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 Moral Injury; interventions for First  Moral Injury; interventions for First

Moral Injury; interventions for First - PowerPoint Presentation

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Moral Injury; interventions for First - PPT Presentation

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

moral injury guilt shame moral injury guilt shame soul values session lost ptsd group spiritual veterans betrayal beliefs feel

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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

Slide2

Objectives

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.

Slide3

2017-2018 - CIT Officer Dan Antrim and Natalie Summit

2019 -Welcome Sgt. Hanafin!

Slide4

Tribal 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

Slide5

Encouragement: Be an independent thinker (for the next hour)

Slide6

What 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.

Slide7

Moral 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.

Slide8

Genesis 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

Slide9

How 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

Slide10

How 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

Slide11

Consequences 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.”

Slide12

Moral 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

Slide13

treatable and possibly curable?

Slide14

Moral Injury Treatments

Sgt. Michael Hanafin #582 Scottsdale PD

LAC MAPC MEd

Slide15

Evidence 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

Slide16

Treatment - 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

Slide17

10 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

Slide18

Treatment

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?

Slide19

SoulUsually a question for religion

Slide20

Maslow’s Hierarchy of Needs

Freedom

Meaninglessness

Isolation

Death

Slide21

Summary 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.

Slide22

VALUES

Slide23

How 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

Slide24

Betrayal 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?

Slide25

Formalized Therapies

Developed with veterans in mind, but with minor alterations can be adapted to first responders.

Slide26

Four 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.

Slide27

Adaptive 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)

Slide28

Impact 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

Slide29

Building 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%.

Slide30

Building 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

Slide31

Questions?

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

Slide32

Bibliography

Brock, Rita Nakashima, Rev., Ph.D. and Lettini, Gabriella,

Soul Repair

, (Boston: Beacon Press2012)

 

Junger, Sebastian,

Tribe

, (New York, New York: Twelve, 2016);

Slide33

End