Carol K. Stewart, Teresa A. Wilkins, Ph.D.

The Effect of Religion and Spirituality on Combat-Related Guilt and Shame in Moral Injury

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U.S. involvement in recent long-term military conflicts has created an increased focus on the various challenges for service members returning from combat. Primary among these challenges are the experienced symptoms of post-traumatic stress disorder (PTSD). Researchers have recently begun to explore spiritually related symptoms not included in the PTSD criteria. These symptoms may include negative changes in or loss of spirituality (Dresher & Foy, 1995; Fontana & Rosenheck, 2005), negative attributions about God (Witlivet, Phipps, Feldman, & Beckham, 2004), and guilt, shame, and forgiveness problems (Kubany, Abueg, Kilauano, Manke, & Kaplan, 1997). This group of spiritually related symptoms has been termed moral injury. The ability to discriminate between those with PTSD and those with moral injury may lead to the utilization of treatment models more appropriate for those whom moral conflict is the source of post-deployment symptoms (Dresher, et al., 2011).

Participants were 144 military service personnel ranging in age from 18-72 (Army, Air Force, Navy, Marine Corps, Coast Guard, and National Guard) who had served in conflicts dating back to Vietnam. They completed four surveys: Assessment of Spirituality and Religious Sentiments Scale (ASPIRES, Piedmont, 2004), Moral Injury Questionnaire-military version (MIQ-M, Currier, et al.,2015), Guilt and Shame Proneness scale (GASP, Cohen, Wolf, Panter, and Insko, 2011), and the International Personality Item Pool (IPIP-50, Goldberg, 1991) scale. Hypotheses include religious involvement and spiritual transcendence predicting less shame and guilt related to moral injury and high religious crisis predicting higher levels of guilt and shame.  Differences between participants across services and across conflicts will be analyzed. Hierarchical regression will be used to determine the effects of spirituality and religiosity, over and above personality, on the guilt and shame emotions of moral injury. The possible moderation effect of gender on spirituality’s impact on guilt and on shame will also be examined. Understanding and separating out from PTSD those factors that contribute uniquely to moral injury may increase clinicians’ effectiveness in addressing issues of distress for service members returning from war. Of particular significance to pastoral counselors is the study’s focus on spiritual factors and their impact on mental health.

Keywords: Moral Injury, PTSD, Spirituality, Religion, ASPIRES, IPIP-50, GASP, MIQ-M