# Using Moral Elevation to Improve Functioning in Veterans with PTSD and Moral Injury: A Pilot Study of a Web-Based Intervention

> **NIH VA I21** · OLIN TEAGUE VETERANS CENTER · 2021 · —

## Abstract

Despite the use of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), many
Veterans report continued symptoms and impairment after treatment. Additionally, there is evidence to
suggest those treatments are less effective for moral injury (MI) distress—experiencing severe guilt,
shame, and anger about witnessing or performing an act that violates one’s deeply held values.
Current treatments are also limited as they do not directly facilitate building positive resources to
enhance social functioning. Given the prevalence of trauma distress and limitations to existing
treatments, novel approaches are needed to (1) target both PTSD and MI and (2) directly impact
psychosocial growth and functional recovery. Research indicates that positive psychology interventions
effectively enhance well-being through cultivating positive emotions. Moral elevation (hereafter
“elevation”)—a distinct, positive emotional state described as feeling moved by others’ virtuous
actions—may be relevant to PTSD and MI recovery because it encourages social engagement and
serves as a template for interpreting the world in a healthier way. Additionally, preliminary results from
a pilot study showed promising evidence that elevation was negatively correlated with PTSD avoidance
symptoms and MI. Therefore, the goal of this proposed study is to conduct a pilot trial of a web-based
elevation intervention to determine if such an intervention is a feasible and acceptable therapeutic
approach for Operations Enduring Freedom, Iraqi Freedom, and New Dawn Veterans. [This study will
also assess the feasibility of randomization, retention, and completion of a no-treatment condition
(i.e., comparison group) in preparation for future randomized controlled trials (RCTs).] The sample will
include [24] Veterans [(12 per group)] who experience at least one morally injurious event and with a
current diagnosis of PTSD. The online elevation intervention consists of two exercises per week for one
month, totaling eight sessions. Sessions will include watching validated videos that elicit elevation and
recalling moments when one experienced elevation in daily life, paired with journaling about one’s
reactions to witnessed virtuous behavior. Participants [in the intervention condition] will also be
presented with a brief goal to be completed prior to the next session to facilitate greater social
engagement. [Participants randomized to the no-treatment condition will access the same online portal
twice per week, but will not be exposed to any intervention components.] All participants will complete
brief self-report measures at each online session. All participants will also complete self-report
measures at baseline and 1-month follow-up that will assess PTSD symptoms, MI distress, prosocial
behavior, and quality of social relationships. At the follow-up assessment, participants randomized to
the intervention condition will complete an individual qualitative interview with a member o...

## Key facts

- **NIH application ID:** 10393484
- **Project number:** 5I21RX003035-03
- **Recipient organization:** OLIN TEAGUE VETERANS CENTER
- **Principal Investigator:** Adam Patrick McGuire
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10393484

## Citation

> US National Institutes of Health, RePORTER application 10393484, Using Moral Elevation to Improve Functioning in Veterans with PTSD and Moral Injury: A Pilot Study of a Web-Based Intervention (5I21RX003035-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10393484. Licensed CC0.

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