(PS11-A10) Moral Injury and PTSD Symptomatology: The Moderating Role of Experiential Avoidance

Potentially morally injurious events (PMIEs) are those in which one perpetrates, fails to prevent, learns about, or witnesses an act that violates one’s moral code or belief system (Litz et al., 2009). PMIEs may also include the experience of betrayal by a once-trusted authority figure (Shay, 2014). Some individuals exposed to PMIEs may develop a syndrome called moral injury – a constellation of symptoms such as guilt, shame, and disgust sparked by the dissonance resulting from conflict between one’s deeply held moral beliefs and the event that transgressed those beliefs (Hall et al., 2021). In addition to putting individuals at risk for moral injury, PMIEs are also associated with a variety of negative mental health outcomes including PTSD (Forkus & Weiss, 2021). For example, Henning & Frueh (1997) found that combat-related guilt – an outcome germane to moral injury - accounted for 30% of the unique variance in reexperiencing and avoidance symptoms and 8% of the unique variance in PTSD symptom severity in a sample of veterans. Therefore, investigating the roles of PMIEs and moral injury in the development and maintenance of post-traumatic stress symptoms (PTSS) is critical to understanding the underlying mechanisms of this relationship. A central feature of the maintenance of PTSS is experiential avoidance (EA; Orcutt et al., 2020). EA includes attempts to avoid aversive feelings and distress or attempts to modify experiences that may produce aversive feelings and distress (Chawla & Ostafin, 2007). EA is associated with several moral injury-related outcomes such as guilt, shame, difficulty forgiving the self, and self-condemnation (Hinkel, 2019). However, the role of EA in the relationship between PMIEs and PTSS has not yet been investigated. The current study explored the moderating role of EA in the relationship between exposure to PMIEs and post-traumatic symptoms. Given previous research in this area, it was hypothesized that higher levels of EA would be associated with a stronger positive relationship between exposure to PMIEs and PTSS. PROCESS macro 4.2 (Hayes, 2022) was used to test a simple moderation model, with EA examined as a moderator of the relationship between PMIEs (IV) and PTSS (DV) in a sample of 280 undergraduate students. Results suggested exposure to PMIEs (β = .60, p< .001), EA (β = .55, p< .001), and the interaction between PMIEs and EA (β = .03, p= .017) were significant, positive predictors of PTSS. The overall model demonstrated good fit (R = .50, F[3, 276] = 30.53, p < .001) and significant moderation, with the examined variables accounting for approximately 25% of the variance in PTSS, and PMIEs exerting a larger effect on PTSS in those with higher levels of EA. This study contributes to the nascent literature on moral injury in civilian populations. To our knowledge, this is the first study that has explored the role of experiential avoidance in the relationship between PMIEs and PTSS in a civilian sample. Results implicate experiential avoidance as a treatment target for those exposed to PMIEs.