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.