Publication year
2012
Citation Title
Adaptive disclosure: An open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries.
Journal Name
Behavior Therapy
Journal Volume
43
Issue Number
2
Page Numbers
407-415
DOI
10.1016/j.beth.2011.09.001
Summary
A program development and evaluation study with a sample of Marine Service Members assessed the initial clinical feasibility of adaptive disclosure (AD), a new intervention developed to address combat stress injuries in Active Duty Service members. AD is a comparatively short-term therapy mode designed specifically for Active Duty Service members recovering from combat related trauma. Initial findings indicate that brief, early interventions such as AD can be effective in treating combat and operational stress injuries among Active Duty Service members preparing for potential redeployment.
Key Findings
Service members receiving AD exhibited significant improvement in posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and related posttraumatic cognitions, especially negative beliefs about self and negative beliefs about the world.
Twenty-five percent of those referred started the treatment but dropped out, comparable to attrition rates for conventional PTSD treatments.
There was a significant increase in perceptions of personal strength and growth.
Service members reported that the intervention helped them feel more in control and was tailored to their individual needs; they also reported that they would use it as needed following future deployments and that they would recommend this intervention to other Marines.
Implications for Program Leaders
Assist Service members in choosing and locating treatment that best fits their preferences and needs
Offer workshops to Service members and their families regarding coping strategies that can be used during reintegration
Create peer support groups for Service members to allow them to have a space to process their deployment experiences upon returning home
Implications for Policy Makers
Continue to support programs for Service members and their families to assist with possible reintegration challenges
Recommend training for professionals who work with military families regarding challenges Service members may face during post-deployment and coping skills that may help them navigate those challenges
Encourage investigation into which types of programs are most effective for military families throughout the deployment cycle
Methods
Active Duty Marines and Sailors who (a) deployed at least once to Iraq or Afghanistan, (b) reported symptoms consistent with a diagnosis of PTSD, and (c) had received an initial mental health evaluation were referred by Camp Pendleton Mental Health Clinic staff for participation.
Participants completed measures of PTSD, depression, alcohol use, posttraumatic cognitions and posttraumatic growth before and after participating in the program.
Four PhD psychologists delivered AD via six 90-minute sessions.
Scores on questionnaires were compared befor and after treatment to see if there was a change.
Participants
Participants included 44 Active Duty Marines and Sailors; of the participants, 95% were male and 5% female. Seventy-three percent were 18-29 years of age.
Of the participants, 58% were White, 15% were Latino, 8% were Black, 4% were Asian American, 4% were Native American, 11% were missing data or indicated another race.
The participants included 16% E1-E3, 59% E4-E5, 21% E6-E9, and 4% O1-O4.
Limitations
Without random assignment and a control group, it is impossible to conclude that improvements were caused by the AD intervention.
Because participants were referred by mental health professionals, the Service members treated may not be representative of the larger population of Service members.
Without a comparison to other more conventional treatment approaches, it is impossible to know the degree to which symptom improvements were the result of the novel treatment techniques.
Avenues for Future Research
Replicate the study in a larger, more diverse sample, and utilize an experimental design to test for valid effects of treatment
Investigate nonclinical programs that can allow families to learn certain skills that will aid in Service member reintegration
Examine programs that capitalize on Service members' strengths and growth rather than only treating maladaptive responses
Focus
Multiple Branches
Target Population
Population Focus
Military Component
Abstract
We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.
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