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, LMFTMinneapolis 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 rapportSessions 2-3: Developing skills and tools for communication with a Higher PowerSession 4: TheodicySession 5: Meditative and prayer copingSessions 6-7: ForgivenessSession 8: Consolidation of gains, identification of future resources.
4 Signs of Moral Injury/Spiritual Distress Loss of previously held spiritual beliefsStruggle or conflict in relationship with a Higher PowerDifficulty forgiving self, others, or a Higher PowerFeeling that there is no meaning or purpose in lifeReduced trust in othersInappropriate guilt and shame
5 Consequences of Moral Injury/Spiritual Distress Increased risk for suicidal ideation and attemptsReduced mental health resilienceLoss of social support from community of faith, family and values-based activities
6 Previous Pilot Study956 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 StudyDetermine if BSS can be as effective as Present Centered Group TherapyAssess effects of BSS on moral injury/spiritual distressLarger 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% Unreported38 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 StrengthNo 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 BSS68% 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 ConclusionsBSS 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: ForgivenessGood Goats: Healing Our Image of God
16 ReferencesMott, 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 ClinicSuris, 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,