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Building Spiritual Strength (BSS)
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Veterans managing moral injury/spiritual distress are at high risk for suicide, have a longer and more severe course of PTSD and depression, and use more mental health services than their peers. BSS groups are an ethically appropriate, spiritually integrated model for resolving moral injury/spiritual distress. Two randomized controlled trials provide evidence of safety and effectiveness.
Versions of BSS are available for healthcare providers in the COVID context, and for individuals managing addiction; empirical data on efficacy for these versions is pending.
Origin:
December 2005, Edith Nourse Rogers Memorial Veterans' Hospital (Bedford), Lewiston VA Clinic (Lewiston, Maine), Minneapolis VA Medical Center (Minneapolis, Minnesota)
Adoptions:
21 successful, 59 in-progress
Awards and Recognition:
American Psychological Association Div. 36 Award in Applied Psychology of Religion and Spirituality, Endorsed by National Chaplain Service, Diffusion of Excellence Promising Practi ... American Psychological Association Div. 36 Award in Applied Psychology of Religion and Spirituality, Endorsed by National Chaplain Service, Diffusion of Excellence Promising Practice
Partners:
Diffusion of Excellence, Office of Rural Health
Recent Updates
Overview
Problem
Solution
- First study of BSS BSS Pilot Study
- Second Clinical Trial of BSS Spiritually Integrated Care for PTSD and Moral Injury
Files
Results
- Article on the theory of moral injury upon which BSS is based. Moral Injury in Developmental Context
- Quantitative study on the developmental theory of moral injury Psychospiritual development and moral injury resilience
Files
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Published articles on BSS
Videos
Training videos describing the theory and some of the techniques used in the BSS protocol.
Example of the Empty Chair Technique
Example of Session 6, Forgiveness
Implementation
Timeline
-
Month 1
Schedule and implement training with Dr. Harris and/or a member of her teamSet up logistics: Time, space, printed materials, education for referring providers -
Months 2-3
Recruit initial group cohort, working with mental health and chaplains as referral sources.Implement initial group cohort.
Departments
- Social work
- Chaplaincy
- Psychology
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Files
- Manual for group leaders BSS Intervention Manual
- First study on BSS Published Article on Second Study
- academic articl Published article on the theory behind BSS
- word file Participant workbook
- word file Supplemental Self Forgiveness Workbook
- word file Baseline Interview
- word file Training Manual
- academic article Published article on Pilot Study
Links
- YouTube training videos BSS Facilitator Training Video
Optional Resources
| Resource type | Resource description |
|---|---|
PROCESSES |
|
TOOLS |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Some individuals erroneously believe that it is inappropriate to provide spiritually integrated care in a public health care setting. | Educate those concerned using the ethics/scope portion of the facilitator training materials. |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email BuildingSpiritualStrength@VA.GOV with questions about this innovation.
About
Origin story
Original team
J. Irene Harris
Director, Social and Community Reintegration Research Center
Ch. Timothy Usset, M. Div., M.P.H., LMFT
Research Health Scientist/ACPE Certified Educator
Susannah Kondrath, Ph.D.
Psychologist
Rotunda East, M.Div
Chaplain
Joseph MacMahon
Chaplain
We began our first group today at John D. Dingell VAMC in Detroit, MI
Congratulations! Stay in touch if the team at Maine MISTT can help you!
VA Puget Sound just completed a successful group.
Congratulations Ch. McGregor!
After training with Dr. Harris, John D. Dingell VAMC in Detroit, MI is now in the process of adopting this innovation.
Thanks so much for your update!
The Marine Corps Air Ground Combat Center at Twentynine Palms is now starting a BSS program.
As of July, 2022, some additional sites that have been trained in BSS include the Moral Injury Institute in Springfield MO, the North Carolina Conference of the United Methodist Church, and the San Diego Vets Center.
Many BSS leaders are seeking help with procedures for screening for moral injury syndrome. The following publications can be helpful:
Kopacz, M., Bishop, T. M., Ayre, A., Boska, R. L., Goldstrom, D., Tomberlin, D., ... & Harris, J. I. (2022). Feasibility of using moral injury screening instruments in VA chaplaincy spiritual assessments. Journal of health care chaplaincy, 1-12.
Nieuwsma, J. A., Brancu, M., Wortmann, J., Smigelsky, M. A., King, H. A., VISN 6 MIRECC Workgroup, & Meador, K. G. (2021). Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis. Clinical Psychology & Psychotherapy, 28(1), 239-250.
Places that BSS has been adopted outside of the VA:
Army Family Life Chaplain Corps
Franciscan Renewal Center, Phoenix, AZ
Vets Center, Trenton NJ
Vets Center, Dayton OH
Missoula Vets Center
Tulsa Vets Center
Escanaba Vets Center
Chesapeake Vets Center
Lifespan Health, Providence, RI
Penn State, Harrisburg
Aurora Behavioral Health
Center for Life Management
Reclaim Justice
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