By Brett T. Litz PhD, Leslie Lebowitz PhD, Matt J. Gray PhD, William P. Nash M.D.
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Extra info for Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury
462), which can include intentional killing while enraged. The authors state that “through repetition, new learning and disconfirmation of trauma-related beliefs can be incorporated into the [fear] structure, resulting in a reduction in PTSD symptoms” (p. 464), particularly “a more realistic view of the amount of responsibility and control during the event” (p. 468). , pre- or peri-event fear or anger, postevent remorse), probes for these contextual details during the imaginal exposure, and reflects back the patient’s acknowledgments of the context during processing.
In the case of morally injurious combat and operational experiences, there are instances in which judgments and beliefs about the transgressions may be appropriate and accurate, as well as psychologically toxic and excruciating. Furthermore, attempts to attribute these actions to the “context of war,” even when appropriate, may ring hollow and/or undermine a therapist’s credibility to a service member steeped in a culture of personal responsibility and moral accountability. Finally, in cognitive therapy, in-session Socratic questioning and homework assignments are used to challenge automatic thoughts about guilt and shame.
Complicated or prolonged grief reactions stemming from traumatic losses share some symptomatic and etiological features with PTSD but have been shown to be distinct in a number of ways that have important implications for treatment. Specifically, although avoidance is prominent in PTSD, and is central to exposure-based treatment approaches, complicated grief reactions are often characterized by seeking out reminders of the deceased and ruminative tendencies (Prigerson & Jacobs, 2001). In fact, avoidance symptoms have been found to be only modestly predictive of traumatic loss-related distress (see Lichtenthal, Cruess, & Prigerson, 2004, for an excellent review).