Chronic Pain, PTSD and Moral Injury in Military Veterans: Suffering and the Compromised Self
Abstract: Veterans with chronic pain may face complex additional challenges, notably the potentially high rate of comorbid post-traumatic stress disorder. Linked to this is the developing concept of moral injury, essentially feelings of guilt and shame associated with transgressing one’s moral beliefs. Work has begun to explore moral injury in the context of psychological trauma, however it has not to date been considered in relation to chronic pain. As the moral injury concept is still developing, this paper explores what is known about the roles of guilt and shame in psychological trauma and chronic pain, and aims to set this in a military context, to begin to understand clinical implications and to make recommendations for further research. A search of the literature reveals that guilt and shame in psychological trauma and chronic pain are not well understood, and research has predominantly focused on these as consequences, rather than as potential contributory elements. Literature is currently separated, focusing either on PTSD or on chronic pain, and we suggest a more integrated approach is required.
Abstract: Objective: The present study is a retrospective quasi-experimental study to evaluate the effectiveness of the Warrior PATHH (WP) program at improving posttraumatic growth (PTG) outcomes and reducing PTSD symptoms compared to a waitlist control among a sample of Veterans. Method: Participants (n = 164) were U.S. military Veterans with a history of trauma. Participants were either undergoing the Warrior PATHH program or a waitlist. Primary outcome measures were administered at baseline and at 90-day follow-up and consisted of the Posttraumatic Growth Inventory – Expanded (PTGI-X) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Secondary outcome measures assessed psychosocial functioning and included measures of depression and anxiety symptoms, sleep, wellbeing, and social support. Results: Significant differences were observed between groups on the PTGI-X (F(1, 205) = 23.667, p < .001, partial η2 = 0.103), and the PCL-5 (F(1, 205) = 262.460, p < .001, partial η2 = 0.561) with the WP group showing significant positive psychological change following a traumatic event as measured by the PTGI-X and decreased PTSD symptoms as measured by the PCL-5 compared to those in the waitlist condition. Those in the treatment arm also demonstrated gains to psychosocial functioning. Conclusions: Consistent with previous research, participants in the Warrior PATHH program exhibited significant increases in PTG outcomes, decreased PTSD symptoms, and broad improvements to psychosocial functioning. These findings suggest it is an effective training program to foster PTG outcomes among Veterans. This study is unique as it is the first to compare the effects of WP programming with a sample of waitlisted Veterans.