A Novel Posttraumatic Stress Disorder Treatment for Veterans With Moral Injury
Key facts
- Who runs it
- VA Office of Research and Development
- Where
- Durham, San Francisco, and The Bronx, United StatesSee the 3 sites
- Trial code
- Status
- Completed
- People taking part
- 100 people enrolled
- Started
- 12 Aug 2019
- Ended
- 31 Dec 2024
- Type of study
- Interventional, 2 groupsOne group gets an existing treatment, for comparison.
- Treatments tested
- Impact of Killing (IOK)
- Present Centered Therapy
- Record updated
- 20 November 2025
Who can take part
- Age
- 18 years to 82 years
- Sex
- Women and men
- Healthy volunteers
- Cannot take part
The registry criteria, word for word
Show all 11 criteriaShow less
Who can take part
- Veterans 18-82 years of age
- Veterans who meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for Post-traumatic Stress Disorder (PTSD) or score 23 or higher on the Clinician-Administered PTSD Scale for DSM-5 (CAPS) screening interview
- Veterans who endorsed killing or being responsible for the death of another in a war zone and report continued distress regarding these events; Distress will be operationalized by a positive response to one or more of the nine self-directed moral injury items on the Expressions of Moral Injury Scale-Military Version (EMIS-M) or item #4 on the Moral Injury Events Scale (MIES)
- Veterans who have initiated or completed an evidence-based treatment for PTSD, such as Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE)
- If receiving CPT or PE, Veterans must complete treatment and wait two weeks prior to screening
- If receiving prescription medication for PTSD, Veterans must be one month stable on medication and not make any changes to medication during the course of the active treatment phase of the study
Who cannot take part
- Veterans with moderate or severe alcohol or drug dependence within the past three months
- Veterans receiving individual therapy for PTSD or those planning to start skills-based or trauma-focused group psychotherapy will be excluded; However, these Veterans will be offered the opportunity to be screened again after completion of individual PTSD therapy or once they are three months stable in group treatment, with no plans to discontinue this treatment
- Veterans with current or lifetime diagnosis of a psychotic disorder or current untreated/unmanaged mania
- Veterans with recent psychiatric hospitalizations
- Veterans with recent suicidal or homicidal behaviors (chronic suicidal ideation is not exclusionary)
Where in United States
- Durham VA Medical Center, Durham, NCDurham, United States
- San Francisco VA Medical Center, San Francisco, CASan Francisco, United States
- James J. Peters VA Medical Center, Bronx, NYThe Bronx, United States
About the trial
What the trial wants to find out
The objective of this project is to test the efficacy of an individual treatment for post-traumatic stress disorder (PTSD) stemming from moral injury called Impact of Killing (IOK), compared to a present-centered therapy (PCT) control condition, and to determine the rehabilitative utility of IOK for Veterans with PTSD. The first aim is to test whether IOK can help improve psychosocial functioning for Veterans, as well as PTSD symptoms. The second aim is to determine whether IOK gains made by Veterans in treatment are durable, as measured by a six-month follow-up assessment. Veterans who kill in war are at increased risk for functional difficulties, PTSD, alcohol abuse, and suicide. Even after current PTSD psychotherapies, most Veterans continue to meet diagnostic criteria for PTSD, highlighting the need for expanding treatments for PTSD and functioning. IOK is a treatment that can be provided following existing PTSD treatments, filling a critical gap for Veterans with moral injury who continue to suffer from mental health symptoms and functional difficulties.
The 2 groups in the trial
- Impact of Killing (IOK)Treatment being tested
Participants in this arm will receive 10 sessions (60-90 minutes) of a cognitive-behavioral moral injury treatment called IOK .
- Present Centered TherapyExisting treatment, for comparison
Participants in this arm will receive 10 sessions (60-90 minutes) of a PTSD treatment that does not focus on trauma or cognitive restructuring, but rather the functional impact of trauma called Present Center Therapy (PCT)
Data and sources
- Registry record
- Listed on ClinicalTrials.gov.
- Publications
- Psychotherapy for Impact of Killing During War: A Randomized Clinical Trial.JAMA psychiatry, 2026
- Record updated
- 20 November 2025