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J. Irene Harris, Ph.D., L.P. Christopher R. Erbes, Ph.d., L.P.

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Presentation on theme: "J. Irene Harris, Ph.D., L.P. Christopher R. Erbes, Ph.d., L.P."— Presentation transcript:

1 Building Spiritual Strength: Evolving Treatment for PTSD and Moral Injury/Spiritual Distress
J. Irene Harris, Ph.D., L.P. Christopher R. Erbes, Ph.d., L.P. Timothy Usset, M.DIV., BCC, LMFT Minneapolis VA Health Care System

2 Making PTSD Treatment Accessible
While highly effective, evidence-based treatments for PTSD are accessed by only 11%1,2 of combat veterans, and of those, almost half drop out of treatment3-5. Building Spiritual Strength is a spiritually-integrated model for treating PTSD designed to reach veterans who will not access conventional mental health services. Describe the content of the 8 sessions. While highly effective, evidence-based treatments for PTSD are available to all combat veterans, only 11% use these treatments, and of those, almost half drop out of treatment. Building Spiritual Strength is a spiritually-integrated model for treating PTSD that can be implemented in religious settings and delivered by specially trained clergy

3 Building Spiritual Strength Intervention
Session 1: Orientation to group rules, limits of confidentiality, “storytelling;” establishing rapport Sessions 2-3: Developing skills and tools for communication with a Higher Power Session 4: Theodicy Session 5: Meditative and prayer coping Sessions 6-7: Forgiveness Session 8: Consolidation of gains, identification of future resources.

4 Signs of Moral Injury/Spiritual Distress
Loss of previously held spiritual beliefs Struggle or conflict in relationship with a Higher Power Difficulty forgiving self, others, or a Higher Power Feeling that there is no meaning or purpose in life Reduced trust in others Inappropriate guilt and shame

5 Consequences of Moral Injury/Spiritual Distress
Increased risk for suicidal ideation and attempts Reduced mental health resilience Loss of social support from community of faith, family and values-based activities

6 Previous Pilot Study9 56 Veterans with PTSD randomized to BSS or a wait-list control group. Significant improvements in PTSD symptoms, depression symptoms, and positive religious coping as compared to the wait list. Data trend suggests BSS is more effective for minority veterans.

7 Current Study Determine if BSS can be as effective as Present Centered Group Therapy Assess effects of BSS on moral injury/spiritual distress Larger sample size (138) Chaplains with mental health training as therapists

8 Study Results Average age 58.33 (SD=13.00) 14% female
70% Caucasian, 8% African-American, 3% Hispanic, 1% each Asian, Native American, Multiracial, 17% Unreported 38 Catholic, 84 Protestant, 5 Agnostic, 13 Spiritual but not Religious, 1 Sufi, 2 Jewish, 1 Native American Spiritualty, 1 Shinto (note that some participants reported multiple faith affiliations) 67 randomized to Present Centered Group therapy, 71 randomized to Building Spiritual Strength No significant differences in PTSD symptoms or spiritual distress across groups at baseline


10 Study Results-PTSD Symptoms
No differences in rates of treatment completion across groups. Reduction in PTSD symptoms were the same for both PCGT and BSS 68% of BSS clients and 70% of PCGT clients had clinically significant reduction in PTSD symptoms based on the Clinician Administered PTSD Scale. Define and contextualize Retribution Theodicy

11 Study Results-Spiritual Distress
Tested for differences in the subscales of the Religious and Spiritual Struggles Scale (Divine, Demonic, Interpersonal, Moral, Ultimate Meaning, and Doubt) Of these scales, those in BSS demonstrated statistically significant decreases in the Divine subscale as compared to those in PCGT. This scale measures distress in one’s relationship with a Higher Power. (Condition: t = 2.65, p = .009, Time x Condition: t = -1.60, p = .001) Define and contextualize Retribution Theodicy

12 Results: Changes in Spiritual Distress (Relationship with the Divine)

13 Conclusions BSS appears to be as effective as PCGT for PTSD symptoms at the end of treatment. BSS is more effective than PCGT in treating spiritual distress. To our knowledge, this is the only clinical trial of a treatment for moral injury/spiritual distress that documents reduction of spiritual distress. Further study of psychospiritual development is indicated.

14 Additional Resources Brett Litz: Adaptive Disclosure
Everett Worthington: Forgiveness Good Goats: Healing Our Image of God

15 Contact Information J. Irene Harris: Timothy Usset:

16 References Mott, J.M., Mondragon, S., Hundt, N., Beason-Smith, M. Grady, R.H. & Teng, E.J. (2014). Characteristics of veterans who initiate and complete Cognitive Processing therapy and Prolonged Exposure for PTSD. Journal of Traumatic Stress, 27, 265—273. Shiner, B., D’Avelio, L.W., Nguyen, T.M., Zayed, M.H., Yong-Xu, Y., Desai, R.A., Schnurr, P.P., Fiore, LD. & Watts, B.V. (2012). Measuring use of evidence based psychotherapy for posttraumatic stress disorder. Administration and Policy in Mental Health and Mental Health Services Research, 40, Schnurr, P.P., Friedman, M.F., Engel, C.C., Foa, E.B., Shea, M.T., Chow, B.K., Resick P.A., Thurston V., Orsillo S.M., Haug, R., turner, C., & Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA, 297, 82—30. Kehle-Forbes, S.M., Meis, L.A., Polusny, M.A. (2014). Treatment initiation and dropout from Prolonged Exposure and Cognitive Processing Therapy in a VA Outpatient Clinic Suris, A., Link-Malcolm, J., Chard, K., Ahn, C. & North, C. (2013). A randomized clinical trial of Cognitive Processing Therapy for Veterans with PTSD related to military sexual trauma. Journal of Traumatic Stress, 26, Tanielian, T.R. & Jaycox, L.H. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. RAND Corporation, Santa Monica, CA. Visco, R. (2009). Postdeployment self-reporting of mental health problems and barriers to care. Perspectives in Psychiatric Care, 45, Litz, B.T., Stein, N., Delaney, E., Lebowitz, L., Nash, W.P., Silva, C. & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology review, 29, Harris, J.I., Erbes., C.R., Engdahl., B.E., Thuras, P., Murray-Swank, N, Grace, D., Ogden, H., Olson, R.H.A., Winskowski, A.M., Bacon, R., Malec, C., Campion, K., & Le, TuVan (2011). The effectiveness of a trauma focused spiritually integrated intervention for veterans exposed to trauma. Journal of Clinical Psychology, 67,

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