Using Mindfulness to Manage Moral Injury in Veterans: Feasibility, Satisfaction, and Initial Evidence of a Live Web-based Randomized Controlled Trial

Objective: The present study assessed initial evidence of program feasibility, satisfaction, and pre-to post-intervention changes in moral injury symptoms among recent-era veterans who participated in Mindfulness to Manage Moral Injury (MMMI), a live facilitated web-based 7-week mindfulness-based program targeting moral injury among veterans. Method: Of 56 recent-era veterans who met study criteria and were randomized, 40 (71.4%) completed the pre- and post-intervention survey and attended at least one treatment session. Of these 40, 21 completed MMMI and 19 completed an equally intensive educational support (ES) control intervention. Among the analytic sample ( n = 40), most participants identified as White (77.5%), were men (62.5%), and reported a service-connected disability (82.5%). Results: Participants attended on average 6.11 sessions. Program satisfaction was moderately high across both conditions. Several significant condition x time interactions were found, with those in the MMMI condition reporting greater pre- to post-intervention decreases in moral injury (η2=.121), impaired functioning due to moral injury (η2=.129), shame-related experiences due to moral injury (η2=.105), and other-directed moral injury (e.g., betrayal, difficulty forgiving others; η2=.129) as compared to the ES condition. Conclusions: These preliminary findings suggest MMMI appears feasible and acceptable and may be able to reach veterans who may not seek traditional Veterans Affairs Medical Center care or who prefer a web-based program. Given its promise for the treatment of moral injury among veterans, MMMI warrants additional large-scale clinical-trial testing.