Examining risk factors of moral injury and cognitive remediation among military personnel, veterans, and public safety personnel with posttraumatic stress disorder

Abstract

Military personnel, veterans (MPV), and public safety personnel (PSP) are at an increased risk for developing posttraumatic stress disorder (PTSD). A risk factor for developing PTSD may include adverse childhood experiences (ACEs). Difficulties with emotion regulation (ER), a factor associated with the onset, development, and severity of PTSD, is a proposed mechanism to explain this relation. A burgeoning area of research among MPV includes moral injury (MI). MI is the distress associated with transgressing or betraying one’s morals or values through action or inaction by oneself or others. Existing research has found that MI is associated with PTSD; however, little research has investigated potential risk factors of MI. Given the associations between MI and PTSD, this thesis investigates whether risk factors associated with PTSD are also associated with MI. Studies one and two are the first investigations to examine whether ACEs and difficulties with ER, respectively, are associated with MI among a sample of MPV. It was found that childhood emotional abuse was significantly associated with MI, while the association between difficulties with ER and MI were not significant. Another understudied area of research among MPV and PSP is the treatment of cognitive difficulties associated with PTSD. Notably, cognitive dysfunction has associations with difficulties with ER and impaired functioning. In study three, we conducted a randomized controlled trial investigating whether Goal Management Training (GMT), a skills-based, top-down cognitive remediation intervention, would assist with cognitive dysfunction, difficulties with ER, functioning, symptoms of PTSD, and symptoms associated with PTSD among a sample of MPV and PSP. It was found that GMT significantly improved areas of cognitive functioning, daily functioning, ER, symptoms of PTSD, and symptoms associated with PTSD when compared to a waitlist condition. Together, these studies further our knowledge of MI and PTSD among MPV and PSP.