Treating War-Related Moral Injury and Loss with Adaptive Disclosure: A Case Study

Abstract

Existing evidence-based treatments for posttraumatic stress disorder (PTSD), while effective for many fear-based traumas, do not sufficiently target the unique phenomenology of psychological wounds stemming from combat, specifically, moral injury and traumatic loss. The experience of moral injury and loss cause deeply complex challenges across multiple domains—behavioral, biological, cognitive, social, and spiritual—in ways that are significantly different from danger-based harms. Adaptive disclosure, a new psychotherapy, was specifically designed to address this gap in treatment and help service members and veterans begin the process of healing from combat stress and trauma. This chapter presents the conceptual foundation and change agents for adaptive disclosure along with the case of a new veteran whose principal harm was moral injury complicated by loss. The patient in this case made modest gains in PTSD symptom severity alongside authentic cognitive and behavioral signs of increased agency, proactivity, hopefulness, and vitality that were clear departures from moral injury, suggesting the utility of this treatment approach in addressing the psychological wounds of war.