title: Impact of Killing in War: A Randomized, Controlled Pilot Trial.
abstract: OBJECTIVE
  The purpose of this pilot study was to test the effectiveness of Impact of Killing (IOK), a novel, cognitive-behavioral treatment (CBT) aimed at reducing mental health symptoms and functional impairment.
  
  
  METHODS
  Participants were 33 combat Veterans with a posttraumatic stress disorder (PTSD) diagnosis who had completed trauma-focused psychotherapy and reported distress regarding killing or feeling responsible for the deaths of others in war. Veterans were randomized to either IOK treatment or a 6-week waitlist condition, after which Veterans could receive IOK. IOK is a 6- to 8-session, weekly, individual, CBT, lasting 60-90 minutes, and focused on key themes, including physiology of killing responses, moral injury, self-forgiveness, spirituality, making amends, and improved functioning.
  
  
  RESULTS
  We found that compared to controls (N = 16), the IOK group (N = 17) experienced a significant improvement in PTSD symptoms, general psychiatric symptoms, and quality of life functional measures. Veterans who received IOK reported that the treatment was acceptable and feasible.
  
  
  CONCLUSIONS
  These results provide preliminary evidence that Veterans can benefit from a treatment focused on the impact of killing after initial trauma therapy.
authors.affiliation: San Francisco VA Medical Center.|University of California, San Francisco.
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.affiliation: San Francisco VA Medical Center.|University of California, San Francisco.
authors.forename: Kristine
authors.initials: K
authors.lastname: Burkman
authors.affiliation: San Francisco VA Medical Center.
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.affiliation: San Francisco VA Medical Center.
authors.forename: Julie
authors.initials: J
authors.lastname: Dinh
authors.affiliation: San Francisco VA Medical Center.
authors.forename: Jeane
authors.initials: J
authors.lastname: Bosch
authors.affiliation: San Francisco VA Medical Center.|University of California, San Francisco.
authors.forename: Jessica
authors.initials: J
authors.lastname: Keyser
authors.affiliation: San Francisco VA Medical Center.|University of California, San Francisco.
authors.forename: Martha
authors.initials: M
authors.lastname: Schmitz
authors.affiliation: San Francisco VA Medical Center.|University of California, San Francisco.|Mental Illness Research, Education & Clinical Center.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003130:Combat Disorders / Q000628:therapy*; D006708:Homicide / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D014857:Warfare
keywords: killing; moral injury; posttraumatic stress disorder; treatment; veteran; war