Nordefco conference 2024

Moral Injury in Veterans: ideas for measurement & treatment.
Dominic Murphy, Professor. Combat Stress & King's College London Dominic.Murphy@combatstress.org.uk (UK)

Exposure to potentially morally injurious events is increasingly recognised as a concern across a range of occupational groups, including military veterans. Moral injury-related mental health difficulties can be challenging for clinicians to treat and there is currently no validated treatment available for UK veterans.   Although there is a proliferation of interest in moral, there has been no operational definition of the syndrome and no standard assessment scheme or measure, which has hampered research and care in this area. This talk will briefly describe an international effort to define the syndrome of moral injury and develop and validate the Moral Injury Outcome Scale (MIOS).  In addition, the talk will discuss a new treatment for Moral Injury named Restore and Rebuild (R&R).

About the speaker
Professor Murphy is an academic consultant clinical psychologist, having completed both a PhD in Health Psychology and a Doctorate in Clinical Psychology. He is an expert in the field of psychological trauma and has extensive experience of caring for, and conducting research with, traumatised populations.  Dominic leads the Combat Stress Centre for Applied Military Health Research, is the current President of the UK Psychological Trauma Society, a Director for the European Society for Traumatic Stress Studies, and a Director of the KCMHR at King’s College London.  Dominic has focused on translational research to improve the outcomes for those affected by trauma and is widely published with over 200 scientific papers and reports.

Exploring moral injury in Danish military veterans: Initial findings and treatment approaches.
Anni B. S. Nielsen, PhD. vetc-vic004@mil.dk and Kathrine Friis, clinical specialist in psychotherapy and psycho traumatology vetc-mpa205@mil.dk. Danish Veterans Centre (DEN)

In this presentation, we explore initial findings and strategies for addressing moral injury among Danish military veterans including how moral injuries can be addressed in treatment. The presentation will focus on the adaptation and application of the Moral Injury Outcomes Scale (MIOS), incorporating data from veterans serving in the Red Sea as well as treatment-seeking Danish veterans. In the presentation we will describe the process from translating the MIOS into Danish, implementing it in our ongoing data collections; and discuss treatment implications for moral injury at the Danish Veterans Centre.

Information about the speakers
Anni B.S. Nielsen, MSc, RN, holds a PhD in Medicine from the University of Copenhagen. She is a senior researcher at The Research and Knowledge Centre in the Danish Veteran Centre. Her research includes quantitative studies of self-rated health and other health outcomes. Her current focus is on veterans, examining health outcomes like PTSD and predictors of mental health problems after treatment. She has implemented data collection on impacts of potential morally injurious events among Danish veterans.

Katrine Friis, MSc, is a certified clinical specialist in psychotherapy and psycho traumatology. She is a senior psychologist at the Department of Military Psychology in the Danish Veteran Centre. Her treatment experience includes managing trauma, insomnia, trauma-related nightmares, guilt, and shame in military personnel. Additionally, she is involved in research projects focused on the management of insomnia and complex PTSD. Together with her colleagues, she has developed and is now implementing a patient-centered modular treatment approach for complex PTSD.

Moral injury in the context of culture: reflections from an ongoing Danish study.
Lars Williams, PhD. Danish Institute for International Studies lawi@diis.dk (DEN)

In debates on military trauma, the concept of moral injury commonly refers to the psychological impact of having one’s moral expectations and beliefs violated. Yet, although moral injury has the potential to extend our understanding of combat-related trauma beyond the individualized focus of the clinical realm, most studies nevertheless focus on clinical assessment, diagnosis, and treatment. In this presentation, I aim to contribute to a better understanding of the cultural and contextual dimensions of moral injury. How can we address aspects like social practices, public perception, national narratives of war, and individual life trajectories as significant elements shaping the experience of morally injurious events for soldiers? And how may this create a foundation for more context-sensitive research and intervention? To this end, I build on the existing social science literature on moral injury and draw on preliminary results and reflections from an ongoing study of moral injury in a Danish context.


Information about the speaker
Lars Williams, holds a Ph.D. in Medical Anthropology, as well as degrees in Psychology and Journalism. His research explores how cultural notions and practices shape experiences, symptoms and course of treatment of mental illness, and post-traumatic stress disorder (PTSD) specifically. His current work focuses on the mental health of Danish military veterans follow their deployments to combat zones. He has been a lecturer and researcher at University of Copenhagen, a visiting researcher at Harvard University and at London School of Economics. He is currently a visiting researcher at the Division of Social and Transcultural Psychiatry, McGill University.

The religious dimension.
Synne Garff Director, Priest and author. Centre for faith, loss and trauma sgarffster@gmail.com (DEN)

In addition to conventional medical and psychological treatment, it can be beneficial to include religious perspectives when dealing with morally traumatized and injured people. When it comes to moral injuries Christianity stands on more than 2000 years of tradition. The Bible contains stories about evil, suffering, forgiveness, Gods love, compassion, faith and hope. Synne Garff shares findings from her new book 'The inner war. On moral injury in working life', where she introduces the concept of moral injury to Danish readers and highlights the internationally recognized method, Bible-based trauma healing. More than 240.000 people have participated in trauma healing groups. The method has been proven effective in restoring hope. A new material has been developed specifically for veterans.

Information about the speaker
Synne Garff holds a degree in Italian Studies, a supplementary degree in Theological Studies and is a master facilitator in the internationally recognized and research-based method Bible-based trauma healing from Trauma Healing Institute in US. She is specialized on the religious dimension related to trauma and Director of Centre for faith, loss and trauma. She also serves as a voluntary priest and is the author of a number of books. As international director of the Danish Bible Society for almost a decade, Synne Garff traveled extensively in conflict areas and worked with traumatized people globally.

Problematic Anger among Military Personnel after Combat Deployment: Prevalence and Risk Factors.
Andreas Nordstrand, PhD. Norwegian Forces Joint Medical Services (NOR)

Problematic anger, marked by excessive frequency, intensity, and duration, poses a significant challenge in military populations. In A novel study, we investigated problematic anger among 6205 Norwegian military personnel who had deployed to Afghanistan, finding that 8.4% reported struggling with such challenges. This makes problematic anger the most prevalent type of emotional distress in this veteran cohort. Moreover, deployment-related shame and guilt, chronic pain, and challenges transitioning to civilian life were linked to problematic anger, while staying in service after deployment, or as a reservist in the Home Guard reduced the risk. These findings underscore the need for multifaceted interventions and highlight how maintaining connections to the military can improve outcomes for service members. The presentation discusses the key results of this study.

Information about the speakers
Associate Professor at Department of Psychology - NTNU, and Commander in the Norwegian Armed Forces - Joint Medical Services. Clinical psychologist from NTNU, and educated within Intensive Short-Term Pscyhodynamic Therapy (ISTDP) and Cognitive Behavioral Therapy (CBT). Research interests: posttraumatic growth (PTG), psychological trauma, PTSD, veterans, military psychology, moral injury, acute stress managment, disaster psychology.

Moral Injury and Adaptive Disclosure: Results from Swedish veteran survey and veteran-oriented clinical method for healing.
Sofia Nilsson, PhD. National Defence University (SWE) and Louise Weibull, PhD. The Swedish Soldiers Homes Association (SWE)

Military leaders face the risk for trauma exposure and subsequent PTSD. However recently there has been a growing recognition of the complexity of the emotional and psychological consequences stemming from exposure to challenging situations. It is acknowledged that some psychological changes cannot be adequately explained within the framework of PTSD and may consequently remain unaddressed. In military personnel suffering from PTSD, moral injury often arises from the ethical complexities inherent in their traumatic experiences. Thus even as PTSD symptoms diminish, an inner conflict may persist, leading to ongoing suffering such as guilt and shame.

This first part of this presentation will discuss the main findings from a survey exploring the prevalence of PTSD and moral injury among Swedish deployed military veterans, as well as identifying variables of relevance for long-term health and well-being. Practical implications will be discussed. The second part introduces briefly, Adaptive disclosure, an evidence-based short term treatment, six to eight 90-minute sessions, developed specifically for veterans with combat-related PTSD resulting from life-threating experiences, traumatic loss and moral injury. In essence, it combines elements of prolonged exposure, cognitive processing therapy, and cognitive behavioral therapy for prolonged grief disorder. Its aims to initiate a process by which soldiers learn new ways of thinking, coping and living with their traumatic experiences.

Information about the speakers
Sofia Nilsson holds a PhD in pedagogy from Karlstad University, Sweden. She serves as an associate professor specializing in work and organizational psychology at the Swedish Defence University. Her research focuses on both quantitative and qualitative methodologies, exploring topics such as the experiences of military veterans deployed abroad, as well as aspects of health, coping mechanisms, and overall well-being.

Louise Weibull holds a PhD in working life science from Karlstad University, Sweden and completed a level 1 program in Cognitive Behavioral Therapy. Her thesis focused emotion management demands in operational theaters to match what is appropriate in various situations, regardless of soldiers’ personal feelings. She works for the Swedish Soldiers Homes Association coordinating veterans and their families’ psychosocial support. Her research interests includes moral injury, military families and post-deployment disorientation.

Afghanistan after August 2021: Taliban Governance and (the lack of) international engagement.
Jens Vesterlund Mathiesen, Special Consultant. Institute for Strategy & War Studies, Royal Danish Defence College (DEN)

After the chaotic withdrawal of Western forces from Afghanistan in August 2021, the Taliban has – once again – assumed power in Kabul. Defying the expectations of most international analysts, the Taliban has now ruled for more than three years, and has only consolidated their grip on power, providing some level of “stability” in the war-torn state. While the security situation in Afghanistan has drastically improved, the economic and humanitarian situation is dire, and the draconic policies of the Taliban regime has critically worsened the lives of women and girls. Looking in from the outside, no state has formally recognized the Taliban government labelling them as an international pariah. At the same time, regional countries are negotiating trade agreements, and bilateral diplomacy is taking place. This presentation will go into these apparent contradictions and present the “murky” situation of Afghanistan after August 2021.

Information about the speaker
Jens Vesterlund Mathiesen is a special advisor and researcher at the Center for Stabilisation, at the Royal Danish Defence College’s (RDDC) Institute for Stategy and War Studies. He is the Programme Coordinator for the RDDC Afghanistan-Pakistan programme financed by the Danish Peace and Stabilisation Fund, and has been researching security, defence and diplomacy in the region and beyond. His teaching and research focuses primarily on Afghanistan after August 2021 and the role of the international community, as well as the recent history of Danish military stabilisation operations. He has previously worked at the Center for Military Studies at the University of Copenhagen. He holds a Masters Degree in Political Science from Aarhus University. 

Afghanistan lost – and so what? Danish veteran perspectives on ‘the end’ of the ‘forever war’ and other critical events.
Thomas Randrup, PhD. Danish Military Academy FAK-ILO-39@fiin.dk (DEN)

This paper ethnographically and anthropologically explores how the events of 9/11, the Fall of Kabul, and the Russian invasion of Ukraine affect Danish Afghanistan veterans along lines, such as motivation, identity, morality, and worldview. How do Danish Afghanistan veterans relate to 9/11 today, and why did they join the ‘war on terror’ in the first place? How do Danish Afghanistan veterans make sense of their deployment experiences in the shadow of Taliban’s return to power? How do Danish Afghanistan veterans feel about the war in Ukraine, and how do they perceive current deployments to the Baltics in comparison with their time in Afghanistan.

Information about the speaker
Thomas Randrup Pedersen is Assistant Professor at the Institute for Leadership and Organization, Royal Danish Defence College. He has a PhD in anthropology from the University of Copenhagen, Denmark, and has for more than a decade devoted his time to the study of Danish soldier and veteran lifeworlds. His research is based on ethnographic fieldwork with Danish combat troops throughout deployment cycles in the contexts of Iraq and Afghanistan. His research interests cover subjects, such as soldierly (un) becomings, transformative experiences, military cultures, identities, masculinities, violence, and ethics.

Psychological change and mental health in Norwegian veterans twenty years after military service in Afghanistan.
Hans Jakob Bøe, PhD. Norwegian Forces Joint Medical Services (NOR)

In 2020 the Norwegian Armed Forces Joint Medical Services invited all Norwegian Afghanistan veterans to participate in a survey focusing on potentially traumatic experiences during their deployment, mental health status, somatic health complaints, and quality of life. Approximately 6220 veterans responded to the survey and 10,4 % of them reported mental health symptoms to a degree that suggested they suffer from a mental health disorder. Post-deployment psychological change was measured as the deprecation, growth, or no change in three domains; the existential domain, the interpersonal domain, and the self. Deprecation was most prevalent in the interpersonal domain. The presentation discusses the relationship between potentially traumatic experiences during deployment, psychological change, and mental health.

Information about the speaker
Major Hans Jakob Bøe (Ph.D) is a clinical psychologist and researcher at the Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services. He is also an associate professor at the Institute of Psychology, University of Oslo. The main topics of interest are psychotherapy, affect regulation, resilience, stress, leadership, and crisis management.

After twenty years of war in Afghanistan – A survey for all Swedish Afghanistan Veterans.
Frederik Svärd, Csm. Veterans Affairs Department (SWE)

More than 7 500 veterans from Sweden have served in Afghanistan between 2002-2021. When the Nato mission in Afghanistan ended, the Veteran Affairs wanted to give each veteran the opportunity to share their experiences from the time served. This survey is a result of that ambition. It also provides a benchmark for future surveys of ended participation in international military missions. 9 out of 10 of the survey’s respondents rated their experience in a favourable manner.

Information about the speaker
Frederik Svärd started in the Swedish Army as a conscript in 1989. Infantry/logistics officer since 1993. Been teaching at the Military Academy, served in regimental staff, served as ADC for a general at HQ. Four tours in NATO, EU and UN missions. Bosnia 1996 as Staff Section Leader, Log officer for SF in Congo/Uganda 2003, Company Cdr in Kosovo 2005 and Force Sergeant Major for Force Commander MINUSMA Mali 2020. Since 2023 as Command Sergeant Major for Swedish Armed Forces Veterans Affair Dep.

Long-term follow up on Finnish veterans.
Petteri Simola, PhD. psych (FIN)

The main focus of the presentation is on arranging long-term monitoring of the psychological well-being of veterans. However, the presentation also discusses the current process and current results of veterans’ mental well-being.

Information about the speaker
Petteri Simola (PhD, psych) works as a research manager at Human Performance Division (Finnish Defence Research Agency, FDRA). He also holds an academic position of an Associate Professor/Docent (Military Psychology) at National Defence University (NDU). His main focus areas at FDRA are related to personnel selection processes and research related to psychological performance. Academic publications at Orcid: Petteri Simola (0000-0003-2759-0592) - ORCID

The psychological well-being aspects of soldiers who have participated in international missions.
Lidija Stoniene, Capt. Psych. and Gabija Kačeraite, 1st LT. Psych. (LTU)

The research data are presented in the project “The study of the assumptions of suicidal behavior in the Lithuanian military: stress, resilience and attitudes towards suicide“. Scientific research co-financed by the European Social Fund in collaboration with the Lithuanian Science Council (LMTLT).  A comparison between soldiers who were deployed and those who have never been deployed, and who participated in the scientific study, will be presented. The key objectives of the comparison is to see if there are any changes in psychological well-being, physical health, alcohol consumption, psychological resilience, insomnia, relationship satisfaction, and perceived focus among soldiers who have been deployed compared to those who have not.

Information about the speaker
Captain Lidija Stoniene is a psychologist in the Military Psychology Division at MD Jonas Basanavicius Military Medical Service of the Lithuanian Armed Forces. Her areas of expertise include psychological crisis management, suicidal behaviors, and well-being of military personnel and their families. She is also a cognitive and behavioral therapist.

First lieutenant Gabija Kaceraite is a psychologist in the Military Psychology Division at MD Jonas Basanavicius Military Medical Service of the Lithuanian Armed Forces. Her areas of interest include suicidal behaviors, coping personality, and posttraumatic stress disorder management. She is also a student of cognitive and behavioral therapy.

Military Veterans on the Civilian Labour Market.
Peter Bäckström, PhD. Swedish Defence Research Agency (SWE)

Sweden has a long tradition of participating in international peacekeeping operations. However, despite the large number of Swedish men and women sent abroad, very little has been known about the long term labour market consequences of their service. In two recent studies, I used rich administrative data on Swedish veterans who were deployed over the period 1993 to 2010, and estimated the long term effects of deployment on a range of labour market outcomes, including earnings and indicators of labour market marginalisation. This presentation discusses the main findings from these studies.  

Information about the speaker
Peter Bäckström has a PhD in economics from Umeå University, Umeå, Sweden. He is a senior researcher at the Department of Defence Analysis at the Swedish Defence Research Agency in Sweden. He is also a visiting researcher at the Umeå School of Business, Economics, and Statistics. His research interests include military recruitment and the labour-market consequences of military service.

The advantage of a broad ministerial backing for the veteran cause.
Ola Bøe-Hansen, Commander Senior Grade, RNorN, Deputy Chief Veterans Affairs (NOR)

From its inception the recognition, following up and care for veterans in Norway has been seen as a matter not only for the Armed Forces but the whole society. This encompasses both public service providers as health, labour services and welfare and municipalities as well as veteran organisations (NGOs). A prerequisite for making this work has been a broad ministerial investment in the different aspects of the veteran cause, as exemplified by the Government's latest action plan for veterans (2024) where 7 ministries have co-signed the plan. This seems to be a fairly unique approach amongst the Nordic countries.

Information about the speaker
CDR Bøe-Hansen has a broad background within the armed forces, from fortresses and naval frigates, to the Command College and Defence Staff.  He is a veteran from several tours to international operations, and is also the author of several books from naval history to academic works within communications and narrative theory.

Experiences with training of peer-support.
Viljar Kurg, board member, NGO Veterans of Estonian Defence Forces (EST)

In 2017 Estonian Defence Forces’ (EDF) psychologists noticed, that quite often the veterans who are in the worse psychological condition at the time of contact with psychologists, are those who have left or retired from the service. It is important to identify the veterans with mental health complaints at an early stage in order to prevent symptom escalation. In addition, it was known that talking about one’s psychological problems or turning to a psychologist were both still quite stigmatized at EDF. Therefore EDF and NGO Veterans of Estonian Defence Forces designed the program “Friend’s Arm”. The aim of the program was to train voluntary peer-support veterans, who can notice the early signs of mental problems and know how to approach the veteran. This presentation gives an overview of the program and what we have learned from it.

Information about the speaker
Viljar Kurg is a board member of NGO Veterans of Estonian Defence Forces. He has served as platoon sergeant and STRATCOM officer at 6 different international military operations. Currently he has retired from active service, but continues service at EDF as director at Center of Support Services.

Register-based study of deployed female compared to male Swedish military veterans.
Kristian Neovius, PhD. Aux Analysis (SWE)

Studies on Swedish military veterans deployed since 1990 have found that veterans in general constitute a healthy group of individuals up to 30 years after return from deployment. However, more than 90% of these veterans are male. Whether the findings from men are representative also for the minority of female veterans has not been investigated. Therefore we have conducted a large register-based analysis focusing on all Swedish female veterans deployed since 1990. This presentation discusses the results for female veterans compared to male veterans in terms of mental, physical and social outcomes post-deployment.

Information about the speaker
Kristian Neovius has a PhD in epidemiology from the Karolinska Institute, Stockholm, Sweden. After his PhD, Kristian specialized in health economic evaluations of new treatments and technologies working as a freelance consultant. Since 2017 he is focusing on register-based epidemiological studies of Swedish military veterans.

Danish Female Veterans
Helene Pristed Nielsen PhD, Danish Defence, Naval Command (DEN)

Denmark is a country which generally prides itself as being gender equal. This is expressed within the Danish Armed Forces through identical physical requirements for both male and female soldiers, gender-mixed accommodation and all positions being open to all genders. However, when partaking in international missions, female Danish soldiers often experience being secluded from their unit through gender-segregated accommodation. This has severe social and operational consequences for their performance as soldiers on a supposedly equal footing with their male colleagues. Based on interviews with 25 female soldiers with recent deployment experiences, the presentation focuses on how gender is remade as a professionally differentiating factor among Danish military personnel during deployment. For most of the interviewed women, their professional aspiration is to become ‘one of the boys’ and be recognised as contributing equally to mission goals. However, their military professionalism is hampered through the gender segregation they experience during deployment.

Information about the speaker
Helene Pristed Nielsen has a PhD in minority studies from Aalborg University, Denmark. She works as special advisor to the Royal Danish Naval Command on issues related to diversity, equity and inclusion. Prior to this, she has 20 years of experience in research on gendered divisions in the labour market, gender equality, minority inclusion and equity in access to education and labour markets. She has previously researched deployment experiences among Danish military veterans. She is also an adjunct associate professor at the University of the Faroe Islands.