reSponders City of Scottsdale Police Department Sgt Michael Hanafin 582 Natalie Summit LPC Retired Police crisis Interventionist B815 Objectives Encourage participants to think and engage a different way of exploring trauma in the Public Safety setting ID: 776037
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Slide1
Moral Injury; interventions for First reSponders
City of Scottsdale Police Department
Sgt. Michael
Hanafin
, #582
Natalie Summit LPC; Retired Police crisis Interventionist, #B815
Slide2Objectives
Encourage participants to think and engage a different way of exploring trauma in the Public Safety setting
Introduce Moral Injury
Compare Moral Injury to PTSD
Identify the Moral Injury connection to Veterans and First Responders
Explore
therapuetic
interventions when addressing moral injury.
Slide32017-2018 - CIT Officer Dan Antrim and Natalie Summit
2019 -Welcome Sgt. Hanafin!
Slide4Tribal Warriors
“Soldiers experience this tribal way of thinking at war, but when they come home they realize that the tribe they were actually fighting for wasn’t their country, it was their unit. It makes absolutely no sense to make sacrifices for a group that itself isn’t willing to make sacrifices for you. That is the position American soldiers have been in for the past decade and a half.” -Sebastian Junger, Tribe
Slide5Encouragement: Be an independent thinker (for the next hour)
Slide6What Does It Mean To Be Moral?
Moral - of or relating to principles of right and wrong in behaviorMoral Judgments - expressing or teaching conforming sanctioned by operating on one’s one moral position. “Puppies and Babies are “precious” breathing living beings”Moral/Value: Hurting puppies and babies is bad.
Slide7Moral Injury
Results when individuals violate their core moral beliefs, AND in evaluating their behavior negatively, they feel they no longer live in a reliable, meaningful world and can no longer be regarded as decent human.
Slide8Genesis of Moral Injury:
“We all feel occasional guilt or shame for something we did, but war can require extreme actions that violate the very basis of moral identity. The life-or-death urgency of war forces untenable actions that can elicit profound guilt or shame. When we feel that what we did was wrong or unforgivable and that our lives and our meaning system no longer make sense, our reason for living is in tatters. This shattering of the soul challenges what holds life together and the anguish of moral injury begins.”
--Dr. Rita Nakashima Brock,
Soul Repair
Slide9How does this happen?
Thinking, preparing, or committing to do what is valued as an immoral act
Failing to act in a morally correct way due to cowardice or being ordered not to act and bad things happen
Failing to prevent others’ seriously immoral acts. Possibly witnessing the act itself without the persons’ knowledge
Seeing and/or hearing about someone else violating or betraying a core moral value.
Failing to report knowledge of a sexual assault committed against oneself or another
Slide10How does this happen (continued)?
Feeling betrayed by persons in authority and command staff watches in silence
Giving orders in Public Safety that result in the injury or death of a fellow officer, civilian, child or animal and receive an award
Witnessing a friend get killed or hurt in the line of duty and you survive
Thinking “I got this!” and then knowing that “I am powerless” resulting in suicide
Abandonment and disillusionment from within
Slide11Consequences of Moral Injury
Overwhelming Moral feelings of
guilt
,
shame
,
despair
,
angst
,
remorse
,
anger
,
outrage
,
grief
,
disgust
,
worthlessness
,
demoralization
,
self-condemnation
, and
betrayal
Feel as though they lost their soul and are no longer who they once were
Abandon the values and beliefs that gave their lives meaning and guided their moral choices.
Decide no one can be trusted and isolate themselves from others
Take their own lives in order to eliminate the shame and guilt and despair:
“Its torments to the soul can make death a mercy.”
Slide12Moral Injury is Different than PTSD PTSD Moral Injury
“Startle” Reflex
Memory Loss
Fear
FlashbacksHypervigilance
SorrowGriefRegretShameAlienation
AngerDepressionAnxietyInsomniaNightmaresSelf Medication
Intense Fear Reaction Core Moral Beliefs Violated
Nash, Bill & Woods, D., “Moral Injury,” Huffington Post, March 18 2014
Slide13treatable and possibly curable?
Slide14Moral Injury Treatments
Sgt. Michael Hanafin #582 Scottsdale PD
LAC MAPC MEd
Slide15Evidence Based Treatments
Cognitive Processing Therapy and Prolonged Exposure Therapy are two most popular EBT used
Even after EBT, 60-72% of combat veterans continue to meet dx for PTSD
Slide16Treatment - Moral Injury
Since Moral Injury
is
overwhelming feelings
of
guilt, shame
, despair, angst, remorse, anger, outrage, grief, disgust, worthlessness, demoralization, self-condemnation, and betrayal
caused by
abandoning the values and beliefs
that gave their lives meaning and guided their moral choices or
betrayal
and they feel as though they
lost their soul,
are
no longer who they once were
and that
no one can be trusted
so they isolate themselves from others
Slide1710 Theoretically-Grounded Dimensions of Moral Injury
1.) Guilt2.) Shame3.) Betrayal by Others4.) Moral Concerns5.) Loss of meaning/Purpose6.) difficulty Forgiving7.) Loss of Trust8.) Self-Condemnation9.) Spiritual/Religious Struggles10.) Loss of Religious Faith/Hope
1-8 Psychological
9-10 Religious/Spiritual
Slide18Treatment
Then the questions for treatment become.
What is the
soul
? How was it lost? How can it be regained?
How were deeply held
values
lost?
How can they be regained?
Should they be regained?
How was basic
trust
in others lost?
Can it be rebuilt?
Should it be rebuilt?
Can someone “like” themselves again after having violated their core beliefs?
Slide19SoulUsually a question for religion
Slide20Maslow’s Hierarchy of Needs
Freedom
Meaninglessness
Isolation
Death
Slide21Summary of the Soul
Each is saying the same thing.
The “Soul” is the unique part of the individual that must be expressed for the person to be a fully alive, fully formed person.
It is done through discovery and enactment.
Slide22VALUES
Slide23How are deeply held values lost?
Did you have these values to begin with?
Are you really upset you violated these values, or are you worried others won’t accept you if they know you what you did? (Shame or Guilt?)
Could you have resisted the influence of Authority, Environment, or Peer Pressure?
Stanley Milgram
Solomon Asch
Philip Zimbardo
Robert Cialdini
Slide24Betrayal of Trust
Guilt: The function of guilt is to reconcile a damaged social bond.
Shame: The reaction is to withdraw so the social group can preserve its identity.
Someone betrayed you, or you betrayed someone
Can you trust again?
Should you trust again?
Slide25Formalized Therapies
Developed with veterans in mind, but with minor alterations can be adapted to first responders.
Slide26Four Foundational Assumptions
1.) The individual’s system of moral belief can be injured as well as repaired.
2.) Repair occurs along two pathways
Processing memories
Combating negative self-judgements
3.) Since they believe they are beyond redemption they need an equally forceful contradictory experience.
4.) There is no shortcut to healing.
Slide27Adaptive Disclosure Therapy (AD)
Developed by Brett
Litz
and colleagues in 2007
1 RCT showed reductions in symptoms of PTSD symptoms 2nd RCT underway
Eight Step CBT Group designed to help veterans/first responders process their possible mistakes.
Veteran/First Responder also learn how to disclose in a safe environment w/o guilt or shame.
Psychoeducation / share stories / write letters / confide in an internalized benevolent moral authority (or real moral authority)
Slide28Impact of Killing (IOK)
Developed by Shira
Maguen
PhD
(VA San Francisco)
One RCT Pilot Study
Focuses on self-forgiveness, making amends, healing relationships, and moving forward
Reevaluation of responsibility if appropriate (otherwise acceptance)
Eight Phases
Not meant as a stand alone, used in conjunction with other therapies
Slide29Building Spiritual Strength
Building Spiritual Strength is a spiritually-integrated model for treating PTSD/Moral Injury designed to reach veterans who will not access conventional mental health services.
Dropout rates for BSS range from 6% to 14%.
Slide30Building Spiritual Strength (Group Therapy)
Session 1: Orientation to group rules
Session 2-3: Communication skills for talking with Higher Power
Session 4: Theodicy (Why God permits evil)
Session 5: Meditation and Prayer
Session 6-7: Forgiveness
Session 8: Consolidation of Gains
Slide31Questions?
Sgt. Mike Hanafin
Mhanafin@scottsdaleaz.gov
Natalie Summit LPC; First Responder Specialist at The River Source Treatment Center in Gilbert, AZ Work 602-739-7119;
natalie.summit@theriversource.org
Personal 480-236-0781;
changesat50@gmail.com
“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?”
― Aleksandr Solzhenitsyn, The Gulag Archipelago 1918–1956
Slide32Bibliography
Brock, Rita Nakashima, Rev., Ph.D. and Lettini, Gabriella,
Soul Repair
, (Boston: Beacon Press2012)
Junger, Sebastian,
Tribe
, (New York, New York: Twelve, 2016);
Slide33End