Acceptance and commitment therapy for moral injury (ACT-MI) and present-centered therapy for moral injury (PCT-MI): Results from a randomized controlled pilot trial with war zone deployed veterans.

Acceptance and commitment therapy for moral injury (ACT-MI) and present-centered therapy for moral injury (PCT-MI) were developed and piloted through the study. ACT-MI was created to improve psychosocial functioning among veterans experiencing moral injury. PCT-MI was developed as a transdiagnostic process-based moral injury intervention and an active comparison condition for a future ACT-MI efficacy trial. A randomized controlled pilot trial was conducted where 74 war zone-deployed veterans were randomized to ACT-MI or PCT-MI. Aims were to test the acceptability of ACT-MI and PCT-MI, evaluate study design feasibility, and determine candidate outcomes and sample size for a future efficacy trial. ACT-MI and PCT-MI are 15-session psychotherapies, including group (12 sessions) and individual case conceptualization (three sessions) sessions. ACT-MI was acceptable to veterans as evidenced by Client Satisfaction Questionnaire (CSQ) scores (M = 29.52, SD = 3.73, 95% CI [28.10, 30.94]). In qualitative interviews, ACT-MI was described as impacting psychosocial functioning and providing alternatives to suicidal behavior and substance use. PCT-MI was also acceptable to veterans (CSQ M = 26.41, SD = 5.07; 95% CI [24.40, 28.40]). Veterans reported PCT-MI contributed to social connection, understanding moral injury symptoms, and present moment problem solving. The study design was feasible to implement. The Outcome Questionnaire-45 was the candidate psychosocial functioning measure most sensitive to change (ACT-MI: N = 29, M = -17.45, SD = 19.33, 95% CI [-24.80, -10.10]; PCT-MI: N = 27, M = -5.89, SD = 15.29, 95% CI [-11.94, 0.16]). Next steps are described, including a full-scale efficacy trial to evaluate the impacts of the interventions on psychosocial functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).