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Adaptive Disclosure


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Table of Contents

1. Introduction
2. Background and Evidence
3. Military Culture and Warrior Ethos
4. Guiding Principles of Adaptive Disclosure
5. Assessment, Case Conceptualization, and Treatment Planning
6. Beginning Adaptive Disclosure: Session 1
7. The Exposure Component: Active Treatment Sessions 2 to 7
8. Breakout Components for Loss and Moral Injury: Active Treatment Sessions 2 to 7
9. Ending Treatment and Planning for the Future
10. Using Adaptive Disclosure when Prior Complex Trauma is Present
Appendix 1. Diversity of Military Missions, Organizations, and Relationships
Appendix 2. The Meaning and Implication of Key Events
Appendix 3. Calming and Attention Focusing Techniques

About the Author

Brett T. Litz, PhD, is Professor in the Departments of Psychiatry and Psychology at Boston University and Director of the Mental Health Core of the Massachusetts Veterans Epidemiological Research and Information Center at the VA Boston Healthcare System. He is also Assessment Core Director of the STRONG STAR Consortium and the Consortium to Alleviate PTSD. Dr. Litz focuses on evaluating the mental health outcomes associated with military deployments across the lifespan, with an emphasis on early intervention and treatments for combat and operational trauma, loss, and moral injury. Leslie Lebowitz, PhD, is a clinical psychologist in private practice in Newton Center, Massachusetts. She consults extensively in forensic contexts and provides training in the area of trauma in both community and military settings. Dr. Lebowitz developed the psychological portion of the curriculum for training Air Force Sexual Assault Response Coordinators and continues to do biannual training for the Air Force. Her research focuses on the psychological meaning of trauma and the implications for treatment. Previous research examined the aftermath of sexual violence, and more recent work addresses traumatic loss and moral injury. Matt J. Gray, PhD, is Professor of Psychology at the University of Wyoming. His research focuses on treatment development for broad emotional and psychological impacts of combat, as well as prevention and treatment of sexual violence and intimate partner violence. Dr. Gray has published numerous articles in peer-reviewed journals. He has received the Extraordinary Merit in Research Award and the Outstanding Psychology Faculty Member Award on multiple occasions from the University of Wyoming. William P. Nash, MD, is Director of Psychological Health for the U.S. Marine Corps. While on active duty in the Navy, Dr. Nash was deployed to Iraq with Marines of the 1st Marine Division during the Second Battle of Fallujah. His current interests focus on the prevention, recognition, and treatment of combat and operational stress injuries, including moral injury. He is coeditor of Combat Stress Injuries: Theory, Research, and Management and founding chair of the Military Committee of the Group for the Advancement of Psychiatry.


"Adaptive disclosure approaches the treatment of war-related trauma from a perspective that distinguishes it from other types of trauma, which will revolutionize the treatment of PTSD in the military. The authors consider aspects of trauma that are too frequently ignored: grief and loss and moral injury. Litz, Lebowitz, Gray, and Nash are to be commended for taking us to the next level of caring for our service members and veterans."--Carl A. Castro, PhD, School of Social Work, University of Southern California; Colonel, U.S. Army (Retired)

"Based on decades of clinical experience and scientific exploration, adaptive disclosure represents a novel approach to treatment. So few approaches exist for managing combat-related PTSD, making this book a welcome contribution. Adaptive disclosure holds great promise in its focus on a central problem for many military personnel: difficulty divulging the depths of the conflicts that emerge following traumatic experiences of war. Therapists of all disciplines will benefit from the compelling rationale and model of care presented here."--Terence M. Keane, PhD, National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine

"The approach in this manual will advance our understanding and treatment of PTSD in military personnel and veterans. Litz et al. provide detailed direction to help clinicians identify key clinical issues and themes, including experiences of moral injury and traumatic loss. The book offers thoughtful and accessible guidance for implementing interventions to facilitate more complete healing and recovery. This invaluable resource is a 'must' for any clinician working with this population."--David Forbes, PhD, Professor, Department of Psychiatry, University of Melbourne; Director, Phoenix Australia--Centre for Posttraumatic Mental Health

"This unique book presents a highly innovative and clinically wise approach to addressing the three harms--traumatic loss, life threat, and moral injury--that often continue to trouble our returning veterans. It offers detailed language with which to introduce and explain the many difficult clinical issues related to moral injury and loss, systematizes some of the secrets used by expert clinicians, and provides valuable education about military culture. The book will help all mental health treatment providers--whether trainees or seasoned clinicians--to better navigate the most difficult aspects of care."--Josef I. Ruzek, PhD, Director, Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System

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