道德/精神痛苦，填补了一个关键的治疗空白。IOK通常在一些初始创伤处理治疗后提供，可以整合到现有的创伤护理系统中，为精神伤害的分步治疗模式创造一条途径。
Veterans who kill in war are at risk of developing negative mental health problems including moral injury, PTSD, spiritual distress, and impairments in functioning. Impact of Killing (IOK) is a novel, cognitive-behaviorally based treatment designed to address the symptoms associated with killing that focuses on self-forgiveness and moral repair through cultivation of self-compassion and perspective-taking exercises, such as letter writing, and active participation in values-driven behavior. In a pilot trial assessing IOK, participants demonstrated a reduction in multiple mental health symptoms and improvement in quality-of-life measures, and they reported IOK was acceptable and feasible. Furthermore, trauma therapists have reported that moral injury is relevant to their clinical work, expressed a desire for additional training on the impact of killing, and identified barriers that make addressing killing in clinical settings challenging. Data are currently being collected in a national multi-site trial to examine the efficacy of IOK, compared to a control condition. IOK fills a critical treatment gap by directly addressing the guilt, shame, self-sabotaging behaviors, functional difficulties, impaired self-forgiveness, and moral/spiritual distress directly associated with killing in war. Typically provided following some initial trauma-processing treatment, IOK can be integrated in existing systems of trauma care, creating a pathway for a stepped model of treatment for moral injury.