Adaptive Disclosure
Adaptive Disclosure is a trauma-focused treatment for moral injury and traumatic loss in service members, developed by Brett Litz and colleagues and manualized in 2017. Its core mechanism: exposure-based processing for life-threat trauma, imaginal conversation with deceased for traumatic loss and compassionate moral authority dialogue for moral injury: each wound type matched to its mechanism. This catalogue links it to PTSD, complex trauma and grief and loss, typically in individual format, brief (12 sessions).
Related condition topics
These links support exploration. They do not establish that Adaptive Disclosure is effective or recommended for each condition.
How Adaptive Disclosure works
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. Litz's argument is that these are phenomenologically distinct and call for different interventions. Whether they are neurobiologically distinct is an open question; the imaging work on moral injury is early.
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
Epistemology
Evidence
1 condition assessment available
An overall effectiveness assessment has not been completed. Completed assessments for specific populations appear below.
Condition-specific assessments
Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.
PTSD & Acute Trauma
Population and scope: Adults with PTSD.
Guideline evidence inconclusive
VA/DoD 2023 recommendation 10 finds evidence insufficient for or against Adaptive Disclosure.
Source assessment dated
Guidelines and official sources (1)
1 clinical guideline check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
Adaptive Disclosure is explicitly listed among therapies with insufficient evidence for or against their use for PTSD. It is not absent from the guideline.
Scope: Adaptive Disclosure for adults with PTSD.
Recorded material under review
The existing notes below are retained separately from assessment records. These recorded claims await source checking, including study design, recommendations and numerical estimates.
RCT by Litz et al. (2021) found Adaptive Disclosure non-inferior to Cognitive Processing Therapy in deployed marines and sailors; 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: the standard protocols were built to extinguish fear, and guilt, shame, and meaning violations are not fear responses. The imaginal dialogue with a compassionate moral authority (often a respected mentor, religious figure, or fallen comrade) has no counterpart in PE, CPT, or EMDR. Note what the evidence does and does not cover: the trial asked whether the whole package was non-inferior to CPT, not whether the moral injury component is what did the work.
Training and certification
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
Clinical cautions and blind spots
Assessment and precautions
Active psychosis, severe dissociation, clients without adequate stabilization for trauma processing, active suicidality
Blind spots
Designed specifically for military service members, so using it with a non-military client is a fit question rather than a safety concern: it is unclear how well the protocol transfers to civilian moral injury (healthcare workers, first responders); relatively new with limited replication; 12-session format may not be sufficient for complex presentations
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)
Compared with other approaches
Adaptive Disclosure in 1 Comparative Clinical Vignette
Each vignette presents the same client through multiple theoretical lenses side by side — showing how Adaptive Disclosure formulates presenting problems, sets treatment focus, and sounds in the consulting room compared with other approaches. This comparative pedagogy is unique to Epoché Clinical; no other clinical reference systematically formulates the same case across traditions.
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.