As research on moral injury has advanced, what is termed ‘a socio-cognitive conceptualisation‘ has been proposed to explain how moral injury develops and persists. This model, shown below, outlines the three components of moral injury: predisposing factors, cognitive appraisal (thinking) patterns, and maintaining factors.
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In this socio-cognitive model of moral injury, researchers suggest that a core feature of moral injury is a breakdown in one’s relationship with oneself, others, and humanity as a whole—often resulting in deep disillusionment, distress, and changes in behaviour.
The model outlines three key components:
- Predisposing factors (e.g., adverse childhood experiences): Factors that may increase vulnerability to developing or sustaining moral injury later in life.
- Cognitive appraisal (thinking) patterns: Describe how individuals interpret potentially morally injurious events based on their existing beliefs. These interpretations can sometimes lead to unhelpful or distorted thinking.
- Maintaining factors (e.g., social withdrawal or self-isolation): Factors that may prolong or worsen the impact of moral injury over time.
Together, these components illustrate the complex interaction between a person’s background, prior experiences, their interpretation of difficult events, and their coping behaviours in the development and persistence of moral injury.
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