Moving the field forward on moral injury: Possibilities and pitfalls of experimental research

Research on Moral Injury (MI) is largely based on cross-sectional observational studies, mostly retrospective. Progress in understanding the causal mechanisms between exposure to potentially morally injurious events (PMIEs) and MI is hindered by a lack of adequate study designs. Current experimental psychopathology paradigms rely on mental imagery, thereby limiting ecological validity and affording minimal scope to model moral decision-making and behavior relevant to MI. We propose two complementary pathways to advance causal inference in the field of MI: leveraging natural experiments to study real-world exposure to PMIE and its associations with MI-related outcomes, and development of new experimental paradigms exploiting behavioral economic games to ethically model moral transgressions in the lab. • Causal understanding of moral injury is hindered by lack of adequate study designs • Imagery-based psychopathology paradigms lack authenticity and ecological validity • Natural experiments and economic games are promising pathways to causal inference