Following Your Moral Compass

Are you finding yourself grappling with the weight of moral distress, feeling trapped by the dissonance between your current reality and your deeply held values? If so, you're not alone. Moral distress occurs when we act against our deeply held values, leading to a heavy burden of pain and regret.

What Is a Morally Injurious Event (MIE)?

• A situation that violates an important personal value and has high stakes (Litz et al., 2009).
• Morals are communal and collectively shared expectations for behavior in society—for instance, care, fairness, and loyalty (Farnsworth and colleagues, 2017; Litz and colleagues, 2009).
• Could involve something you did/didn't do, witnessed, or learned about; You might feel like a victim, the person responsible, a witness, or a mixture.

Why Do MIEs Hurt?

• Our morals guide our behavior and worldview; when these morals are violated, we experience moral suffering, an anguish that results from that gap between what we think "should" be happening, and what is happening (Farnsworth et al., 2017; Litz et al., 2009).
• Dr. Steven Hayes (2019) “pain and purpose are two sides of the same thing. A person struggling with depression is very likely a person yearning to feel fully. A socially anxious person is very likely a person yearning to connect with others. You hurt where you care, and you care where you hurt” (p.23).

What Does Moral Distress Look Like?

• Prolonged moral emotions like guilt, shame, helplessness, rage, despair; spiritual crisis (Smith-MacDonald, et al., 2022).
• Loss of safety, joy, connection, trust (ibid, 2022).

When Does It Become Moral Injury?

• When moral pain impairs daily functioning (Farnworth et al., 2017).
• Avoiding and escaping through unhealthy coping (substance use, overworking, ruminating, self-blame) leads to more distress.
• Can lead to burnout, relationship issues, PTSD, depression, suicidality (Smith-MacDonald, et al, 2022).

Acceptance and Commitment Therapy (ACT)

ACT is an evidence-based method that has decades of research support, including in the field of moral distress and moral injury. ACT offers a transformative approach to navigate this distress, emphasizing openness, awareness, and engagement (Hayes et al., 2011). It leverages the six core processes of ACT to help you engage more deeply with your values, accept your thoughts and feelings, and take meaningful action in alignment with what matters most to you. Here's a closer look at these processes and how you can start engaging with them today:

Present Moment Awareness

Mini-Exercise: Right now, pause. Notice the space you're in and acknowledge your relative safety. Connect with the present by focusing on your breath or the sensations in your body. This moment of awareness is your foundation for change.

Acceptance. Mini-Exercise: Reflect on something from your past that's been troubling you. Say "yes" to its existence—not because you agree with it or desire it, but because it already exists. Acknowledging reality is the first step towards meaningful change.

Defusion. Mini-Exercise: Think of a thought that often brings you down. Now, reframe it by saying, "I have a thought that..." before the thought. Notice how this small shift can change your relationship with the thought, creating a space between you and it.

Self-as-Context. Mini-Exercise: Identify a self-critical thought you've had recently. Now, question its universality: Is this thought true in every situation? By recognizing that you are not your experiences, you can see that your self-criticism is just one perspective among many.

Values. Mini-Exercise: Consider what value is most highlighted by your experience of moral distress. Is it integrity, compassion, or perhaps justice? Identifying this value can guide your actions moving forward.

Committed Action. Mini-Exercise: Choose one small, achievable action that aligns with your identified value. It doesn't have to be grand; even a tiny step taken consistently can lead to significant change.

If you are interested in digging deeper, my ACT for Moral Distress Course is rooted in evidence-based practices and tailored to address the unique challenges of moral distress, offering more than just coping mechanisms. It provides a path to rediscover your moral compass, align your actions with your values, and embrace life with renewed purpose and integrity.

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Whether you're dealing with the emotional toll of challenging work environments, struggling to reconcile personal ethics with professional duties, or simply seeking a more authentic and values-driven life, this course is a step towards not just surviving, but thriving in the face of moral adversity.

Reflection Questions

1. Reflecting on the mini-exercises, which ACT process resonated with you the most, and why?
2. How can integrating these practices into your daily life support your journey towards alignment and integrity?