Moral injury is values-based and can arise when someone perpetrates, witnesses, or is unable to prevent actions that violate their conscience - or when they experience betrayal by trusted individuals, leaders, or institutions in high-stakes settings. It often involves identity rupture and shame.
Recently, it has officially been recognized by the American Psychiatric Association (APA), thanks to research led by the Harvard T.H. Chan School of Public Health [1].
While PTSD is primarily organized around threat and fear (e.g., hypervigilance, intrusive memories, avoidance), moral injury is organized around meaning, responsibility, and conscience. The two can co-occur, but they don’t always move through the same support pathways. In fact, recent research shows moral injury independently predicts 6x higher odds of lifetime suicide attempt, even after controlling for PTSD and depression [2].
While moral injury is often discussed in military context, research also examines moral injury in other high-stakes roles, including health care workers and first responders [3].
Although research is limited regarding experiences involving expanded states of consciousness specifically for moral injury, one study mentioned that it may be useful for moral injury given the unique ability to improve cognitive flexibility, mindfulness, capacity to tolerate difficult emotions, and foster empathy and sense of connectedness towards self and others.
As interest grows in approaches involving expanded states of consciousness, therapists are increasingly asked to understand not only outcomes, but also the underlying mechanisms and clinical implications of these approaches.
What You'll Learn:
- Defining moral injury and how it differs from PTSD
- How moral injury shows up in real life
- What current research says regarding expanded states of consciousness
- The therapist’s role in preparation and post-experience integration
- Ethical, legal, and practice considerations when navigating client interest in these experiences
- How to speak with clients about these approaches in a responsible manner
[1] https://hsph.harvard.edu/news/moral-injury-officially-recognized-as-mental-health-condition/
[2] Griffin, B. J., Maguen, S., McCue, M. L., Pietrzak, R. H., McLean, C. P., Hamblen, J. L., Jendro, A. M., & Norman, S. B. (2025). Moral injury is independently associated with suicidal ideation and suicide attempt in high-stress, service-oriented occupations. npj Mental Health Research, 4, 32. https://doi.org/10.1038/s44184-025-00151-9
[3] Litz, B. T. (2025). Moral injury: State of the Science. Journal of Traumatic Stress, 1–13. https://doi.org/10.1002/jts.23125
-2-1.png){kind=logo}
