Connecting with Meaning While Living with Moral Pain: A Workshop on ACT for Moral Injury (ACT-MI)

Connecting with Meaning While Living with Moral Pain: A Workshop on ACT for Moral Injury (ACT-MI)

Connecting with Meaning While Living with Moral Pain: A Workshop on ACT for Moral Injury (ACT-MI)

Dates and Location of this IN-PERSON 2-Day Workshop:

IN-PERSON at the Sheraton, New Orleans

Tuesday, July 15, 2025 from 8:30 a.m. to 4:45 p.m.
Wednesday, July 16, 2025 from 8:30 a.m. to 4:45 p.m.
CE credits available: 13  

Workshop Leaders:

Lauren M. Borges, Ph.D.  

Jacob K. Farnsworth, Ph.D. 

Sean M. Barnes, Ph.D. 

 

Workshop Description: 

Moral distress is an ever-present reality of the human experience. In some cases, this distress stems from the consequences of our own actions, or the actions of those we trusted. We are increasingly confronted with news of other’s moral violations through media outlets and social platforms, thereby heightening our awareness of the moral distress we face. While all humans experience moral distress, exposure to high stakes contexts that threaten safety and social belonging may be more likely to result in clinically significant impacts. But recovery is possible. As a client who graduated from Acceptance and Commitment Therapy for Moral Injury (ACT-MI) shared, “I can live life again. I can go outside. I can spend time with my kids. I can be a better mom. I thank God every day that I got to be a part of this.”

High stakes experiences evoking moral distress, “potentially morally injurious events” (PMIEs), can include healthcare work, war, domestic violence, sexual assault, racism, political violence, experiences of journalists, terrorism, school shootings, life-threatening impacts of climate change, infidelity, homophobia, or similar events [1-6]. After a PMIE, it is common that individuals experience painful moral emotions (e.g., guilt, shame, contempt, anger, disgust) and morally-focused cognitions (e.g., blame directed at the self or others). While these responses can be evolutionarily and often socially adaptive, they can also be profoundly distressing. Understandably, when people experience painful moral emotions and cognitions they may go to great lengths to avoid or control them. Moral injury emerges when efforts to control moral pain significantly interfere with social, psychological, and spiritual functioning [7-8]. Extreme behaviors like suicidal actions and substance use are common responses to avoid or control moral pain. Similarly, symptoms of PTSD and depression, such as isolation, are often ways to avoid or manage moral pain. Given the widespread impact of moral distress and its significant consequences, it is essential for clinicians to develop skills to address and treat moral injury effectively.

Acceptance and Commitment Therapy for Moral Injury (ACT-MI) is a promising approach to working with moral pain and intervening on moral injury [7-9]. ACT-MI is an innovative, process-based, and transdiagnostic 15-session hybrid group (12-group psychotherapy sessions) and individual psychotherapy (3-individual case conceptualization sessions) where individuals learn new strategies to hold their moral pain while living their values. Results from a clinical trial (N = 74 participants) will be presented, suggesting that ACT-MI participants experienced clinically significant change in psychosocial functioning and found the intervention to be highly acceptable. Qualitative interviews suggest that skills supporting mindfulness, perspective taking, and living values were central to the transformative impacts of ACT-MI.

Day 1 of the workshop will begin with an exploration of data from the ACT-MI clinical trial. Case conceptualizing will provide a process-based framework for intervention where participants will learn strategies from ACT-MI designed to disrupt the behaviors maintaining moral injury and facilitate new learning in the presence of moral pain. 
Participants will be invited to explore their own moral pain and related behaviors as they are guided through the arc of the ACT-MI intervention.

Day 2 of the workshop will continue the exploration of the 15-session ACT-MI intervention by bringing more depth, fluency, and flexibility for applying skills to engage with moral pain while staying connected to a sense of meaning and purpose. New experiential exercises and metaphors will be introduced, and case conceptualizing will be revisited to disrupt the pathways maintaining moral injury from different angles.

Across the workshop, participants will engage in experiential exercises at individual and group levels to practice skills to hold moral pain flexibly and connect with values. Individually, participants will be invited to apply ACT-MI to holding their own moral pain. In small groups they will have the opportunity to practice role plays and real plays as client and therapist applying ACT-MI skills to their “client’s” moral distress. Workshop participants will also connect with the social functions of moral emotions as a community through experiential exercises in a large group.

References

  1. Borges, L. M., Holliday, R., Barnes, S. M., Bahraini, N. H., Kinney, A. R., Forster, J. E., & Brenner, L. A. (2021). A longitudinal analysis of the role of potentially morally injurious events on COVID-19 related psychosocial functioning among healthcare providers. PLOS ONE. doi: 10.1371/journal.pone.0260033 
  2. Borges, L. M., Desai, A., Barnes, S. M., & Johnson, J. P. S. (2022). The role of social determinants of health in moral injury: Implications and future directions. Current Treatment Options in Psychiatry, 9(2), 202-214. doi:10.1007/s40501-022-00272-4
  3. Currier, J. M, McDermott, R. C., Farnsworth, J. K., & Borges, L. M. (2019). Temporal associations between moral injury and PTSD symptom clusters in military veterans. Journal of Traumatic Stress, 32(3), 382-392. doi:10.1002/jts.22367
  4. Desai, A., Holliday, R., Wallis, M., Thornewill, A., Bahraini, N. H., & Borges, L. M.* (2023). In the wake of Dobbs v. Jackson Women’s Health Organization: Policy Changes as a context for moral injury development. Obstetrics and Gynecology, 141(1), 15-21. doi:10.1097/AOG.0000000000005009
  5. Fulton, T., Lathan, E. C., Karkare, M. C., Guelfo, A., Eghbalzad, L., Ahluwalia, V., Ely, T. D., Turner, J. A., Turner, M. D., Currier, J. M., Mekawi, Y., & Fani, N. (2024). Civilian Moral Injury and Amygdala Functional Connectivity During Attention to Threat. Biological psychiatry. Cognitive neuroscience and neuroimaging, 9(1), 112–120.
  6. Henritze, E., Goldman, S., Simon, S., & Brown, A. D. (2023). Moral injury as an inclusive mental health framework for addressing climate change distress and promoting justice-oriented care. The Lancet. Planetary health, 7(3), e238–e241. doi:10.1016/S2542-5196(22)00335-7
  7. Borges, L. M., Barnes, S. M., Farnsworth, J. K., Drescher, K. D., & Walser, R. D. (2022). Case conceptualizing in Acceptance and Commitment Therapy for Moral Injury (ACT-MI): An active and ongoing approach to understanding and intervening on moral injury. Frontiers in Psychiatry, 13, 1-14. doi:10.3389/fpsyt.2022.910414
  8. Farnsworth, J. K., Drescher, R. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual Behavioral Science, 6(4), 391-397. doi:10.1016/j.jcbs.2017.07.003
  9. Borges, L. M. (2019). A Service Member’s experience of Acceptance and Commitment Therapy for Moral Injury (ACT-MI): “Learning to accept my pain and injury by reconnecting with my values and starting to live a meaningful life.” Journal of Contextual Behavioral Science, 13, 134-140. doi:10.1016/j.jcbs.2019.08.002

 

 

About the Workshop Leaders:

Lauren M. Borges, Ph.D.

Lauren M. Borges, Ph.D. is a clinical research psychologist at the Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for suicide prevention. She holds an academic appointment of Associate Professor in the Department of Psychiatry at the University of Colorado School of Medicine. She is a consultant for VA's National Suicide Risk Management Consultation Program. She is federally funded to investigate different applications of Acceptance and Commitment Therapy for moral injury and for suicidal behavior among Veterans and health care providers. She is a co-author of Acceptance and Commitment Therapy for Moral Injury (ACT-MI) and clinically specializes in the treatment of moral injury and suicidal behavior. She has written numerous peer reviewed journal articles on moral injury, ACT, and suicide prevention and has provided many workshops at national and international conferences on ACT-MI, functional analysis, an d ACT for suicide prevention.

Jacob Farnsworth, Ph.D.

Jake Farnsworth, Ph.D. is the Psychology Discipline Lead and Psychology Internship Training Director for VA Eastern Colorado Health Care System. He is an instructor with the Department of Psychiatry at the University of Colorado School of Medicine. He is a co-author of Acceptance and Commitment Therapy for Moral Injury (ACT-MI) and has written numerous articles and book chapters on the subject and related topics. Clinically, Dr. Farnsworth specializes in the intersection of trauma-related disorders, substance use, and military-related moral injury.

Sean Barnes, Ph.D.

Sean M. Barnes, Ph.D. is a licensed clinical psychologist in Aurora, Colorado with expertise in suicide risk management and the use of Acceptance and Commitment Therapy (ACT) for depression, moral injury, and vital living among individuals at risk of suicide. Dr. Barnes is an Associate Professor in the Department of Psychiatry at the University of Colorado Anschutz Medical Campus and clinical research psychologist with the Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Veteran Suicide Prevention. Dr. Barnes has extensive experience providing consultation and supervision on suicide risk management and ACT, has authored numerous peer reviewed articles and book chapters, and has been providing workshops on suicide prevention since 2015.

Following this workshop participants will be able to:

  1. Describe populations who could benefit from moral injury treatment
  2. Discuss data supporting ACT-MI
  3. Describe how to conceptualize moral injury using principles from ACT-MI and contextual behavioral science
  4. Experientially explore the workability of avoiding and controlling moral pain
  5. Using the ACT-MI conceptual framework, apply procedures from ACT-MI to create a context for holding moral pain through the observer self 
  6. Support clients in building present moment awareness and the ability to hold moral pain without becoming consumed by it.
  7. Define the relationship between moral pain and values as two sides of the same coin. 
  8. Practice holding morally painful memories from the perspective of an observer who has but is not defined by these memories
  9. Practice holding sweet, cherished memories from an observer perspective as the place where memories occur 
  10. Explain how to guide clients in building patterns of behavior informed by their values.
    *Note: Kent D. Drescher, Ph.D. and Robyn D. Walser, Ph.D. are ACT-MI authors and will contribute to the workshop planning, but will not be presenting at the proposed pre-conference workshop. 
     

Target audience: Beginner, Intermediate, Advanced, Clinical, Research

Components: Conceptual analysis, Literature review, Original data, Experiential exercises, Didactic presentation, Case presentation, Role play
Topic Areas: Clinical 

Package Includes: A general certificate of attendance

CEs Available (13 hours): CEs for Psychologists

staff_1