The Minneapolis VA Medical Center was an early leader in researching and defining moral injuries — the mental breaks that soldiers can suffer when their use of lethal force during war contradicts their deeply held spiritual beliefs.

Now, clinicians and chaplains at the veterans hospital are studying how to treat it.

Psychologist Irene Harris and colleagues tested an eight-session, chaplain-led program on veterans with post-traumatic stress disorder, while others with PTSD received a treatment called present-centered group therapy that has no spiritual component.

Declines in PTSD symptoms, such as anxiety and event flashbacks, occurred in both groups. Where the new program (called Building Spiritual Strength) differed was in its reduction of spiritual distress — the disruption of someone’s belief system.

Progress in that measure is critical, Harris said, because spiritual stress and sudden doubt in the divine can increase the risk of suicide.

“It’s getting swept under the rug” when treatment doesn’t include a spiritual component, Harris said. “And often, if something doesn’t get talked about, it gets worse.”

Results from the small, comparative study were presented this month at the Minneapolis VA’s annual research day. Other studies updated progress in testing a steroidal treatment for Gulf War Illness and identified predictors of veterans who struggle with chronic pain.

Harris’ study was the second to test the spiritual treatment that they invented a decade ago. They billed it as the first comparative clinical trial to show that a treatment for moral injury could reduce spiritual distress.

VA leaders hope the chaplain-led approach will be inviting to veterans who are reluctant to initially pursue formal mental health treatment.

One goal is to train chaplains outside of the military. Harris said it can be combined with traditional PTSD and mental health therapies.

It treats distress caused by a disruption in the relationship with a higher power. Soldiers who are Christians and use lethal force might trip on the “thou shall not kill” commandment, for example, and need reminding that forgiveness is at the core of their faith.