Review of Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury

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Z. Benek Altayli, PsyD

Litz, B.T., Libowitz, M.J., & Nash, W.P. (2016). Adaptive disclosure: A new treatment for military trauma, loss, and moral injury. New York: The Guilford Press.

Adaptive Disclosure is written with heart and clarity to provide an alternative treatment approach to widely accepted, manualized, Cognitive Behavioral Therapy (CBT) based treatments for service members and veterans who suffer from posttraumatic syndromes. The treatment approach, Adaptive Disclosure, comprises of eight, 90-minute sessions that aim to “plant healing seeds,” rather than a “prescriptive dose of a treatment that cures.” Adaptive Disclosure is written for a clinician who is interested in learning about the principles and fundamentals of posttraumatic stress treatment, with or without prior experience.

The attempt to create distance and distinction from the traditionally taught, used, and accepted approaches is a theme that is evident throughout this sobering book. The first couple of chapters take on the task of summarizing the current understanding of Posttraumatic Stress Disorder (PSTD); the widely used and accepted treatment approaches and strategies for PTSD; a review of the success rate of the CBT based treatments that are used for the military and veteran population; and essence of Adaptive Disclosure and the reasons this new approach is promising to be more effective than the traditional treatments for PTSD. The first major distinction is made between danger-based experiences that create fear-based post-trauma syndromes (the DSM system’s approach to PSTD) and the stress-based syndromes due primarily to the experience of traumatic lossand moral injury. According to the authors, the peri-event reactions, phenomenology, and unfolding needs and corrective elements are significantly different in these three distinct event categories that cause posttraumatic stress syndromes.

An important strength of Adaptive Disclosure is the importance it places on diversity and relationship factors that have outcome implications. One of the chapters is dedicated to educating the reader on the fundamentals of military ethos, how this “code” is related to the etiology of the aftermath of traumatic loss and moral injury, seen in this population.  In addition to finding out about facts and additional resources on military ethos, the reader in this chapter can expect to be prompted to contemplate and develop a deeper understanding of the meaning of experiencing post-trauma syndromes for the service members and veterans that is different than civilians. In a related vein to the discussion of the importance of the military culture, ethos and context, a discussion about the therapeutic relationship and its importance for the effectiveness of any treatment approach is also explicitly discussed. In fact, the general tendency to pay closer attention to following the instructions in the manuals and somewhat neglecting the significance of the quality of the relationship is hypothesized to be one of the CBT based therapies’ limitations.

After taking time to establish a good understanding of the perceived strengths and shortcomings of how we currently understand and treat post-trauma syndrome, the latter chapters of the book take on more of a manual feel. Adaptive Disclosure as a therapeutic strategy is described in three steps: (1) Intake session where information about the presenting problem is gathered, the case is conceptualized and categorized in one of the three stress categories (i.e., fear-based stress, loss related stress and moral injury), and the treatment plan is clarified; (2) the following six sessions provide psychoeducation and in the working phase, incorporate an imaginal exposure exercises to facilitate emotional processing of the war experience, uncover relevant associations, and help the service member or veteran to articulate their raw, uncensored beliefs about the meaning and implications of their experience. Depending on the categorization of the seminal event that is being addressed, the imaginal experience, the meaning making process and the exposure experiences are different; (3) the last session is used to review the experiences, underscore positive lessons learned, and plan for the long haul in light of what was addressed and achieved in the previous sessions. These chapters are written with details, preparing the reader clinician to incorporate the Adaptive Disclosure model into their current practice, and in their work with service members and veterans who suffer from a posttraumatic condition.

Adaptive Disclosure is easy to read; the perspectives, ideas, information and instructions are clearly communicated.  It is an excellent amalgamation of what is fundamental and what can be considered as new in the treatment of posttraumatic stress. Finally, Adaptive Disclosuremakes it easy to see how even those who have the most conservative approach to change in their practice could benefit from reexamining what they know and what they have been doing thus far through the fresh lens that this book provides.

Z. Benek Altayli, PsyD is the director of Wellness Center Mental Health Services (MHS), at University of Colorado, Colorado Springs. She has been in this position since 2008. She has focused interest in psychological trauma assessment, diagnosis and treatment; more specifically she is interested in complex traumatic stress disorders and their treatment. Dr. Altayli has experience and expertise with disaster preparedness and response and is a part of APA’s Disaster Resource Network. Additionally, she works with and trains other professionals on behavioral crises and emergencies assessment and intervention. Currently Dr. Altayli holds APA and Division 56 memberships, and is serving in the Colorado Psychological Association’s Board of Directors.