Coping and Adaptation for Recovery From Moral Injury: A Group Intervention for Clinical Psychology Residents

NCT07887581 | Not Yet Recruiting

• 2 other identifiers: CARE-MI-PIRPID2024-157925OB-I00
• Study Type: interventional
• Target: 10
• Locations: 0 countries
• Sites: N/A

Brief Summary

Moral distress may arise when health care professionals are unable to act in accordance with their professional values or believe that they have participated in, witnessed, or been unable to prevent situations that conflict with those values. Repeated or particularly difficult experiences may affect emotional well-being, professional identity, and the meaning associated with clinical work. This single-group pilot study will evaluate the feasibility, acceptability, and preliminary effects of Coping and Adaptation for Recovery from Moral Injury (CARE-MI), a four-session group intervention for clinical psychology residents in Spain. Each 90-minute session addresses one of four components: moral awareness, emotional flexibility, moral repair, and professional flourishing. The program is designed to help participants recognize morally difficult experiences, respond more flexibly to associated thoughts and emotions, review responsibility in a fair and contextualized way, and protect the values and resources needed for professional practice. Participants will complete assessments before and after the intervention. Changes in moral distress and psychological well-being will be examined, together with indicators of intervention feasibility and acceptability.

Conditions

Moral Distress; Moral Injury

Keywords

Clinical Psychology Residents; Group Psychological Intervention; Moral Distress; Moral Injury; Professional Well-Being; Healthcare Professionals

Outcome Measures

Primary Outcomes (1)

• Change in Moral Injury Assessed With the Health Care Moral Injury Scale

  Moral injury will be assessed using the 10-item Health Care Moral Injury Scale (HMIS). Each item is rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Item scores are summed to produce a total score ranging from 10 to 50, with higher scores indicating greater moral injury. The outcome will be the change in total HMIS score from baseline to post-intervention.

  Baseline and Week 4 (immediately after completion of the four-session intervention).

Secondary Outcomes (5)

• Change in Mental Well-Being Assessed With the Warwick-Edinburgh Mental Well-Being Scale

  Baseline and Week 4 (immediately after completion of the four-session intervention).

• Change in Depressive Symptoms Assessed With the Patient Health Questionnaire-9

  Baseline and Week 4 (immediately after completion of the four-session intervention).

• Change in Anxiety Symptoms Assessed With the Generalized Anxiety Disorder-7

  Baseline and Week 4 (immediately after completion of the four-session intervention).

• Intervention Completion Rate

  From the first intervention session through Week 4.

• Participant Satisfaction With the CARE-MI Intervention

  Week 4 (immediately after completion of the four-session intervention).

Study Arms (1)

CARE-MI Group Intervention

EXPERIMENTAL

Participants will receive the CARE-MI intervention, consisting of four 90-minute group sessions: Moral Awareness, Emotional Flexibility, Moral Repair, and Professional Flourishing. The sessions include psychoeducation, guided reflection, experiential exercises, hypothetical clinical situations, and individual worksheets adapted for clinical psychology residents.

Behavioral: CARE-MI Group Intervention

Interventions

CARE-MI Group Intervention BEHAVIORAL

CARE-MI is a manualized group intervention consisting of four 90-minute sessions. The four components are Moral Awareness, Emotional Flexibility, Moral Repair, and Professional Flourishing. The intervention includes psychoeducation, guided reflection, experiential exercises, hypothetical clinical situations, and individual worksheets adapted for clinical psychology residents. Participants are not required to disclose detailed personal or clinical experiences to the group.

CARE-MI Group Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 18 years or older.
• Currently undertaking specialized postgraduate training as a clinical psychology resident in Spain.
• Able to understand written and spoken Spanish.
• Willing and able to attend the CARE-MI group sessions and complete the study assessments.
• Able to provide informed consent.

You may not qualify if:

• Not currently undertaking specialized postgraduate training as a clinical psychology resident.
• Inability to understand the study information or provide informed consent.
• Insufficient command of Spanish to participate in the group intervention or complete the assessments.
• Any acute psychological or psychiatric condition that, in the judgment of the research team, requires immediate or more intensive clinical care and would make participation in the group intervention inappropriate.

Sponsors & Collaborators

• Universidad Complutense de Madrid: lead
• Camilo Jose Cela University: collaborator
• Hospital Universitario 12 de Octubre: collaborator

MeSH Terms

Conditions

Stress Disorders, Post-Traumatic

Condition Hierarchy (Ancestors)

Stress Disorders, Traumatic; Trauma and Stressor Related Disorders; Mental Disorders

Study Officials

• Regina Espinosa López, PhD

  Camilo Jose Cela University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Regina Espinosa López, PhD

CONTACT

+34 658519107; respinosa@ucjc.edu

Carmen Valiente Ots, PhD

CONTACT

mcvalien@ucm.es

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: All participants will receive the same four-session CARE-MI group intervention. Assessments will be conducted before and after the intervention, with no concurrent comparator group.

Study Record Dates

• First Submitted: October 8, 2026
• First Posted: October 21, 2026
• Study Start (Estimated): December 10, 2026
• Primary Completion (Estimated): January 30, 2027
• Study Completion (Estimated): March 31, 2027
• Last Updated: October 21, 2026

Record last verified: 2026-10

Data Sharing

• IPD Sharing: Will not share