How big a role might spirituality play in helping Veterans cope with the ravages of post-traumatic stress?   The VA would like to know.

Wounded Souls

“Young people go into combat and see their friends getting killed,” said Dr. Nagy Youssef, a psychiatrist with full clinical privileges at the Augusta VA in Georgia and an associate professor of psychiatry at Augusta University.  “They might have to kill enemy combatants. They face very difficult decisions, sometimes life and death decisions that must be made in fractions of a second. This can take an enormous toll on them. Some feel they’ve done something terrible for which they can never be forgiven.  We call it moral injury.”

Youssef and several colleagues recently touched on the complex subject of moral injury in a paper they published in The Journal of Nervous and Mental Disease (Volume 205, Number 2, February 2017).  In it they note that many Veterans have deeply held spiritual or religious beliefs that could increase their vulnerability to moral injury.

Dropping Out

“I’ve treated a lot of Veterans with PTSD,” he said.  “Often we treat our Veterans and Service Members with medication to help reduce symptoms like flashbacks or nightmares.  We give them prolonged exposure or cognitive processing therapy with or without medications. These help a good portion of patients… but not all.”

The 44-year-old researcher said about half of Veterans with PTSD have a good response to standard therapy while the other half experience mixed results.

“At least a third do not respond to conventional therapies and medications at all,” he said. “A number of them simply stop going to therapy.  Some find that it does not address the spiritual wounds and inner conflict they feel.  Others see it as not holistic enough. So they drop out.”

Dr. Nagy Youssef

Dr. Nagy Youssef

Youssef wants to know if incorporating a spiritual aspect into trauma-based therapy — for those patients interested in such an approach — might keep more Veterans coming in for treatment.  To find out, he and his team are conducting a survey.

“So far we’ve interviewed about 40 Veterans,” he said.  “We’re hoping to interview at least 125.  The results of the survey will tell us whether or not we should proceed with a larger study concerning spirituality and its value in the healing process.”

Duke University and the Durham VA are collaborating with Youssef on the project.

Different Strokes

The psychiatrist said the larger study, should it proceed, would incorporate aspects of each patient’s religion or spiritual beliefs with a particular emphasis on love and forgiveness.

“We would customize the therapy,” he said, “because everybody is different.  Everybody has their own unique concept of what spirituality is.  So the therapy we provide needs to reflect that.  The religious or spiritual material we incorporate into the therapy must have special meaning for each Veteran.”

The researcher said the concept of forgiveness is a major element that can be found in all the world’s religions and would thus be a central theme in spiritual therapy.

“Some Veterans suffering from PTSD sincerely believe that God, or whatever they perceive to be their higher power, will never forgive them for what they’ve done,” he said.  “I doubt if these feelings of shame and guilt can ever be fully addressed with standard therapy or medication.  We need to give these patients evidence —from the Bible, the Torah, the Koran or whatever they believe in— that they can be forgiven, that there’s always a second chance.”

A female therapist comforting a female Veteran.

A researcher associated with the VA is exploring the potential role spirituality might play in therapy given to Veterans suffering from post-traumatic stress.

Many Veterans have deeply held spiritual or religious beliefs that could increase their vulnerability to moral injury.

He continued:  “We hope this approach turns out to be highly motivating for the Veterans in our study.  If they find this spiritual approach to be meaningful, and helpful, they’ll keep coming to therapy.  That’s the key:  showing up for treatment.”

Youssef emphasized that introducing a spiritual element into treatment is not meant to be a replacement for conventional therapies, but an enhancement for those Veterans who may find it beneficial.  “We do not advocate at all quitting standard therapy,” he said.  “This is meant to be a holistic approach that simply works at a different level . . . a different dimension.”

To learn more about how VA is helping Veterans with PTSD, visit the VA National Center for PTSD Website at

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Published on Mar. 21, 2017

Estimated reading time is 3.8 min.

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  1. Ronald Ford March 25, 2017 at 7:00 pm

    I urge everyone to read this article carefully, particularly “We would customize the therapy,” he said, “because everybody is different. Everybody has their own unique concept of what spirituality is. So the therapy we provide needs to reflect that. The religious or spiritual material we incorporate into the therapy must have special meaning for each Veteran.”.

    Trying to impose your own personal views and beliefs on someone suffering from PTS, can do more harm than good no matter how well intentioned it may be. I have counseled and taught over 200 veteran couples over the past 6 years that are suffering with PTS. To help, you must approach spiritually from where they are in their beliefs, even if you personally believe differently.

  2. Lowell Exum March 25, 2017 at 9:33 am

    What are we talking about? When we are talking about spirituality that is very general and not specific. Are we talking about the God of the Bible and applying the truth of His Word to our circumstances? Or are we talking about some feel-good sentimentality or eastern meditation practice? Only the Lord Jesus Christ can bring true healing and restoration.

    The reason why we feel guilt is because God has given each one of us a conscience. We know what is right and what is wrong. God can forgive us but not on the basis of anything good that we have done. We are not good. We are all sinners. But God is loving and merciful and sent His only Son to be the sacrifice for our sins so that whoever repents and trusts in Him, will be forgiven and granted the free gift of everlasting life!

  3. Stephen Guleff March 24, 2017 at 1:05 pm

    I have been in a PTSD Spiritually Group for the past ten years at the West Palm Beach VA Medical Center. I thought this was part of the PTSD program system wide. This group has given me a reason to continue and hope for all that follow with this DISORDER. I Have been treated for the past 15 years and have been through every program the VA has to offer. Our group is not religiously based but is about transcendence and has had a core of 12 Vets for many years , with new people trying this program periodically. This is not for all but for me it was one more tool for me to use seeking the joy we all have a right to enjoy/

  4. James Corona March 24, 2017 at 1:02 pm

    The Lord Jesus Christ suffered PTSD in the worst sense “fighting” and dying for mankind; therefore
    God is the “BEST answer and therapy for PTSD!

  5. DANIEL E MAHONE March 24, 2017 at 11:42 am

    Man was created by GOD, in the image and likeness of GOD. Therefore, man’s body, soul, spirit must be addressed in order for him/her to be treated. I worked in the aviation community, aircraft have: structural, mechanical/hydraulic, electronic/electrical, systems. Each required maintenance. So it is with mankind.

  6. David F Boots March 24, 2017 at 11:01 am

    Spirituality is a game stopper for me.With PTSD I just know in my heart that God will never forgive me for what I’ve done in combat. Even though I have made great progress in cognitive therapy , when each day is over , I know I’ll never make it to Heaven. Even though I have seen scriptures proving that bad people have gone to heaven, I feel what I have done that there is no chance for me.

    • Richard Y Diaz March 24, 2017 at 12:19 pm

      Amen. All healing comes from the Healer of healers the Lord Jesus Christ. Implementing a holistic approach and emphasizing Spirituality is what heals the soul. Many of us need healing in all 3 aspects that God created us with: Body, Soul and Spirit. Surrendering to our higher power ( Christ in the case of Christians) is an much added theraputic healing of the mind in specific and the whole body in general. I am an advocate in using spirituality and biblical therapies in all human being troubles and illnesses and disease just as well as we use it in marital therapies. Many vets and their families can then use biblical therapy techniques on a daily basis within their own homes. You carry it with you wherever you go and use it daily and devotional.

    • Scottie Joines March 24, 2017 at 12:24 pm

      That is a lie. If it was true that would mean that your actions are more powerful than Christ and he’s a liar. Christ is not a liar and he is all powerful having defeated even death itself.

    • Ronald Ford March 25, 2017 at 6:49 pm

      David, I work with veterans and their families as a part of the National Veterans Wellness and Healing Center in Angel Fire, NM. We have had several veterans go through our program that feel as you do about forgiveness. We have helped them to gain great insight and healing regarding their spiritually and view of forgiveness. Check out our website Our retreats are no cost to veterans and partners other than travel here and back. You can also contact me via the website.

    • Daisy Jones March 25, 2017 at 8:27 pm

      I thoroughly believe in spiritual therapy. We all have done terrible things on and off the battlefield. God forgives and He will help us forgive ourselves and experience His love. I know this to be true. Psalm 139 is one of many scriptures to encourage us all in the process. Heaven is real and we will go there with Christ.

    • David Maulsby March 26, 2017 at 5:44 pm

      David, I’d love to hear more about why you call faith a game stopper and what you describe as the scripture proving some bad people go to heaven.

  7. joe martinez jr March 24, 2017 at 10:23 am

    I am a retired marine (31 yrs) an dropped out of VA counseling sessions for good reasons.

    I instead redevoted my faith to Christ and now help others understand that Christ is the only answer to
    being created into a new image.

    • David Philpott March 25, 2017 at 11:06 am

      You are absolutely correct. Jesus Christ died on the cross so that our sins could be forgiven. Belief in Him is the ONLY way to total and complete forgiveness. Where the trouble lies, however, is in our inability to forgive ourselves. We can forgive others, but we also must forgive ourselves. But by not doing that, we are saying that we are better than God. We have to realize that the power of forgiveness has to include both accepting God’s gift of forgiveness and accepting the same gift from our own selves. It is, a lot of times, easier said than done.

  8. Ronald Cross March 22, 2017 at 3:42 am

    A spiritual base, I believe, based upon personal experience, does make a positive difference.
    In my case, my practice and foundation in Buddhism (I practice Nichiren Buddhism through the SGI which is quite different from the purely meditative forms zuch as Zen, for example) enabled me to become aware of what it was and tame the beast of PTSD and to become the master of it. Without going into great detail, I was able to center and understand the causality. I was able to regain control of my life in it’s totality. I have been able to use my experience to help myzelf and others.
    At the time, there was or I had no means of acquiring support from any group. I was in my own. Without a strong spiritual base, I would have been lost in the abyss, the dark rabbit hole with no way out.
    No matter the source or nature of one’s spirituality, as long as it is positive, it is or can be the base, the foundation upon which to grow or build.

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