Moral injury: Strategies for building resistance and resilience

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By Kevin Kloster

My phone rang at 1:48 a.m. It was the chief asking if I would drive to the station to meet a lieutenant’s wife and son. She hadn’t heard from her husband in over 12 hours, and they were worried because he was depressed.

Then the chief shared with me that they found him in his car. It was a death by suicide.

| MORE: Moral injury — What is it and how does it impact first responders?

Months earlier, the lieutenant had made a mistake on the job. He was a perfectionist who didn’t want the mistake in his file, so he initially blamed others. When it was discovered that it was, in fact, his error, he felt shame, guilt, regret and self-hatred. He could no longer live with the pain. This is one type of moral injury.

Defining moral injury

Moral injury is the intense psychological, spiritual, emotional and moral pain that stems from doing something, failing to do something, witnessing an act or experiencing betrayal that violates one’s moral code or values. Moral injury can lead to intense shame, unrelenting guilt or deep anger this is expressed as self-hatred or hatred of others, disgust in self or others, lack of trust, relationship issues, self-sabotage, isolation, distancing from faith, substance abuse or even suicide.

Moral injury is not post-traumatic stress disorder (PTSD), but it shares some characteristics — nightmares, sleep disturbances, anxiety and depression. PTSD is a fear-based trauma most often stemming from a life-threatening event. Moral injury is a value-based trauma most often resulting from an event that violated a one’s deeply held values or sense of right and wrong. PTSD is a clinical diagnosis that can be treated with medications, eye movement desensitization and preprocessing (EMDR) and other types of therapy. Moral injury is not a clinical diagnosis — there is nothing physically or mentally wrong; rather, the person has experienced something they believe is wrong that impacts them psychologically, spiritually, relationally, emotionally and even physically.

Healing or recovery involves work that addresses some combination of the following:

• Narrative processing of the event
• Grief work and loss acknowledgment
• Self-forgiveness and making amends
• Rebuilding trust and relationships
• Clarifying violated values
• Spiritual reconciliation
• Meaning-making and integration

As a chaplain among first responders, I’ve seen how moral injury has disrupted lives, families and departments. Most, if not all, of the first responder suicides that I’ve encountered involve a moral injury at some level. And I suspect moral injury is at the root of much of the substance abuse among first responders as well, as they seek to numb the internal pain.

Rather than focusing on recovery or models of repair, wouldn’t it benefit everyone if we could reduce the impact of moral injury before it turns traumatic, ideally by developing resistance and greater resilience against it?

Resistance: Building immunity

Think of resistance like a vaccine. When you get a vaccine, your body builds antibodies to keep you from getting sick. When it comes to moral injury there are some actions that, like a vaccine, can help build resistance.

But before we can build resistance, it is important to determine the origin of the moral injury.

• Self-originating means I did something or failed to do something that violates my values, my sense of right and wrong, my moral compass.
• Other-originating means someone else did something or failed to do something that violates my values.

We can, to some degree, build resistance for self-originating moral injury.

Practices that strengthen resistance to moral injury

At the heart of preventing moral injury lies moral integrity — the alignment between one’s moral compass and one’s actions. When a car is properly aligned, it drives smoothly. When misaligned, it vibrates and pulls off course. Similarly, when our actions contradict our values, internal dissonance creates distress, and that distress can become moral injury.

Such moral struggles fall into four categories:

1. Moral confusion is not knowing what to do in a situation — we need a moral compass to guide our choices. Moral compasses aren’t fixed constructs; they may change as we face new experiences in life, gain knowledge or cope with hardships. Therefore, everyone’s moral compass is unique. Building resistance requires clarity of one’s values, morals, beliefs and professional ethics. Knowing these values is the key first step in following them and thereby avoiding moral injury.

Action: Reflect on your most important values and beliefs.

2. Moral challenges are when you know the right thing to do but it’s difficult to do it. Moral challenges need moral courage to stand up for one’s values and beliefs despite barriers or consequences. Finding one’s voice to confront something that isn’t right is empowering but comes with risks of being dismissed, discounted or punished. Inherent in moral courage is the individual’s capacity to overcome fear and stand up for their core values.

In this context, building resistance means following a CODE:

• Courage: Feel the fear and then act with boldness.
• Obligations to honor: What is the right thing to do?
• Danger management: What do I need to handle my fear of what might happen?
• Expression: What action do I need to take to maintain my integrity?

Action: Use these strategies to handle fear: Develop back up plans if things don’t go your way such as contingencies for new roles, jobs, family or financial preparations; use positive self-talk or reframing; practice mindfulness and self-care; rely on your faith; and find allies who support you.

3. Moral temptations include situations when one knows the right thing to do but feels the intense desire to do the wrong thing. Temptation thrives on instant gratification. Research shows that self-control [1], grit [2], conscientiousness [3], mindfulness [4] and emotional intelligence [5] reduce impulsive decision-making.

Building resistance means developing strong moral character by making a PACT:

• Practice the pause and visualize negative consequences
• Ask self: How would you feel if you gave in to temptation? How would it impact your relationships, your reputation, and your self-respect?
• Commit to your values – doing the right thing when no one is looking.
• Turn to people who share your values. Who might you call for support?

Action: Cultivate accountability relationships. Find two to three people (mentors, Chaplains, trusted leaders) who can speak truth, reflect honestly and prevent moral drift.

4. Moral dilemmas are complex situations where one must choose between competing values where no option feels 100% right. It’s the choice between being loyal to a friend who is drinking on the job or protecting others whom this person might end up practicing medicine on. In these cases, building resistance to moral injury means putting on a thinking CAP:

• Consider your professional code of ethics. Are there protocols that guide your decision?
• Appeal to your dominant value. In the above dilemma, your value for protecting others from harm may be greater than loyalty to a colleague.
• Ponder ethically. There are a variety of ethical frameworks you can use, but here are some of the questions they ask: What is the universal principle I should follow? What’s the most loving thing to do? What choice brings the most good? What kind of person would I be if I made this choice?

Action: Select one of these questions to guide your decision-making.

Moral Resilience: Bending without breaking

Image/Courtesy of Kevin Kloster

If resistance is immunity, then resilience is rebound.

It is the capacity to bend under stress without shattering — to return to equilibrium after moral distress.

Psychologist George Bonanno’s [6] research demonstrates that resilience is common and learnable.

It is not a rare trait but rather a set of skills one can learn.

Consider the various dimensions of the self that are depicted in Figure 2. Each of these dimensions can be affected by moral injury and, likewise, they can be strengthened to become protective factors when faced with potentially morally injurious events.

Practices that strengthen physical resilience

Research has demonstrated that moral injury creates muscle tension, chronic pain, joint pain, fatigue, sleeplessness and gastrointestinal issues7 Because moral injury affects the whole person, strengthening physical health enhances resilience. When the body is stronger, one is better able to cope with potentially moral injury events. Here’s how you can build physical resilience.

• Exercise increases resilience-enhancing neurochemicals. Emory University conducted a resilience study involving mice. For 3 weeks, one set of mice ran to their hearts content on exercise wheels. Another cohort was kept inactive. After 3 weeks, the running mice had a higher level of a chemical called galanin, which helps improve mental health. The researchers then shocked all the mice’s paws to induce stress. The running mice rebounded more quickly than the inactive mice. The study suggests that exercise helps build resilience [8].

  Action: Hit the gym.

• Nutrition supports emotional regulation and stress recovery. Many of us, when stressed, have eaten an entire box of cookies or bag of potato chips. We gravitate to the aptly named comfort foods. Research shows9 that resilience was associated with a better diet quality. Think of it this way: A sturdy house that weathers the worst of storms needs a strong foundation. Your body is the same. If you help it by providing it with the nutrients it needs, particularly during stressful times, you’ll likely lessen physical symptoms caused by stress and give your body the strength it needs to get through the rough patch.

  Action: Eat well.

• Sleep is foundational. A Harvard Medical School study1⁰ found that 40% of first responders had sleep disorders. Shift work leads to sleep deprivation, emotional imbalance and negativity bias (more focus on negative events than positive) and reduced self-esteem.

  Action: Aim for at least 7 hours of quality sleep each night.

Practices that strengthen emotional resilience

Moral injury often manifests as shame, guilt, anger, grief, anxiety or self-blame. One can experience a loss of self-worth, loss of sense of self, loss of confidence, ruminating thoughts and trouble concentrating. Here’s how you can enhance your emotional resilience:

• Vulnerability and asking for help are strengths not weaknesses. Boys are often taught as kids, “Boys don’t cry” whereas girls hear, “Stop overreacting.” Showing people how you really feel takes courage and strength and allows others to support you. The Fraternal Order of Police partnered with NBC News to survey active and retired law enforcement officers across the nation. The results: 90% reported stigma as the barrier to getting help. They were afraid they would be perceived as weak and possibly passed over for a promotion. Also, 73% said peer support was the most helpful form of healing.11 Culturally, many first responders are conditioned to suppress vulnerability, yet unprocessed emotion fuels moral injury1². Action: Practice saying, “I’m not OK” with your team so that it feels OK to ask for help.
• Talk about what happened. Talking through morally distressing events may initially increase discomfort, but narrative processing activates higher-order brain regions and integrates emotional memory. You may feel like you are pulling backward, but imagine an arrow in a bow — life is actually preparing you to fly forward. The key is to keep engaging when you want to pull away and quit. Talking about it helps. Action: Practice regular debriefs with your team after potentially morally injurious experiences.
• Reframing is thinking about a negative or challenging situation in a more positive way. One might blame themselves for something that happened, but reframing it can help them see that they really did their best. Reframing techniques change physical responses to stress because the body’s stress response is triggered by perceived stress more often than it is by actual stressful events. Action: Practice flipping negative beliefs into positive ones with your team.

Practices that strengthen social resilience

Moral injury rooted in shame, self-blame, self-hatred, anger, disgust or guilt can lead to social isolation. If you have experienced a betrayal of trust, you may be very guarded in relationships. But building strong social connections has proven to be protective against trauma and builds resilience1³. Withdrawal and isolation amplify distress. Positive connections mitigate it. Here’s how you can strengthen your social resilience:

• Build trust before trauma. In other words, find your tribe that you trust — people who are reliable, who will follow through on commitments, and hold your struggles in confidence. These are your go-to people — the safe people who create a space where you can be vulnerable, express feelings, talk through what happened and find support. The more social support you have, the more people there are to help you rebound from moral distress.1⁴Action: Write the names of three people you trust and let them know they made the list.
• Serve others. Allan Luks, author of “The Healing Power of Doing Good: The Health and Spiritual Benefits of Helping Others,” has researched a phenomenon he calls “Helper’s High.”1⁵ Serving others helps improve physical and emotional health by reducing stress. It also helps protect against anxiety, burnout and depression. Individuals who have volunteered throughout their lifetime typically live longer and have better psychological well-being. In addition to the health benefits, volunteering gives people a sense of purpose. When we help others, we can experience sensations of satisfaction and happiness, and the act of giving releases endorphins in the brain, which are the body’s natural “feel good” chemicals. These endorphins trigger a positive feeling in the body, similar to the feeling of pleasure that comes from exercise and laughter. Action: Volunteer where your passion lies.

Practices that strengthen spiritual resilience

Moral injury often triggers a spiritual crisis marked by questioning beliefs, being angry at God, feeling unforgivable, losing faith, a distrust in humanity, decreased spiritual practices, and even anomie — the complete collapse of a moral system. Studies have shown that people with low spiritual well-being were likely to have an elevated level of moral injury. Those with strong levels of life meaning and purpose were less likely to experience moral injury. Strengthening spiritual fitness builds resilience against moral injury.1⁶ So, what can you do to strengthen your spiritual fitness and, hence, resilience?

• Embrace spiritual practices: Research shows that practices such as prayer, meditation, yoga and communal worship reduce stress and restore meaning.1⁷ A little time at the beginning of the day and throughout the day to meditate, pray, breathe, reflect, walk in nature, being present in the moment , or having a spiritual community for support helps people handle potentially morally injurious events. Action: Find what practice works for you and do it daily.
• Practice gratitude: Being grateful counteracts the negativity bias of trauma.1⁸ Trauma tends to heighten a negative mindset. Being grateful trains the mind to see the positive, even amid struggle. This helps increase hope and optimism — both key protective factors for moral injury. Action: Start the day by considering something for which you are grateful.

• Foster a positive image of God: Among those who believe in a higher power, people with a positive image of God have better mental health than those with a negative image of God. 1⁹ People who believe that God is loving, kind, forgiving and compassionate can rebound from potentially morally injurious events more quickly than those who think God is mean, judgmental, punishing and demanding of righteousness. When facing a potentially morally injurious event, a positive image of God helps with forgiveness, self-forgiveness, self-hatred, hatred of others, anger at God, as well as finding purpose and meaning in what happened that can foster growth2⁰.

  Action: Focus on the goodness of God.

A different kind of training

Fire departments pride themselves on operations-based training, and rightly so. But our readiness also depends on moral, physical, emotional, social and spiritual fitness. Training should also address issues like moral challenges, sleep and physical health, asking for help, building trust, serving others and practices that support reflection and gratitude. Building resistance and resilience to moral injury is as important as any other training we do in the fire service because it helps protect the lives of firefighters as well as those they serve.

Health & Wellness

Trauma recovery for first responders: You are worth the work

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April 08, 2025 10:23 AM

 · 

Lexipol Content Development Team

ABOUT THE AUTHOR
Rev. Kevin Kloster is the chaplain for the Rapid City (S.D.) Fire Department. He has over 27 years as a chaplain in both law enforcement and the fire service. He currently serves as the Director of Moral Injury with VOA Northern Rockies where he leads a team of professionals across South Dakota, Wyoming and Montana working with veterans who have experienced moral injury in their service to our country. He is a frequent speaker and trainer at veteran and first responder agencies.

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