Affective Mechanisms of Moral Injury in Trauma Recovery Among Asylum Seekers: Exploring the Protective Effects of Mindfulness and Compassion Training

We aimed to investigate and then therapeutically mitigate the affective-risk mechanisms of moral injury (MI) on trauma recovery among asylum seekers. Study aims were tested in a single-site, randomized, waitlist-controlled trial of mindfulness-based trauma recovery for refugees (MBTR-R) among 158 Eritrean trauma-affected asylum seekers (46.2% female) residing in a high-risk, urban, postdisplacement setting in Israel. First, parallel mediation in PROCESS documented that shame and anger both independently mediated the effects of MI related to moral transgressions committed by the asylum seeker and moral transgressions committed by trusted others (MI-betrayal) on posttraumatic stress disorder (PTSD) and depression. Second, moderated parallel mediation in PROCESS documented that at 1-week postintervention, MBTR-R moderated the mediated pathways between MI-betrayal, anger, PTSD, and depression. Findings contribute to understanding MI-related affective mechanisms in trauma recovery and how mindfulness- and compassion-based training may therapeutically affect these pathways to recovery after displacement.