Adaptive disclosure, a combat-specific PTSD treatment, versus cognitive-processing therapy, in deployed marines and sailors: A randomized controlled non-inferiority trial

A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers

“…If it is conceptualized that avoidance of these painful experiences prevents the provider from engaging meaningfully in their life (e.g., this individual previously ascribed tremendous meaning to their role as a healthcare provider), helping this individual reconnect with work while experiencing painful thoughts and emotions that arise in the presence of their role as a healthcare provider could be critical to their recovery. A number of interventions focused on cognitive, behavioral, and social processes have been applied to the treatment of moral injury in warzone Veterans and Service-Members which may be relevant to helping healthcare providers respond to moral distress more flexibly [28][29][30]. Interventions, such as Acceptance and Commitment Therapy, which have been developed to target both psychosocial functioning in moral injury [27,28] and psychosocial functioning within healthcare providers [31,32], may be particularly beneficial.…”

Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review

“…To align with the policies of the residential program, there were no explicit discussions of MIEs • All veterans reported that they benefited from the intervention, particularly from the distinct clinical elements that are hallmark of ACT (e.g., diffusion—developing a new relationship with their thoughts; reconnect with values) • Veterans reported that they would recommend it to other veterans • Some veterans noted that 6 sessions were too short, with others reporting difficulty in completing the treatment concurrently to other interventions as part of the residential program Gray et al ( 2012 ) US Marine Corps base camp 44 Active-duty marines and Navy Corps personnel (95% male) with PTSD Open trial Adaptive disclosure 6 weekly individual sessions (90 min) An emotion-focused psychotherapy developed specifically for AD personnel to address MI, traumatic loss/grief and impacts of life-threatening experiences. Sessions focus on identifying the index event, psychoeducation, imaginal exposure, and experiential processing • Significant improvements were found for PTSD, depression symptoms, post-traumatic cognitions, and post-traumatic growth at post-treatment Baseline PCL: M = 60.13 Post-treatment PCL: M = 50.55 Baseline PHQ: M = 14.32 Post-treatment PHQ: M = 10.97 Baseline PTCI: M = 10.95 Post-treatment PTCI: M = 9.48 Baseline PTGI: M = 2.28 Post-treatment PTGI: M = 2.58 • A non-significant improvement was found for alcohol use Baseline AUDIT: M = 7.80 Post-treatment AUDIT: M = 6.49 • Participants reported satisfaction with the treatment Litz et al ( 2021 ) US Military garrison 122 Active-duty personnel (92% male) with PTSD RCT Adaptive disclosure 8 weekly individual sessions (90 min) See Gray et al ( 2012 ) Comparator: CPT Cognitive version 12 weekly individual sessions (60 min) CPT without the written account of the trauma • AD was found to be non-inferior to CPT-C, with no difference found between CAPS total severity change score between AD and CPT-C • AD Baseline CAPS: M = 74.58 (SD = 19.25) Post-treatment CAPS: M = 56.89 (SD = 28.12) Baseline PHQ-9: M = 15.42 (SD = 5.86) Post-treatment PHQ-9: M = 12.90 (SD = 6.56) Improved or recovered: 24% Dropout: 37% • CPT-C Baseline CAPS: M = 76.53 (SD = 18.43) Post-treatment CAPS: M = 53.33 (SD = 31.68...…”

“…Adaptive Disclosure has been proposed as an alternative intervention for MI. Adaptive Disclosure is an emotion-focused, cognitive-behavioral therapy with 6- and 8-session protocols developed specifically for active-duty military personnel (Litz et al, 2021 ). The intervention is designed to flexibly address MI, traumatic loss and grief, or the impacts of life-threatening experiences.…”

“…It involves psychoeducation, imaginal exposure, and experiential processing. In comparison to standard PE, the exposure components of Adaptive Disclosure focus on identifying distressing appraisals and cognitions rather than fear extinction, and standard cognitive restructuring exercises are largely replaced with experiential exercises (Litz et al, 2021 ). Adaptive Disclosure has been tested in a pilot open trial (Gray et al, 2012 ) and a non-inferiority RCT (Litz et al, 2021 ).…”

Association Between Responsibility for the Death of Others and Postdeployment Mental Health and Functioning in US Soldiers

“…These alternative conceptualizations may be a possible explanation for the low success rates of first-line psychotherapy approaches for military-related PTSD in active-duty soldiers, with only 31% of participants achieving recovery. 56 However, 2 psychotherapy approaches (Adaptive Disclosure 57 and Impact of Killing in War 58 ) that address the psychological sequelae of killing in combat show promising preliminary results in reducing PTSD in active-duty Marines and sailors and veterans, respectively. These treatment options may benefit soldiers with postdeployment PTSD who reported responsibility for the death of others, but additional research is needed.…”