Development of a Group Psychotherapy for Combat Veterans With Moral Injury: Protocol for a User-Centered Study

Area of Science:

• Psychiatry
• Psychology
• Clinical Psychology

Background:

• Approximately 25% of combat veterans with PTSD experience potentially morally injurious events (PMIEs).
• Moral injury, resulting from PMIEs, causes significant functional and psychiatric impairment, affecting veterans' identity, relationships, and emotional well-being.
• Existing PTSD treatments may be insufficient for veterans with moral injury due to their civilian origin and inability to address war-specific trauma details.

Purpose of the Study:

• To develop and pilot test a treatment manual for a depth-oriented group psychotherapy tailored for morally injured US combat veterans.
• To enhance treatment effectiveness and usability through user-centered design principles.

Main Methods:

• Utilized user-centered design, incorporating continuous user feedback throughout treatment development.
• Conducted semistructured qualitative interviews with veterans and VA clinicians to identify needs and barriers.
• Designed and iteratively refined a treatment manual through rapid prototyping open trials and feedback from veterans, clinicians, and an expert panel.

Main Results:

• The study is currently in the data collection and analysis phase, with anticipated completion in April 2026.
• The primary hypothesis is that the developed treatment manual will meet predefined criteria for usability, feasibility, learnability, and acceptability.

Conclusions:

• The project successfully developed and piloted a treatment manual for group psychotherapy addressing moral injury in combat veterans.
• User-centered design methods are expected to ensure the manual's usability, feasibility, and acceptability.
• Future steps include a randomized controlled trial and dissemination of findings to inform further treatment development for moral injury.