Impact of Killing in War: A Randomized, Controlled Pilot Trial

Objective The purpose of this pilot study was to test the effectiveness of Impact of Killing (IOK), a novel, cognitive‐behavioral treatment (CBT) aimed at reducing mental health symptoms and functional impairment. Method Participants were 33 combat Veterans with a posttraumatic stress disorder (PTSD...

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Published inJournal of clinical psychology Vol. 73; no. 9; pp. 997 - 1012
Main Authors Maguen, Shira, Burkman, Kristine, Madden, Erin, Dinh, Julie, Bosch, Jeane, Keyser, Jessica, Schmitz, Martha, Neylan, Thomas C.
Format Journal Article
LanguageEnglish
Published United States Wiley Periodicals Inc 01.09.2017
Subjects
Aged
Cognitive therapy
Cognitive Therapy - methods
Combat Disorders - therapy
Homicide - psychology
Humans
killing
Male
Middle Aged
moral injury
Outcome Assessment (Health Care)
Pilot Projects
Post traumatic stress disorder
posttraumatic stress disorder
Quality of Life
Stress Disorders, Post-Traumatic - therapy
treatment
United States
United States Department of Veterans Affairs
veteran
Veterans
Veterans - psychology
War
Warfare
killing
treatment
war
veteran
moral injury
posttraumatic stress disorder
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Summary:Objective The purpose of this pilot study was to test the effectiveness of Impact of Killing (IOK), a novel, cognitive‐behavioral treatment (CBT) aimed at reducing mental health symptoms and functional impairment. Method Participants were 33 combat Veterans with a posttraumatic stress disorder (PTSD) diagnosis who had completed trauma‐focused psychotherapy and reported distress regarding killing or feeling responsible for the deaths of others in war. Veterans were randomized to either IOK treatment or a 6‐week waitlist condition, after which Veterans could receive IOK. IOK is a 6‐ to 8‐session, weekly, individual, CBT, lasting 60–90 minutes, and focused on key themes, including physiology of killing responses, moral injury, self‐forgiveness, spirituality, making amends, and improved functioning. Results We found that compared to controls (N = 16), the IOK group (N = 17) experienced a significant improvement in PTSD symptoms, general psychiatric symptoms, and quality of life functional measures. Veterans who received IOK reported that the treatment was acceptable and feasible. Conclusion These results provide preliminary evidence that Veterans can benefit from a treatment focused on the impact of killing after initial trauma therapy.
Bibliography:This research was funded by VA Health Services Research and Development RRP 12–237 (PI: Maguen); University of California, San Francisco REAC 525014–36248 (PI: Maguen); and VA Health Sciences Research and Development Research Career Development Award 06–042 (PI: Maguen). The funding sources did not play a role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
We thank all of the veterans who participated in this research and shared their stories and experiences with us. We also thank Rosemary Griffin, MPH, Peter Yeomans, PhD, the VHA PTSD clinicians, and the many others who provided referrals and feedback, without whom this work would not be possible.
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ISSN:0021-9762
1097-4679
DOI:10.1002/jclp.22471