Enhancing Veteran Wellbeing through Mindfulness Programs

Introduction to Mindfulness and Moral Injury in Veterans

Moral injury is a term that has gained traction in recent years as it describes the psychological distress that results from actions, or the lack of actions, that violate an individual’s moral or ethical code (Kelley et al., 2025). It is particularly relevant for veterans who have experienced combat, where the consequences of their actions may lead to profound feelings of guilt, shame, and self-condemnation (Litz et al., 2009). This psychological burden can contribute significantly to mental health issues such as PTSD, depression, and anxiety, which are prevalent among veterans (Bravo et al., 2020).

Mindfulness, defined as the practice of maintaining moment-to-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment, offers a potential path toward alleviating the symptoms of moral injury (Kabat-Zinn, 1990). By fostering a non-judgmental awareness of present experiences, mindfulness can help veterans process their emotions and experiences, leading to improved mental health outcomes.

The Mindfulness to Manage Moral Injury (MMMI) program is a web-based, 7-week mindfulness-based intervention specifically designed for veterans. It aims to address the unique emotional challenges associated with moral injury, providing a space for veterans to explore their feelings and cultivate self-compassion (Kelley et al., 2025).

Feasibility and Satisfaction in Mindfulness Programs for Veterans

Understanding the feasibility and satisfaction levels associated with mindfulness programs is critical for their implementation in veteran care. A pilot study involving 56 post-9/11 veterans revealed that 82.1% attended at least one treatment session, while 44.6% completed all seven sessions of the MMMI program (Kelley et al., 2025). These attendance rates suggest a high level of engagement, indicating that online mindfulness programs can effectively reach veterans who might not seek traditional care through Veterans Affairs Medical Centers (VAMCs).

Participants expressed a high level of satisfaction with the MMMI program, particularly in the areas of learning and applying mindfulness techniques to manage their moral injury symptoms. The study found that veterans in the MMMI condition reported higher satisfaction scores compared to those in the Education and Support (ES) condition, with statistically significant differences in various satisfaction metrics (Kelley et al., 2025).

Table 1: Treatment Satisfaction Scores

Key Components of Mindfulness to Manage Moral Injury (MMMI)

The MMMI program incorporates several key components that are essential for effectively addressing moral injury among veterans. These components include:

1. Mindfulness Practices: Participants engage in various mindfulness exercises designed to increase awareness of their thoughts and feelings without judgment. This helps veterans to acknowledge and process their moral injury experiences.

2. Self-Compassion Training: A crucial element of the program is teaching veterans how to cultivate self-compassion. This is particularly important given the guilt and shame often associated with moral injury.

3. Peer Support: The group format allows veterans to share their experiences and provide support to one another, fostering a sense of community and reducing feelings of isolation.

4. Psychoeducation: Participants receive information about moral injury and its effects, helping them to understand their experiences in a broader context.

5. Home Practice Assignments: Veterans are encouraged to practice mindfulness techniques at home, reinforcing the skills learned during sessions.

Comparison of MMMI and Education and Support (ES) Conditions

While both the MMMI and ES conditions targeted moral injury, they differed significantly in their approaches. The ES condition focused on providing information and resources related to moral injury without incorporating mindfulness practices. Although participants in the ES condition also reported some benefit, the MMMI group demonstrated greater satisfaction and more significant engagement with the material.

Table 2: Comparison of Program Components

Future Directions for Mindfulness Interventions in Veteran Care

The promising results of the MMMI program suggest several future directions for mindfulness interventions in veteran care:

1. Larger Scale Trials: To validate the efficacy of the MMMI program, larger randomized controlled trials should be conducted, including diverse veteran populations.

2. Integration into VA Services: The incorporation of mindfulness programs into existing VA services may enhance accessibility for veterans seeking mental health support.

3. Long-term Follow-up Studies: To assess the sustainability of mindfulness benefits, long-term follow-up studies should be conducted, evaluating the ongoing impact of mindfulness on veterans’ mental health.

4. Expansion of Content: Future iterations of the program could explore additional topics such as resilience training and coping strategies for dealing with trauma.

5. Technology Utilization: Exploring the use of technology, such as mobile applications and online platforms, can facilitate the delivery of mindfulness interventions to veterans, particularly those in remote areas.

FAQ Section

What is moral injury?

Moral injury refers to the emotional distress experienced when a person’s actions or inactions violate their moral or ethical beliefs, often leading to feelings of guilt, shame, and loss of trust.

How does mindfulness help with moral injury?

Mindfulness helps individuals to become aware of their thoughts and feelings without judgment, allowing them to process their experiences more healthily and cultivate self-compassion.

What is the MMMI program?

The Mindfulness to Manage Moral Injury (MMMI) program is a web-based, 7-week intervention designed to help veterans address the emotional challenges of moral injury through mindfulness practices.

How can veterans access the MMMI program?

Veterans can access the MMMI program through participating institutions or organizations that provide mental health services, often facilitated by trained professionals.

Are there any risks associated with mindfulness programs?

Mindfulness programs are generally safe; however, participants may experience discomfort when confronting difficult emotions. It is essential to have trained facilitators to guide veterans through the process.

References

1. Bravo, A. J., Kelley, M. L., Mason, R., Ehlke, S. J., Vinci, C., & Redman, J. C. (2020). Rumination as a mediator of the associations between moral injury and mental health problems in combat wounded veterans. Traumatology, 26(1), 52–60. doi:10.1037/trm0000198

2. Kelley, M. L., Bravo, A. J., Burgin, E. E., Gaylord, S. A., Vinci, C., Strowger, M., Gabelmann, J. M., & Currier, J. M. (2025). Using mindfulness to manage moral injury in veterans: Feasibility and satisfaction of a pilot randomized controlled trial. Journal of Clinical Psychology. doi:10.1002/jclp.23778

3. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press.

4. Litz, B. T., Stein, N., Delaney, E., et al. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. doi:10.1016/j.cpr.2009.07.003

5. U.S. Department of Veterans Affairs. (2020). Whole Health: The Circle of Health

6. Williams, J. M., & Keng, S. L. (2019). Mindfulness interventions for mental health in the military: A review of current literature. Military Medicine, 184(5-6), 353-363. doi:10.1093/milmed/usz059

7. Cenkner, D. P., Yeomans, P. D., Antal, C. J., & Scott, J. C. (2021). A pilot study of a moral injury group intervention co-facilitated by a chaplain and psychologist. Journal of Traumatic Stress, 34(2), 367–374. doi:10.1002/jts.22642