Towards an Extended Cognitive Model of Moral Injury—The Role of Mental Defeat

Moral injury (MI) is a proposed syndrome that develops when someone is exposed to, participates in, or fails to prevent an action that fundamentally violates their moral code and results in maladaptive cognitions about oneself and humanity. Post-traumatic stress disorder (PTSD) is a disorder based on maladaptive cognitions that develops following a traumatic event. Decades of PTSD research underscore that the experience of mental defeat, or the perception that one was completely defeated during the traumatic event, plays a significant role in the development and maintenance of PTSD. Less work, however, has been done to develop a cognitive model of MI and to understand how mental defeat plays a role in the underlying maladaptive cognitions. Understanding the cognitive model of MI is key to developing effective cognitive therapy. In this paper, we first examine the role of mental defeat in PTSD cognitive models and then compare the PTSD cognitive model to proposed cognitive models for MI. Based on these comparisons and overlapping symptomology, we suggest that mental defeat plays an important role in MI cognitive models.