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Cited by 25Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

A controlled trial of adaptive disclosure- enhanced to improve functioning and treat posttraumatic stress disorder

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Litz, Brett T., Yeterian, Julie, Berke, Danielle, Lang, Ariel J., Gray, Matt J., Nienow, Tasha, Frankfurt, Sheila, Harris, Jeanette Irene +2 more·2024·Journal of Consulting and Clinical Psychology
DOI 10.1037/ccp0000873PMC PMC11771448
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Abstract

OBJECTIVE: This is a randomized controlled trial (NCT03056157) of an enhanced adaptive disclosure (AD) psychotherapy compared to present-centered therapy (PCT; each 12 sessions) in 174 veterans with posttraumatic stress disorder (PTSD) related to traumatic loss (TL) and moral injury (MI). AD employs different strategies for different trauma types. AD-Enhanced (AD-E) uses letter writing (e.g., to the deceased), loving-kindness meditation, and bolstered homework to facilitate improved functioning to repair TL and MI-related trauma. METHOD: The primary outcomes were the Sheehan Disability Scale (SDS), evaluated at baseline, throughout treatment, and at 3- and 6-month follow-ups (Brief Inventory of Psychosocial Functioning was also administered), the Clinician-Administered PTSD Scale (CAPS-5), the Dimensions of Anger Reactions, the Revised Conflict Tactics Scale, and the Quick Drinking Screen. RESULTS: There were statistically significant between-group differences on two outcomes: The intent-to-treat (ITT) mixed-model analysis of SDS scores indicated greater improvement from baseline to posttreatment in the AD-E group (d = 2.97) compared to the PCT group, d = 1.86; -2.36, 95% CI [-3.92, -0.77], t(1,510) = -2.92, p < .001, d = 0.15. Twenty-one percent more AD-E cases made clinically significant changes on the SDS than PCT cases. From baseline to posttreatment, AD-E was also more efficacious on the CAPS-5 (d = 0.39). These differential effects did not persist at follow-up intervals. CONCLUSION: This was the first psychotherapy of veterans with TL/MI-related PTSD to show superiority relative to PCT with respect to functioning and PTSD, although the differential effect sizes were small to medium and not maintained at follow-up. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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  • Open and controlled trials of Adaptive Disclosure and AD-enhanced protocols report improvements in PTSD symptoms, depression, and functioning consistent with proposed processes, although formal mediation analyses remain limited.

    “Open and controlled trials of AD and AD-enhanced protocols report improvements in PTSD symptoms, depression, and functioning consistent with these proposed processes, although formal mediation analyses remain limited (90, 91).”

    From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [90]

    The paper’s account of earlier AD trials reports improvements in PTSD and depression and functional change (passage 1, section labeled Abstract > Conclusion; page unavailable). Its Results report improved PTSD symptoms and functioning with AD-E (passages 4–5; page unavailable). The Discussion says questions remain about the individual change agents, but our copy does not explicitly establish that formal mediation analyses across these trials are limited or that the observed improvements followed the proposed processes. (LLM, conf=0.84)

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  • Adaptive Disclosure methods were designed to expand moral and relational perspectives and challenge shame-based self-appraisals by situating morally painful experiences within broader compassionate frameworks, thereby engaging processes consistent with self-transcendence.

    “Clinically, these methods were designed, in part, to expand moral and relational perspectives and to challenge shame-based self-appraisals by situating morally painful experiences within broader, more compassionate relational and contextual frameworks, thereby engaging processes consistent with self-transcendence (90).”

    From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [90]

    The treatment description in our copy (page unavailable) says Adaptive Disclosure uses dialogue with a compassionate moral authority to challenge guilt, shame, and condemnation of self and others. It also describes changing beliefs about personal and collective humanity. The copy does not identify these methods as engaging self-transcendence, so that final characterization remains an interpretation rather than a finding attributed to the source. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Moral repair-oriented interventions like Adaptive Disclosure use imaginal dialogue and perspective-taking to promote movement from rigid, self-condemning narratives toward more expansive, contextualized accounts, which conceptually overlap with self-transcendence-related perspective shifting and mindful positive reappraisal.

    “Moral repair–oriented interventions like Adaptive Disclosure use imaginal dialogue and perspective-taking to promote movement from rigid, self-condemning narratives toward more expansive, contextualized accounts (31, 90), which conceptually overlap with ST-related perspective shifting and mindful positive reappraisal (33, 36, 65).”

    From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [90]

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Research works printed but not linked: 42

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Cited by

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Authors
Litz, B. T., Yeterian, J., Berke, D., Lang, A. J., Gray, M. J., Nienow, T., Frankfurt, S., Harris, J. I., Maguen, S., & Rusowicz-Orazem, L.
Affiliations
  • VA Boston Healthcare System (US)
  • VA Connecticut Healthcare System (US)
  • Hunter College (US)
  • VA San Diego Healthcare System (US)
  • University of Wyoming (US)
  • Minneapolis VA Health Care System (US)
  • VA Heart of Texas Health Care Network (US)
  • San Francisco VA Health Care System (US)
  • Boston University (US)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2024-03
Volume
92
Issue
3
Pages
150-164
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/ccp0000873
PMC
PMC11771448
OpenAlex
W4391867066
Cited by
25
References
0
Citations by year
2026: 13 · 2025: 8 · 2024: 4
FWCI
12.53
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
U.S. Department of Veterans Affairs (5I01RX002135)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
post-traumatic stress disorder, moral injury, traumatic loss, veterans, present-centered therapy, letter writing, loving-kindness meditation, psychosocial functioning, disability, anger, conflict tactics, alcohol consumption, trauma-focused psychotherapy
MeSH terms
Humans, Psychotherapy, Stress Disorders, Post-Traumatic, Databases, Factual, Disclosure, Intention

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