Mindfulness, Moral Injury, Mindfulness to Manage Moral Injury
(MMMI)
Kabat-Zinn (1991) defined mindfulness as “paying attention in a
particular way: on purpose, in the present moment, and
non-judgmentally,” (p. 4). Components of mindfulness (purposefully
paying attention to present-moment experiences) may benefit those with
moral injury symptoms (e.g., Lang et al., 2019; Zalta et al., 2018). For
instance, a cross-sectional study of veterans found that nonjudging of
inner experience and acting with awareness moderated the association
between moral injury and drug abuse symptoms (Davies et al., 2019). To
develop MMMI, we adapted the Mindfulness to Manage Chronic Pain (MMCP)
program. Designed by Miller and colleagues (Brintz et al., 2020), MMCP
is a web-delivered, group-based, interactive, instructor-taught,
six-session mindfulness training adapted from Kabat-Zinn’s (1990)
in-person, group-based Mindfulness-based Stress-Reduction program
(MBSR). In adapting the program, we removed the emphasis on chronic pain
and replaced it with a focus on the psychological pain of moral injury.
We also extended the program to seven sessions to allow for an
additional focus on self-compassion/compassion, and compassion-related
exercises (see Author et al., 2022).
MBSR (Kabat-Zinn, 1991) is an empirically supported mindfulness training
which uses a range of mindfulness practices to increase awareness,
promote non-judgment and acceptance, and generate compassion. MBSR
shares tenets with Monitor and Acceptance Theory (MAT; Lindsay &
Creswell, 2017, 2019). In MAT, Lindsay and Creswell (2019) contend that
with time and practice, attention monitoring and acceptance skills may
reduce negative affectivity, stress, and stress-related health outcomes
(Lindsay & Creswell, 2019). Moral injury often involves guilt and shame
directed toward the self and other painful, other-directed emotions,
such as anger and wish for revenge. Thus, in MMMI, our goal was to teach
veterans to use mindfulness techniques to bring awareness to difficult
experiences and to simultaneously manage and release judgment by
bringing acceptance to psychologically painful emotions associated with
moral injury, thereby cultivating an attitude of compassion and
acceptance. By reducing condemnation, blame, anger, and simultaneously
increasing acceptance, we would expect veterans to view themselves and
others as worthwhile, despite being imperfect.