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12 September 2023

Restore and Rebuild therapy shows potential as treatment for moral injury in UK Armed Forces

New research from the King’s Centre for Military Health Research (KCMHR) and Combat Stress, the UK’s leading veterans’ mental health charity, has shown that a new form of therapy for moral injury-related mental health difficulties has the potential to help treat members of the UK Armed Forces.


The research, published in European Journal of Psychotraumatology, presents evidence that moral injury related difficulties can be treated effectively with the right intervention.

Moral injury occurs when an individual experiences an event that violates their existing moral beliefs about themselves, those around them, and the wider world. In a military setting, moral injury could occur when a soldier witnesses their colleague mistreat a prisoner and not intervene to stop it, for example.

20 patients, all members of the UK Armed Forces with reported distress related exposure to a morally injurious event during their service, were asked to attend Restore and Rebuild (R&R) – a series of 20 sessions delivered online by a therapist. They were first provided education on moral injury and emotional regulation, before being asked to identify problematic thinking patterns attached to their event. Later sessions encouraged participants to explore self-compassion, improving connections with others and living in accordance with their core values.

Following the conclusion of the R&R intervention, researchers found a statistically significant reduction in levels of PTSD, depression, moral injury related distress, and alcohol misuse in participants both 1 month and 3 months post treatment.

When asked about their experiences of the therapy, Veterans fed back to say that it gave them the opportunity to be fully honest about their experiences and approach their injurious event from a more compassionate perspective. They also reported on the importance of being able to build rapport and trust with the therapist.

Experiencing a morally injurious event can have a long-term negative impact on a person’s wellbeing. Nonetheless, there isn’t currently an approved therapeutic intervention for those in need. Our research has found that Restore and Rebuild has the potential to help, as participants showed a marked improvement in their wellbeing and perception of the injurious event. We now need to test this on a larger group of Veterans over a longer period of time.”

Professor Neil Greenberg, Professor of Defence Mental Health at KCMHR and the study’s senior author

Dr Victoria Williamson, a research Fellow at KCMHR and the University of Oxford, and the study’s first author said, “One of the biggest challenges when treating moral injury that existing psychological treatments often do not fully address patient’s experiences and distress. Our study showed that our patients found the R&R therapeutic process to be engaging and helped to address their psychological difficulties. This is an extremely positive finding as we move forwards with future trials.”

Professor Dominic Murphy, Head of Research at Combat Stress and the study’s other senior author, said: "This study is one of the first of its kind to develop a new treatment for Moral Injury. The trauma and symptoms associated with Moral Injury can pose a real barrier to recovery, so it’s really pleasing that the results are promising.

“We hope to be in a position to roll our new treatment out to support veterans across the UK affected by complex moral traumas, in the near future."

When asked about their involvement in the study, one patient said, “[I’m] talking loads more with my wife about it. I’ve become quite passive, quite calm within stuff, I’m reacting to the children a little bit less. I can put that on to conversations with the kids and open up a little bit more and just be a little bit kinder to myself. I think they can see a softness within me. Conversations are getting better, softer and more understanding since starting this [treatment], which is fantastic.”

This study was possible thanks to funding from the Forces in Mind Trust.


Restore and Rebuild (R&R) – A feasibility pilot study of a co-designed intervention for moral injury-related mental health difficulties. (DOI10.1080/20008066.2023.2256204) (Williamson, V, Murphy, D, Bonson, A, Aldridge, V, Serfioti, D, Greenberg, N) was published in European Journal of Psychotraumatology.

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