Case Report on the Augmentation of Cognitive Processing Therapy with Spiritual Counseling to Address Faith-Based Concerns for an Operator with High Religiosity

This case report describes treatment of a Special Operations Forces (SOF) Operator with high religiosity experiencing posttraumatic stress disorder (PTSD) and moral injury after exposure to indirect combat-related trauma via real-time audiovisual drone feed. The patient completed virtual massed cognitive processing therapy (CPT) augmented by a single spiritual counseling session to address faith-based concerns interfering with trauma processing. Initial symptom exacerbation occurred early during CPT, but following spiritual counseling, the patient engaged more fully in therapy, leading to a significant reduction in PTSD and depressive symptoms. This case highlights the importance of identifying and addressing faith-related moral injury early in treatment and suggests that integrating spiritual counseling with CPT may enhance outcomes for Operators and other Servicemembers suffering with vicarious posttraumatic stress stemming from indirect combat exposure.