Search

Given the risk for veterans with PTSD and moral injury to experience negative social consequences, researchers have increasingly focused on social functioning assessment; however, one gap is the lack of observer-rated assessment and reliance on self-report measures. To better understand the dynamic process of social functioning and how it is affected by PTSD and moral injury distress, it is important to gain perspective on how others perceive those veterans and their interactions. Interpersonal circumplex assessments, such as the Impact Message Inventory-Circumplex (IMI-C), may provide that perspective by asking others to rate observations of veterans’ social behaviors, which is scored in a circular pattern of eight octants representing unique blends of two orthogonal dimensions: affiliation (cold-warm) and control (dominant-submissive). This study demonstrated how the IMI-C can be used to examine significant others’ perceptions of veterans with PTSD and moral injury at baseline (n = 23), prior to a novel positive psychology treatment that focused on inducing moral elevation and its benefits. Using this fine-grained analysis of interpersonal behaviors, this study also described two case studies of veterans who demonstrated notable pre-post changes in how they were perceived by others, providing contextual information including quantitative changes in PTSD symptoms, moral injury, and quality of life, and qualitative reports of interpersonal changes. Preliminary findings suggest significant others characterized veterans’ impact as mostly warm and neither dominant or submissive at baseline. Case examples also suggest meaningful interpersonal shifts in two veterans who found benefit in the moral elevation-based intervention. Lastly, clinical and research implications are discussed.

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 and lasted 1 month. The MOVED intervention and all survey 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 large within-person decreases 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 veterans reported no decreases in moral injury distress, whereas the control condition endorsed medium-sized decreases in the total score. There were no changes in 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.Conclusion: Overall, findings indicate that veterans with PTSD and moral injury distress were interested in an intervention based on exposure to 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.

Introduction: The classic act-person model of shame-proneness defined shame as originating from negative self-appraisals following wrongful actions, conferring broad vulnerability to psychopathology. However, recent developments postulate that shame may originate from real or imagined social evaluation (sociometer view of shame). If so, shame might leave one vulnerable to psychosocial stressors and may manifest in social anxiety specifically, even after accounting for general negative affect. We investigated how shame-proneness predicted concurrent symptoms and prospective responses to interpersonal stressors (social anxiety, feeling evaluated, and other symptoms) over five weeks in a sample including individuals at clinical and subclinical levels of emotional symptoms. Method: We oversampled for individuals meeting criteria for anxiety and depressive disorders based on clinical interviews (n = 58) and also included those not meeting diagnostic criteria (n = 101) to ensure a broad range of symptoms (total N = 159). Participants completed baseline measures of shame- and guilt-proneness, trait negative affect (NA), and symptoms of social anxiety, depression, and generalized anxiety disorders followed by symptom diaries for 5 weeks following their worst psychosocial stressors (1,923 diaries). Results: As expected, even after controlling for NA and guilt-proneness, shame-proneness uniquely predicted concurrent social anxiety (∆R2 = 8%) and prospectively predicted experiences of social evaluation. Shame-proneness demonstrated weaker links to depression, and no unique links to general anxiety and worry. Discussion: Shame-proneness functioned in a manner predicted by sociometer theory, demonstrating specificity for social evaluative symptoms and concerns. Results have implication both for shame theory and clinical practice with shame-prone individuals.