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

• Published in: Journal of consulting and clinical psychology Vol. 92; no. 3; p. 150
• Main Authors: Litz, Brett T, Yeterian, Julie, Berke, Danielle, Lang, Ariel J, Gray, Matt J, Nienow, Tasha, Frankfurt, Sheila, Harris, Jeanette Irene, Maguen, Shira, Rusowicz-Orazem, Luke
• Format: Journal Article
• Language: English
• Published: United States 01.03.2024
• Subjects: Databases, Factual; Disclosure; Humans; Intention; Psychotherapy; Stress Disorders, Post-Traumatic - therapy
• ISSN: 1939-2117
• DOI: 10.1037/ccp0000873

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. 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. 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. 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).