Adaptive Disclosure

Many Marines and Sailors return from deployment with mental health problems related to their
experiences. One such problem is posttraumatic stress disorder (PTSD), which involves
symptoms such as persistent unwanted memories of traumatic events, avoidance of reminders of
the events, excessive watchfulness, jumpiness and irritability. Current therapies for PTSD
focus chiefly on fear related to life-threat and were developed chiefly on civilians. We
developed and piloted tested a psychological treatment for PTSD specifically for service
members who suffer not only life-threat, but also traumatic loss and inner conflicts from
morally challenging experiences. This intervention, Adaptive Disclosure (AD) is an
eight-session PTSD treatment that helps Marines to identify unhelpful beliefs about a
traumatic event and find ways to move forward. Preliminary clinical data suggests that AD is
acceptable to Marines, feasible to implement, and safe and that it reduces PTSD and
depression. The primary objective of this randomized controlled non-inferiority trial is to
determine whether or not AD is as least as effective as Cognitive Processing Therapy,
cognitive only version (CPT-C), which is an empirically validated and commonly used PTSD
treatment.

We plan to recruit 266 Marines for this project. They will be randomly assigned to AD or
CPT-C and followed during and after treatment. The groups will be compared on measures of
mental health (particularly PTSD and depression), work-related functioning, trauma-related
beliefs, coping and attitudes about mental health care.

Inclusion Criteria:

- Age 18 or older

- Current PTSD as diagnosed by the CAPS or subsyndromal PTSD (at least meeting criteria
A and B) with distress and/or functional impairment as determined by the CAPS and
review by study senior clinicians. Co-occurring disorders such as depression, anxiety,
or treated substance abuse or dependence problems are permitted.

- Individuals expected to deploy two or more months from the time of referral and/or
assessment are eligible. Anyone deploying sooner than that would be unable to complete
the entire intervention and thus, are ineligible. Potential enrollees need not be
presently deployable.

- Prospective enrollees must be willing to commit to 8 consecutive weekly sessions
lasting up to 90 minutes in duration and to complete assessment materials.

Exclusion Criteria:

- Serious suicidality or homicidality that has required urgent or emergent evaluation or
treatment within the past three months.

- A known, untreated substance abuse or dependence problem. Inclusion is possible if
there is evidence that the individual has been afforded and is complying with
treatment for the substance problem.

- Serious Axis I mental disorders (those that are normally incompatible with active
military service), such as psychotic disorders or bipolar type I, are not eligible.

- Cognitive impairment that would interfere with one's ability to complete the
intervention. If a potential participant performs below the mildly impaired range on
WAIS-IV Digit Span or CVLT-2, the study neuropsychologist will review the case and
make a clinical judgment based on review of testing and, in some cases, additional
evaluation as to ability to participate.

- Concurrent enrollment in any cognitive-behavioral treatment, group therapy, or any
other treatment that involves systematic disclosure of troubling deployment-related
memories. Participants can continue current pharmacological treatment, marital
counseling, or any supportive therapy.