# Psychosocial Rehabilitation after Moral Injury and Loss with Adaptive Disclosure

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2020 · —

## Abstract

Relative to most civilian traumas (e.g., sexual assault, car accidents, and disasters), posttraumatic stress
disorder (PTSD) from warzone exposure is associated with more chronic and disabling social and occupational
functioning problems, as well as poorer response to treatment. Yet, PTSD treatments for war veterans do not
target or even systematically assess these functional impairments. Rather, first-line treatments for military-
related PTSD focus on symptom change, failing to attend to holistic dimensions of recovery, such as improved
work and family functioning and quality of life. The current first-line treatments for PTSD disseminated and
mandated in the VA, Prolonged Exposure and Cognitive Processing Therapy, were developed and originally
tested on female sexual assault victims. Although strides have been made for these therapies to accommodate
veterans traumatized by contexts that are starkly different from most civilian traumas, the therapies still tend to
overemphasize victimization from danger-based warzone events as the cause of PTSD and the target for
treatment. This is problematic because insufficient attention is paid to the unique phenomenology of warzone
experiences within the warrior culture. In particular, existing therapies do not sufficiently address morally
compromising war experiences (e.g., killing), termed moral injury (MI), and traumatic loss, neither of which
necessarily entail high fear and danger. Yet, these types of experiences are reported by large percentages of
veterans as their worst and most currently haunting deployment events. MI and traumatic loss can cause
emotional disturbances, such as guilt, shame, low motivation, anhedonia, and anger problems that negatively
affect recovery and a variety of functional capacities (e.g., work, self-care, and relationships). The goal of this
study is to fill a substantial care-gap in the VA by [testing] an evidence-based treatment for war-related PTSD
stemming from MI and traumatic loss focused on improving psychosocial functioning. [We have modified and
extended Adaptive Disclosure (AD; Litz et al., 2015), a therapy that was previously tested on deployed
Marines, to treat [only] MI and loss (AD-MIL). We have added evidence-based elements to AD designed to
foster improvements in functioning and address obstacles to engaging in various functional behaviors in-vivo.]
We will conduct a multi-site randomized controlled trial comparing AD-MIL to Present-Centered Therapy (PCT;
Frost et al., 2014). We have five hypotheses, grouped into (A) functional change and (B) mental health change.
With respect to functional and behavioral change, we hypothesize that post-treatment, 3-, and 6-months post-
treatment, Iraq and Afghanistan veterans with PTSD randomized to AD-MIL will have greater: (A.1.) reductions
in social, educational, and occupational disability (the primary endpoint); and (A.2.) improvements in quality of
life. With respect to change in mental health symptoms, we hypothesi...

## Key facts

- **NIH application ID:** 9920599
- **Project number:** 5I01RX002135-04
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** BRETT T LITZ
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-06-01 → 2021-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9920599

## Citation

> US National Institutes of Health, RePORTER application 9920599, Psychosocial Rehabilitation after Moral Injury and Loss with Adaptive Disclosure (5I01RX002135-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9920599. Licensed CC0.

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