Forgiveness Therapy for Veterans With PTSD

Abstract

This dissertation investigated the application of Enright’s forgiveness therapy model as a novel approach to treating veterans with Post-Traumatic Stress Disorder (PTSD), a disorder negatively affecting the lives of a substantial number of veterans who served in combat. With an estimated 11-20% of Operation Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans experiencing PTSD, 7-11% of Vietnam veterans maintaining their PTSD diagnosis, and around 14% for those who served in the Gulf War having PTSD, the urgency for effective treatments is clear. The persistent and pervasive nature of PTSD and its comorbidities, such as major depressive disorder, chronic pain, and substance abuse, have taken a heavy toll on the lives of many veterans and their families. This dissertation depicts the profound impact of combat trauma on veterans' lives, which are often characterized by disturbing nightmares, intense anxiety, social withdrawal, and a pervasive state of hypervigilance, leading to a diminished quality of life, and at times increased suicidality. The gold standard Evidenced-Based Therapies (EBTs) recommended by the VA/DoD and APA for treatment of PTSD–Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT)–are effective for some veterans; however, they result in alarmingly high dropout rates, concerning levels of non-responders, and do not consistently demonstrate significant benefits over non-trauma focused treatments. The numerous limitations to these EBTs indicate a call for alternative therapeutic treatments. Furthermore, the emotional cost they incur by reexposing veterans to traumatic memories results in many veterans opting to defer treatment altogether, amplifying the need for alternatives. Research suggests the often complex, varied, interpersonal, and moral nature of combat trauma requires more nuanced approaches to treatment than the one-size-fits-all monotherapies which are currently offered. Forgiveness therapy poses a potential antidote to any underlying anger, resentment, vengeance, betrayal, interpersonal harm, and moral injury which may have resulted from combat trauma. This study reveals that anger and resentment can play a powerful role in sustaining PTSD symptoms and may at times only be overcome through forgiveness. Furthermore, it posits that the existential experiences many combat veterans undergo and engage in, such as instilled hatred, dehumanization of self and enemy, a fixed “enemy vs. ally” lens, and conditioned lethality, all can pose significant roadblocks to the adoption and implementation of forgiveness. Through an expansive literature review, it explores the ways forgiveness can help treat mental illness, the integration of forgiveness in existing PTSD treatment models, and the specific challenges combat veterans face that forgiveness therapy can uniquely address. The work also includes a discussion of self-forgiveness and the importance of integrating spiritual, religious, and moral dimensions in the healing process. Drawing from Enright’s model of forgiveness therapy, the dissertation proposes a structured group intervention adapted for veterans. In addition, it provides commentary on how the four phases of Enright’s forgiveness model could be uniquely tailored and applied to veterans. In summary, this work advocates for a broader application of forgiveness therapy in treating veterans with PTSD, suggesting that attending to the anger and moral and emotional wounds of combat trauma through forgiveness can offer a path toward healing not fully addressed by existing therapies. The dissertation calls for further research into forgiveness therapy's efficacy for combat veterans, its integration with faith-based approaches, and its potential to fill some of the gaps left by traditional treatments.