The Mindfulness and Acceptance Workbook for Moral Injury: Acceptance and Commitment Therapy Skills for Moving Beyond Shame, Anger, and Trauma to Recla, Evans Wyatt R., Drescher Kent D., Farnsworth Jacob K.

A lifeline for healthcare workers in the midst of moral pain during the COVID-19 crisis

On the front line of the COVID-19 response are thousands of healthcare providers working in strained systems with limited resources. Difficult decisions will be part of the experience of working under these circumstances. The moral dilemmas that providers may face in this crisis will undoubtedly lead to moral distress and emotional pain.

Providers may have to make decisions about life and death, determining who gets life-saving equipment and attention and who does not. Working long and stressful hours may lead to accidental mistakes, oversights, or inaction. Providers working in overburdened or under-resourced systems may experience a sense of being thwarted in their effort to keep their oath and live their values. For providers who hold values such as service, caring, or protection, these potentially morally injurious events may have lasting consequences. Anger, guilt, and shame may plague those suffering from these seemingly impossible situations. If providers become mired in this moral pain, they may find their personal and professional lives become increasingly burdened by moral injury.

The Moral Injury Workbook was developed to facilitate healing for people who have experienced a variety of moral violations and addresses a wide range of moral emotions--from guilt and shame to contempt and anger. It offers a step-by-step program to help readers move beyond their moral pain, reconnect with a fuller sense of self, and re-engage with deeply held values.

This workbook is a lifeline for healthcare providers in the midst of moral pain. Oriented toward and guided by values of caring and compassion, the content of this workbook may be meaningfully applied to and engaged in the personal and professional practices of all who read it. The six core processes of acceptance and commitment therapy (ACT) are broadly addressed in the workbook to apply to a range of moral injuries. They may be used in service of the healing needed by those suffering in the presence and aftermath of this pandemic.

1. Connecting to a fuller sense of self will enable providers to grow awareness of their ever-present values and of the experiences continuously unfolding within and around them.
2. Stepping back from moral rules and de-fusing from the evaluations and criticisms of the mind will enable providers to see the moral values underlying those rules and to decrease the power and impact of those judgments.
3. Clarifying personal values will help providers reconnect with what led them to the healthcare field, and will reorient them in the direction of their moral compass.
4. Acknowledging the moral violations and engaging acceptance of painful emotions will enable providers to both learn from these heart-wrenching events as well as to redirect energy from controlling pain to cultivating purpose.
5. Contacting the present moment through mindful awareness will enhance providers ability to remain connected to themselves, their colleagues, and their patients, orienting attention and action toward values in the here and now.
6. With compassion and in the service of forgiveness, engaging in committed actions aligned with values--including those previously violated--will not only bring about personal moral healing but will also restore vital, enriching professional practices.