Psychosocial Rehabilitation After Moral Injury and Loss With Adaptive Disclosure

Summary

The aim of this study was to determine the efficacy of Adaptive Disclosure for Moral Injury and Loss (AD-MIL), a combat-specific psychotherapy for war-related PTSD stemming from Moral Injury (MI) and traumatic loss (TL) with Iraq and Afghanistan War Veterans with PTSD. AD-MIL will be compared to Present Centered Therapy (PCT). AD-MIL is a modified version of Adaptive Disclosure (AD), which has been modified and extended to solely treat MI and TL by targeting psychological and behavioral obstacles to occupational, relationship, and family functioning, as well as quality of life. PCT is a manualized evidenced-based PTSD treatment used to address functioning problems in several large-scale PTSD trials. The primary end-point was psychosocial functioning (improvements in social, educational and occupational functions). Secondary end-points included PTSD, depression, moral emotions (anger, shame, and guilt), alcohol use, self-compassion, and mindful/valued living.

Conditions

• Post-traumatic Stress Disorder
• Moral Injury
• Traumatic Loss

Interventions

BEHAVIORAL

Adaptive Disclosure for Moral Injury and Loss

AD-MIL is a manualized, 12-session individual psychotherapy designed to improve functioning and to reduce PTSD symptoms by facilitating Veterans doing corrective things in their life to heal and repair traumatic loss and moral injuries. The change agents are: (1) emotional-processing of traumatic loss and moral injuries and motivating a healing and action plan by writing therapeutic letters (e.g., to a lost unit member, to victims of personal transgressions, to people who transgressed); (2) skills training and behavioral contracting to improve functioning and targeting moral injury- and traumatic loss-related psychological and behavioral obstacles to positive and potentially habilitative engagements in occupational, relationship, and family roles; and (3) teaching self- and other-compassion and mindfulness. The goal is to redress the functional impact of moral emotions (anger, shame).

BEHAVIORAL

Present Centered Therapy

Participants randomized to the PCT arm will receive 12 sessions of therapy focused on day-to-day functional problems with no focus on trauma or re-visiting past experiences

Sponsors & Collaborators

• Minneapolis Veterans Affairs Medical Center

  collaborator FED

• San Francisco Veterans Affairs Medical Center

  collaborator FED

• San Diego Veterans Healthcare System

  collaborator FED

• Central Texas Veterans Health Care System

  collaborator OTHER

• VA Office of Research and Development

  lead FED

Principal Investigators

• Brett T. Litz, PhD · VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-01-03

Primary Completion

2021-11-30

Completion

2022-02-28

Countries

• United States

Study Locations