Month: April 2020

Impact of COVID19 on personal morals and ethics – what do we need to do to support key workers and decision makers to reduce the negative impact of moral injury?

What is moral injury?

The concept of the moral injury originated in the work of the psychiatrist Johnathan Shay (1994, 2002, 2014) who treated armed service personnel traumatised by experiences where either they, or their leaders, violated their values. Potentially morally injurious experiences (PMIE’s) include perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations, which can result in psychological distress or moral injury (Litz et al. 2009).  Moral injury is often associated with strong moral emotions related to the event, including guilt, anger and disgust, and can also lead to negative thoughts about oneself or others, for example, “I am a terrible person,” and can lead to distress and psychological difficulties (Farnsworth et al, 2014).  Moral injury can impact upon work and social life.  It has been linked to increased difficulties coping with occupational stressors and difficulties with authority figures. 

What can we learn from research into this area?

Research into moral injury is still in its infancy, however a recent systematic review and meta-analysis found that moral injury is not unique to any particular profession (Williamson et al, 2018). I had not heard the term before I began listening to webinars about how COVID-19 is placing significant demand on key workers. Victoria Williamson, Dominic Murphy and Neil Greenberg from King’s College London have recently written an editorial in the latest edition of Occupational Medicine Journal ‘Front-line key workers, such as healthcare providers and emergency first responders but also other non-healthcare-related staff (e.g. social workers, prison staff), may be especially vulnerable to experiencing moral injuries during this time’.  It’s a compelling read and helpful to those of us that work with key workers and decision makers in a coaching capacity.

When might people experience moral injury?

In the editorial, the authors highlight that key workers are at increased risk of moral injury if:

  • The life of a vulnerable person is lost.  
  • When workers don’t feel supported or that leaders haven’t taken responsibility.  
  • When staff are not prepared for the emotional consequences of the decisions they are making.
  • If other traumatic events occur at the same time such as a personal bereavement.
  • If they have a lack of social support.

The authors are equally keen to point out that exposure to PMIEs does not automatically result in moral injury. 

How can leaders, teams and individuals reduce the risk or impact of moral injury?

The authors highlight the following recommendations which may be beneficial for individuals and teams to consider:

  • Be aware of the possibility of potentially morally injurious events and each other to develop psychological preparedness.
  • Encourage team members to seek informal support from managers, colleagues, chaplains and other welfare providers.
  • Advise team members to seek professional help at an early point, especially if they are having trouble functioning. 
  • Leaders and managers need to check in with their teams at regular points to provide support and to signpost the team members and others to services if needed.
  • Employers should not use debriefing techniques or psychological screening, but they should facilitate team cohesion as well as make informal as well as professional support available.
  • Events need to be frankly discussed and efforts made to ensure that staff understand potential impact on their mental health, whilst ensuring the are also aware that psychological growth can also be expected as staff ‘do their best’ under challenging conditions.

It has been extremely helpful to understand a little more about how PMIE may impact key workers.  The practical recommendations outlined by Williamson et al are also particularly helpful and give some insight into the role of leaders and teams.  They also recognise that not all managers will feel comfortable in having ‘psychologically informed conversations’ with their staff, or possess such skills, and that it’s important that others are available to step into this role, to check in with staff on a regular basis. 


Farnsworth JK, Drescher KD, Nieuwsma JA, Walser RB, Currier JM. (2014).  The role of moral emotions in military trauma: implications for the study and treatment of moral injury. Rev Gen Psychol, 18(4). 

Litz, B.T., Stein, N., Delaney, E., Lebowitz, L., Nash, W.P., Silva, C. and Maguen, S. (2009) ‘Moral injury and moral repair in war veterans: A preliminary model and intervention strategy’, Clinical Psychology Review, 29(8), 695-706.

Shay, J. (1994) Achilles in Vietnam : combat trauma and the undoing of character, New York: Atheneum ; Oxford : Maxwell Macmillan International.
Shay, J. (2002) Odysseus in America : combat trauma and the trials of homecoming, New York: Scribner.
Shay, J. (2014) ‘Moral Injury’, Psychoanalytic Psychology, 31(2), 182-191.

Williamson, V., Stevelink, S., & Greenberg, N. (2018). Occupational moral injury and mental health: Systematic review and meta-analysis. The British Journal of Psychiatry, 212(6), 339-346. 

Williamson,V., Murphy, D., Greenberg, N. (2020). COVID-19 and experiences of moral injury in front-line key workers, Occupational Medicine []

GREAT DREAM – 10 Keys to Happier Living                             Guest Blog from Lou Harris HWBI Ninja

GREAT DREAM – 10 Keys to Happier Living Guest Blog from Lou Harris HWBI Ninja

This blog is about the 10 Keys to Happier Living which describe the practical action we can take to boost our well being. The 10 keys are based on a review of research from psychology and related fields by Vanessa King and Action for Happiness. The first five keys GREAT are based on the Five Ways to Wellbeing and are about how we interact with the outside world in our daily activities, the second five keys DREAM come from inside us and are influenced by our attitude to life. 

I thought it would be interesting to explore the 10 Keys for Happier Living and see how we can apply them in our current climate after previously writing about the positive impact that the Five Ways to Wellbeing had upon my mental health recovery.  

Taking action to maintain and improve our well-being has never been more important. One of the classic positive psychology experiments asks people to write down “three good things” and why you think those three good things happen to you each night for a week. After six months they found people were happier but also noticed a decrease in depressive symptoms. Mental Health First Aid England suggests that the strategies contained within the 10 keys for happier living are:

  • Positive steps to suggest to anyone with a mental health issue, and
  • Positive steps for self-care for carers, and
  • Positive steps for all of us to improve our own mental health.

The 10 Keys that make up our series of blogs are:

HWBInspiration have reviewed each of the 10 keys to happiness and providing tips with how they can help and be applied in our current climate. So why not make a start today on “three good things”? Being grateful can help people to cope with stress but it’s something that we need to consciously learn to get into the habit of doing.  So why not give it a go:

  • Every night – before you go to bed think about your day and remember three good things that happened went well, you enjoyed or were grateful for – they may be small such as hearing the birds sing, making a new recipe and note them down
  • Think about why – for each thing you are grateful for, write down why it happened and why you feel good about it
  • Look Back – after a week look back at what you have written – think about how it makes you feel and consider any patterns
  • Keep it up – keep trying it can become a habit

At HWBInspiration we are quite a visual bunch and find that some of these tools are helpful to capture and track:

Gratitude Jar – Su Fowler-Johnson April 2020

HWBInspiration co-founders, Su & Claire, are grateful to our Associate HWBI Ninjas for sharing their knowledge, skill and insights.

The power of touch – Covid-19 reflections in lockdown

·      There has never been a more important time to look after our own and others wellbeing


·      Human touch plays an important role 

·      What can we do while we are social distancing?

This may sound familiar to workshop facilitators.  I often enter the room in which I am facilitating, depending on how well I know my co-facilitator, I will give them a hug and I often approach delegates, shake their hand to welcome them.  At the beginning of March this year, this all changed due to Covid-19.  At the time, we were not in lockdown however there was talk of social distancing, now referred to as physical distancing.  I noticed myself still wanting to connect with people I work with and so, engaged in toe or elbow tapping.  Two weeks later, non key workers we were asked by the government to work virtually from home (if possible).  This also meant not seeing family members, whom I always hug on seeing them.  Five weeks on, my colleagues and I were talking about the power of human touch, so we decided to review why we need it and how it benefits us.    

Authors such as Brené Brown[1] write about our fundamental need for belonging: “As members of a social species, we derive strength not from our rugged individualism, but from our collective ability to plan, communicate, and work together.” Whole academic journals have also been written on the importance of close relationships for living a longer life[2]. One important component of close social relationships is interpersonal touch.

Interpersonal touch behaviours such as hugging are used to communicate affection or indicate affection from others[3]. Converging evidence indicates that individuals who engage more frequently in interpersonal touch enjoy better physical, psychological, and relational health[4]. Back in 2006, a lab study examining activation of brain regions associated with threat, reported that individuals assigned to a ‘touch condition’ with a stranger showed less threat-related neural activation during exposure to a laboratory stressor. More recently, studies have showed that touch can be used as a tool for communicating empathy, resulting in a painkilling effect[5] and receiving a hug is associated with the reduction of negative mood on days when one has experienced interpersonal conflict[6].  Touch builds connectedness. And this is true whether it’s handshakes to build camaraderie in a workshop or hugs for our family, loved ones and friends.

How can we look after our wellbeing in a world where isolation and physical distancing has become the new temporary “norm”?

The sorts of things that we are practicing and HWBInspiration are:

  • Regular video calls – with work colleagues to check in personally as well as on work topics – always good to ‘eyeball’ family, friends and work colleagues.  You communicate so much more.
  • Setting up ‘What’s App’ groups – to remain connected to different groups for different purposes.
  • Sharing stories
  • Sharing images/photo’s
  • Keeping connected, Tik Tok has become a source of humour that we enjoy sharing when a little low on inspiration
  • Daily exercise routine with partner – our normal walk/run/ route’s have become busy, and we’re delighted to find new routes from our front door that we’ve not discovered.  Why not prepare for ‘On your Feet Britain’ 24/9/20?  For some more tips
  • Keeping in contact with clients – especially those who are in key worker roles to offer a space to ‘decompress’.
  • Keeping a gratitude diary to improve mental health and wellbeing – three things every day.  Today:
  • Blogging – We’ve co-created a blog, which is often a source or procrastination.  It was inspired by a coaching client who is currently in the ‘shielded group’, a loss of physical touch for them, when they describe themselves as a ‘huggy person’ has been profound
  • Being able to work – Working with a well-established collaboration of small businesses we’ve been able to submit a proposal for some innovative leadership development work
  • Sunshine – being able to look out into the garden (we are so very lucky) and noticing the differences every day.
  • Connecting with family – daily check in to see how everyone is doing and how they are coping.  Sharing ideas and keeping each other’s spirits up when it gets difficult.
  • Sleep – paying attention to our sleep patterns, routines and minimising unhelpful impact of ‘gadgets’ before going to bed.  Some more useful tips from World Sleep Day website
  • Nutrition – a well balanced diet is key, and we acknowledge that our usual patterns have been disrupted.  Some more useful tips from the National Nutrition and Hydration Week website
  • Practicing mindfulness – well here is the one thing that we both struggle with.  So, Su is using Headspace App to help, or alternatively she may default to knitting.
  • Give our loved ones a hug – for those of us lucky enough to live with our loved ones / families, give them a hug (unless of course, they have symptoms in which case they should self-isolate in a separate room)
  • Pet your pets
  • Take notice – notice what you feel when you touch different textures, this will keep your sensory and kinaesthetic muscles alive


  1. Brown, B. (2017). Braving the Wilderness: The Quest for True Belonging and the Courage to Stand Alone. Random House.
  2. Dunkel, S et al (2017). How to closer relationships lead to longer life. American Psychologist, 72(6), 511-516.
  3. Jakubiak BK, Feeney BC (2017). Affectionate touch to promote relational, psychological, and physical well-being in adulthood: A theoretical model and review of the research. Personality and Social Psychology Review, 21, 228–52
  4. Cohen S, Janicki-Deverts D, Turner RB, Doyle WJ. (2015). Does hugging provide a stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychological Science, 26, 135–47
  5. Goldstein, P., Weissman-Fogel, I. & Shamay-Tsoory, S.G. (2017). The role of touch in regulating inter-partner physiological coupling during empathy for pain. Scientific Reports 73252
  6. Murphy MLM, Janicki-Deverts D, Cohen S. (2018). Receiving a hug is associated with the attenuation of negative mood that occurs on days with interpersonal conflict. PLoS ONE 13(10)