This multisite RCT (August 2018–November 2023) compared Impact of Killing (IOK) therapy — targeting killing cognitions, acceptance, self-forgiveness, and moral repair — versus present-centered therapy (PCT) in 100 veterans with PTSD who reported distress related to killing or feeling responsible for others' deaths, across 3 VA health care systems in California, New York, and North Carolina.
Both groups improved in psychosocial functioning at posttreatment; IOK showed significantly greater improvement on the Sheehan Disability Scale (SDS) vs. PCT (difference: −3.50; Cohen d = −0.51; P = .02), as well as significantly greater reductions in PTSD and moral injury symptoms. No significant between-group difference was found on the WHOQOL-BREF at posttreatment.
- Sample was 98% male, limiting generalizability to female and non-binary veterans. - Relatively small sample (n = 100) may limit power to detect differences on all outcomes. - Full text is under embargo; secondary and follow-up analyses are not fully reviewable.
For veterans with PTSD who carry distress specifically related to killing in war, IOK therapy offers meaningfully greater gains in daily functioning and symptom relief than standard present-centered therapy. Clinicians at VA settings should consider IOK as a targeted option for this population.
