Associations between higher exposure to potentially morally injurious events and negative posttraumatic cognition trajectories throughout cognitive processing therapy

Abstract: Individuals with higher potentially morally injurious event (PMIE) exposure often exhibit elevated levels of negative posttraumatic cognitions (NPCs). Researchers have argued that individuals with moral injury (MI) following PMIE exposure experience more prescriptive NPCs than those without MI. As these prescriptive NPCs may be harder address using cognitive processing therapy (CPT), first‐line posttraumatic stress disorder (PTSD) treatments may not fully address MI. This study evaluated the impact of PMIE exposure on NPC trajectories during intensive CPT for PTSD. We examined NPC trajectories in a group of 738 service members and veterans (SMVs) who participated in a 2‐week CPT‐based intensive PTSD treatment program. Time was a significant predictor of the Posttraumatic Cognitions Inventory (PTCI) score trajectory over treatment, p < .001. The interaction between time and PMIE exposure also significantly predicted PTCI trajectories, p = .008, such that higher PMIE exposure was related to higher PTCI scores during the first half of treatment; however, by the end of treatment, PTCI scores were visually similar regardless of PMIE exposure. The PTCI subscales (Negative Cognitions About the Self, Negative Cognitions About the World, and Self‐Blame) were also analyzed and resulted in similar associations with time and PMIE exposure as well as with PTCI total score. These findings suggest that intensive CPT appears to be effective in reducing NPCs in SMVs regardless of PMIE exposure. Therefore, even when patients report PMIE exposure, CPT clinicians should continue identifying and targeting NPCs.