# Adaptation of Mindfulness Training to Treat Moral Injury in Veterans

> **NIH NIH R34** · OLD DOMINION UNIVERSITY · 2022 · $189,440

## Abstract

Abstract
Combat theatres place service members in situations where they make difficult decisions that may transgress
deeply held moral beliefs or witness others’ acts of betrayal. Although many veterans are resilient to these types
of experiences, for others, failure to accommodate these events may result in internal conflict that is theorized
to lead to the development of moral injury. Moral injury is distinct from posttraumatic stress disorder (PTSD) and
has been associated with poor mental health outcomes (e.g., depression, anxiety, suicidality) and alcohol/drug
use among veterans. Few evidence-based interventions have been developed to target symptoms of moral
injury. In studies with combat wounded veterans, community veterans, and a predominantly VA treatment-
seeking sample, our team has demonstrated that mindfulness moderates associations between moral injury
symptoms and negative mental health outcomes. In addition, we have demonstrated that combat wounded
veterans are willing to take part in a mindfulness-based moral injury intervention, especially if administered in an
online interactive web-based program. Using an iterative developmental process, the goal of this project is to
adapt an integrative and theory-driven mindfulness-based intervention delivered online to target moral injury in
combat wounded veterans. Aim 1 is to modify an evidence-based, online, interactive, instructor-delivered, six-
session mindfulness program, originally designed to help active duty members manage physical pain (i.e.,
Mindfulness to Manage Chronic Pain [MMCP]), such that it addresses the psychologically painful symptoms
(e.g., guilt, shame) characteristic of those with moral injury. The newly adapted program, Mindfulness to Manage
Moral Injury (MMMI), will then be piloted with one group of eligible combat wounded veterans (N = 6) to generate
qualitative feedback on program content and format; revisions based on this feedback will result in preliminary
manualization. Subsequently, in Aim 2 we propose to develop a facilitator-led online interactive Education
Support (ES) program designed to serve as a control comparison intervention, and then carry out a non-
randomized pilot study comparing the feasibility (i.e., credibility, acceptability, study completion, and adherence
(e.g., to homework assignments) of ES to the revised MMMI program with N = 20 (10 MMMI; 10 ES) combat
wounded veterans. Following this phase of feasibility testing, we will also collect qualitative information and
further refine both the MMMI and ES materials. In Aim 3, we propose a small-scale randomized controlled trial
(N = 60 combat wounded veterans; 30 MMMI; 30 ES) to collect data on recruitment, credibility and acceptability,
completion rates, and adherence in the two newly refined intervention arms at pre-post-test. Aim 3 will assess
for potential primary and secondary outcome measures and lay the groundwork for a large-scale randomized
R01 controlled efficacy trial. If supported,...

## Key facts

- **NIH application ID:** 10471303
- **Project number:** 5R34AT011038-03
- **Recipient organization:** OLD DOMINION UNIVERSITY
- **Principal Investigator:** MICHELLE L KELLEY
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $189,440
- **Award type:** 5
- **Project period:** 2020-09-21 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10471303

## Citation

> US National Institutes of Health, RePORTER application 10471303, Adaptation of Mindfulness Training to Treat Moral Injury in Veterans (5R34AT011038-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10471303. Licensed CC0.

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