Get new posts by email
Focusing on Moral Injury to Treat PTSD/Complex PTSD – Childhood Trauma Recovery

Focusing on Moral Injury to Treat PTSD/Complex PTSD



PTSD/complex PTSD can come about as a result of acting in a way that grossly transgresses one’s own moral values.

For example, I have written elsewhere about children who have committed homicide after years of severe abuse and, as a result, whose complex PTSD is brought about not only by what was done to them but also by the mentally tormenting awareness of the violence they themselves have perpetrated as a result (i.e. homicide). 

This awareness of what they have done, when it grossly transgresses their moral values (e.g. in the case of non-psychopaths who kill impulsively and commit what might be termed a crime passionnel) gives rise to what has been termed as ‘moral injury ‘



Moral injury, then, occurs when those with a functioning conscience, in layman’s language, do something terrible which sickens them on a visceral level and profoundly tortures their conscience (although it can also come about in other ways such as by witnessing a heinous act that goes against one’s morals and values).

When moral injury is a component of PTSD (as in the case of the child killers referred to above) it can make the resolution of the condition all the more intractable.

This means, of course, that if PTSD is to be cured in such cases, it is imperative that the individual’s sense of moral injury is rigorously addressed.

Based on the idea that there are both psychological and SPIRITUAL components of moral injury, Pearce et al. (2018) hypothesize that therapeutic interventions which specifically address moral injury with not just psychological resources, but also spiritual resources, may be especially effective at treating PTSD.

In order to facilitate the testing of this hypothesis, Pearce et al. (2018) adapted Cognitive Processing Therapy (CPT) so that it took account of the spiritual beliefs, values, practices, and motivations.



The term used to describe this newly devised form of treatment is SPIRITUALLY INTEGRATED COGNITIVE PROCESSING THERAPY (SICPT).

This therapy consists of 12 sessions and has been manualized. There are six versions of the manual:


  1. Spiritual version (for use by members of any religion or of no religious persuasion.
  2. Christian version
  3. Jewish version
  4. Muslim version
  5. Buddhist version
  6. Hindu version

Based on limited research (an amalgamation of case studies) the researchers conclude that SICPT does indeed show promise for treating those whose PTSD contains a moral injury component but they also highlight the need for further research in this area.




Michelle Pearce, PhD1, Kerry Haynes, DMin, BCC2, Natalia R Rivera, LCSW, CADCT3, and Harold G. K Spiritually Integrated Cognitive Processing Therapy: A New Treatment for Post-traumatic Stress Disorder That Targets Moral Injury. Global Advances in Health and Medicine Volume 7: 1–7! The Author(s) 2018 Reprints and permissions: DOI: 10.1177/2164956118759939 is reader-supported. When you buy through links on this site, I may earn an affiliate commission.