Identifying moral injury can be tricky for two reasons: First, it’s easily mistaken for PTSD, which shares many of the same symptoms. And second, because veterans may feel too ashamed to talk about their moral infractions, therapists might not even know to look for the signs of moral injury at all, says Joseph Currier, an assistant professor of psychology at the University of South Alabama. To help therapists better understand how to diagnose the condition, he and several colleagues have developed a 20-item questionnaire that screens patients for moral injury, asking patients to rate their agreement with statements like “I did things in war that betrayed my personal values” and “I made mistakes in the war zone that led to injury and death.”

“Most other scales tap into life-threat traumas, where the predominant emotion is going to be fear,” Currier says. “We are learning that serving in war entails a far more diverse set of stressors, and getting at the right one can help therapists create a better and more accurate treatment for patients.”

Even after diagnosis, however, therapists may have a hard time figuring out an effective treatment plan for moral injury, which requires a different approach that PTSD. “Current interventions for PTSD do well when trauma is fear- and victim-based, but not all moral injury fits under this umbrella,” says Brett Litz, the director of the Massachusetts Veterans Epidemiological Research and Information Center. In 2007, Litz and his colleagues developed a moral injury-specific treatment they call “adaptive disclosure,” a multi-session program rooted in cognitive behavioral therapy. The program is designed to help veterans accept their infractions, rather than erase them from memory or explain them away. Veterans also learn how to disclose experiences to others in a safe space without feeling guilt or shame.

Adaptive disclosure is designed as a gradual progression, with each 90-minute session building upon the last. The first meeting is more instructive than participatory, a sort of “Moral Injury 101”: Therapists explain the meaning of the term, the different kinds of situations that cause it, and the negative impact it can have on the psyche and relationships. In the sessions that follow, veterans begin to share their stories, receive encouragement from peers, and write letters, either apologizing to the person they believe they wronged or confiding in a benevolent moral authority figure (like a trusted friend or spiritual leader). Though the veterans aren’t required to send the notes, the written exercise “helps veterans get in touch with their compassionate side, a part of them they might have lost,” says Amidon, who uses adaptive disclosure in OASIS.

Amidon believes the program’s success stems from its emphasis on moving forward. “In order to heal from shame, guilt, and betrayal, you have to own it. [The veterans] first own it themselves, then they own it with a peer group that understands what they’ve gone through and isn’t going to judge,” she says. “A key part of moral repair is acknowledging what you’ve done, and the more people you can acknowledge that with, the more safe people, the more you are going to heal from it.” Preliminary research seems to support this idea: A small 2012 study of 44 marines, published in the journal Behavioral Therapy, found that adaptive disclosure was linked to reduced symptoms of PTSD and depression.