Adaptive Disclosure
Core Mechanism
Exposure-based processing for life-threat trauma + imaginal conversation with deceased for traumatic loss + compassionate moral authority dialogue for moral injury — each wound type matched to its mechanism
Ontology
Combat creates three distinct wound types: fear-conditioned threat responses (classic PTSD), unresolved grief for lost comrades, and moral injury from acts that violate deeply held moral beliefs. These are phenomenologically and neurobiologically distinct.
Therapeutic Voice
"I want you to imagine your buddy sitting across from you right now. What would you want to say to him that you never got to say?"
View of the Person
A moral agent whose war experiences have shattered fundamental assumptions about self as good, the world as just, and life as meaningful — requiring repair at the level of meaning, not just fear extinction
Evidence
VA/DoD: not yet listed; under review. Recognized in STRONG STAR consortium research
RCT by Litz et al. (2021) showing superiority to supportive counseling for active-duty; replication underway
Too new for meta-analysis
One of the only trauma protocols designed specifically for military populations rather than adapted from civilian treatments. The moral injury component is its most distinctive contribution — standard protocols struggle with guilt, shame, and meaning violations because these are not fear responses. The imaginal dialogue with a compassionate moral authority (often a respected mentor, religious figure, or fallen comrade) is clinically powerful and unlike anything in PE, CPT, or EMDR.
Conditions
Epistemology
Blind Spots
Developed for military populations — unclear how well it transfers to civilian moral injury (healthcare workers, first responders); relatively new with limited replication; 12-session format may not be sufficient for complex presentations
Contraindications
Active psychosis, severe dissociation, non-military populations (designed specifically for military service members), clients without adequate stabilization for trauma processing, active suicidality
Training
Training through Litz and colleagues. Combat-specific trauma. Three wound types
No formal certification; military-affiliated centers
16-24 hrs + supervised military cases
$1K-2.5K
Equity & Cultural Adaptations
Philosophical Roots
Litz (moral injury as distinct from PTSD); Shay (Achilles in Vietnam — betrayal of what's right); Brock & Lettini (soul repair); Janoff-Bulman (shattered assumptions); existential phenomenology of guilt (Heidegger, Buber)
Related Modalities
Clinical Vignettes
See how Adaptive Disclosure formulates these cases:
Test Yourself
How does Adaptive Disclosure handle moral injury differently from standard PTSD protocols?
Show answer
Standard protocols (PE, CPT, EMDR) target fear-based trauma. AD was designed specifically for combat's three distinct wound types: life-threat (classic PTSD), traumatic loss (grief for fallen comrades), and moral injury (perpetrating or witnessing acts that violate moral code). Each type gets a different intervention — fear-based exposure for life-threat, imaginal conversation with the deceased for loss, and imaginal dialogue with a compassionate moral authority for moral injury.