Introduction
Moral injury is theorized to be the consequence of events that are perpetration-based (e.g., injuring a noncombatant, witnessing cruel behavior but doing nothing to stop it) or betrayal-based (e.g., betrayal by peers, leadership) that transgress one’s deeply held morals and values (Flipse Vargas et al., 2013; Litz et al., 2009; Shay, 1991). When service members cannot reconcile their experiences with their moral values and beliefs, the dissonance that results may cause a range of negative emotions, cognitions, and attributions (e.g., anger, guilt, shame, loss of trust, lack of forgiveness, self-condemnation, hostility toward authority). These experiences are collectively known as moral injury (Litz et al., 2009). Moral injury symptoms are associated with depression, suicidality, and substance misuse (Bravo et al., 2020; Bryan et al., 2014; Forkus et al., 2021; Kelley, Chae et al., 2021). Consistent with ‘whole person approaches’ to care (U.S. Department of Veterans Affairs, 2020), there is growing interest in developing flexible mind-body approaches for addressing moral injury (Kopacz et al., 2016; Walser & Wharton, 2021) that address the unique experiences of veterans. In this paper, we present findings on feasibility, satisfaction, and preliminary changes in moral injury outcomes from a small, randomized controlled trial of Mindfulness to Manage Moral Injury (MMMI), a live facilitated web-based 7-week mindfulness-based program for veterans targeting moral injury symptoms.