By Brett T. Litz PhD, Leslie Lebowitz PhD, Matt J. Gray PhD, William P. Nash M.D.
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Additional info for Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury
PE also purports to relieve guilt through contextualizing. . , 2007, pp. 28–29). 16 ADAPTIVE DISCLOSURE More recently, Smith et al. (2013) suggested that PE is appropriate for treating guilt associated with perceived perpetration, or harm enacted “as a consequence of the trauma context” (p. 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.
Also, to the credit of PE researchers, Smith et al. (2013) started a discourse in the PE framework to address moral injury (although the clinical recommendations are for “perceived” perpetration only). The impression we have is that CPT and PE are best prepared to help service members who are haunted by “should haves” (hindsight bias), and who shoulder an excessive amount of perceived responsibility due to a known, unequivocal, noncontingent, and horrible outcome. In these cases, it is safe to assume that self-blame is the result of unwarranted and overgeneralized distortion.
Nevertheless, service members and units face unanticipated moral choices and demands, and even prescribed acts of killing or violence may have an immediate or delayed but lasting negative impact. We contend that it is because service members have high moral standards that events that transgress deeply ingrained moral expectations cause so much inner turmoil (see Chapter 3). , processing that is emotional, experiential, provocative; see Edwards, 1990; Greenberg & Safran, 1989) of injurious events.