Cognitive Therapy for Moral Injury in Post-Traumatic Stress Disorder

Moral injury is the profound psychological distress which can arise following participating in, or witnessing, events which transgress an individual’s morals and include harming, betraying, or failure to help others, or being subjected to such events, e.g. being betrayed by leaders. It has been primarily researched in the military, but it also found in other professionals such as healthcare workers coping with the COVID-19 pandemic and civilians following a wide range of traumas.


In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD) to treat patients presenting with moral injury-related PTSD. We outline the key techniques involved in CT-PTSD and describe their application to treating patients with moral injury-related PTSD. A case study of a healthcare worker is presented to illustrate the treatment interventions.


Key learning aims

(1) To recognise moral injury where it arises alongside PTSD.

(2) To understand how Ehlers and Clark’s cognitive model of PTSD can be applied to moral injury.

(3) To be able to apply cognitive therapy for PTSD to patients with moral injury-related PTSD.

Hannah Murray & Anke Ehlers | 2021
In: Cognitive Behaviour Therapist ; ISSN: 1754-470X | 1-42
Epub ahead of print DOI : 10.1017/s1754470x21000040
Casuistry, Cognitive Behavioral Therapy, COVID-19 (en), Disgust, Guilt, Interventions, Mental Health Personnel, Moral Injury (eng), Morale, Posttraumatic Stress Disorder, Psychotrauma, PTSD (en), Shame, Stressors, Traumatic memories, Treatment, Veterans