Integrative Approach to Treating Moral Injury with EMDR
Lee Brient
Abstract
It is commonly understood that members of the defence forces who are exposed to warlike service or traumatic events may develop posttraumatic stress disorder (PTSD). However, there is growing awareness that a separate condition termed Moral Injury often co-occurs with PTSD, featuring a psychological and spiritual distress arising from actions or inactions that violate one’s moral code. Moral Injury presents unique clinical challenges due to its association with deep guilt, shame, and existential conflict, and its resistance to conventional trauma therapies.Although Eye Movement Desensitization and Reprocessing (EMDR) is a proven gold standard for trauma treatment, integrating it with other therapeutic interventions may improve outcomes for those with Moral Injury. This article proposes an EMDR-based framework enhanced by elements of Compassion-Focused Therapy (CFT), Acceptance and Commitment Therapy (ACT), Internal Family Systems (IFS), and Cognitive Processing Therapy (CPT). The proposed approach begins with psychoeducation and stabilisation, incorporating ACT’s mindfulness and values-based strategies to enhance psychological flexibility. CFT can be used to address self-condemnation and moral dissonance, while IFS may help clients engage with internal parts burdened by moral pain. CFT interweaves foster self-compassion, and CPT supports cognitive restructuring and moral reconciliation post-reprocessing.
Available research suggests that this integrative model will enhance emotional regulation, reduce shame, and promote moral healing. The article also discusses adaptations for diverse populations, including veterans, healthcare professionals, and survivors of institutional betrayal. It concludes with recommendations for future research, including randomised controlled trials and longitudinal studies, to properly validate the model’s efficacy in addressing Moral Injury.
Biography
As a mature age Psychology student completing the 4 + 2 route, I was fortunate enough to qualify for general registration while in a position with the Tasmanian State Government treating individuals with substance use disorders. Following a strong desire to be able to support people who have experienced trauma, I moved to a Commonwealth Government position working with veterans and their families in June 2016. Shortly thereafter I began EMDR training and practice.
I am a full member of the EMDRAA, and currently lead an inter-regional EMDR peer support group in my organisation, while in the process of achieving recognition as an Accredited EMDR Practitioner.
As a member of the Australian Psychology Society (APS) and the Psychology and Substance Use (PSU) interest group, I have authored and co-authored 2 previous articles for the InPsych Journal, while completing a Masters of Addictive Behaviours.
Two previous presentations APS and AMMA conferences.