Exploring the potential of psychedelic-assisted psychotherapy for moral injury : A scoping review

This scoping review addresses the need to comprehensively explore the potential of psychedelic-assisted psychotherapy (PAP) to facilitate recovery from moral injury. Moral injury (MI), characterized by profound psychological distress arising from morally challenging experiences, has garnered increased attention as a complex mental health concern with significant functional sequelae, especially in the context of post-traumatic stress disorder (PTSD). There is growing interest in exploring alternative therapeutic approaches, with psychedelics emerging as an exciting potential intervention, as moral injury impacts treatment resistance, suicidality, social isolation, and overall functioning. Ten studies were included from 11,734 publications. Studies utilized psilocybin, MDMA, or LSD. None focused specifically on moral injury. Diagnoses included PTSD, alcohol use disorder, insomnia, human Immunodeficiency virus-related demoralized men, barbiturate dependence, anxiety associated with life-threatening illness, major depression, and PTSD comorbid with generalized anxiety disorder, panic disorder, and borderline personality disorder. Studies reported rapid, increasing, and sustained self-compassion over time, alongside increases in self-forgiveness and self-acceptance, reduction in demoralization, and decreased drinking scores. Though in other diagnostic contexts, PAP has shown efficacy in addressing symptoms commonly associated with moral injury, particularly within the context of PTSD. It holds promise as an intervention for MI and requires further exploration.

Highlights

• MI correlates with poor PTSD outcomes, including treatment resistance, isolation, suicidality, and reduced functioning.
• No peer-reviewed studies examine PAP's impact on MI, revealing a key research gap for trauma-related disorders.
• Studies using LSD, psilocybin, and MDMA suggest improved MI-related symptoms, such as self-compassion, and reduced shame and guilt.
• Further research is essential to understand benefits, mechanisms, and adaptation of PAP for various populations.