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Psychosocial Rehabilitation After Moral Injury and Loss With Adaptive Disclosure

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.

ClinicalTrials.gov Identifier: NCT03056157

Recruitment Status : Recruiting

First Posted : February 17, 2017

Last Update Posted : January 25, 2021

See Contacts and Locations

Sponsor:

Collaborators:

Minneapolis Veterans Affairs Medical Center

San Francisco Veterans Affairs Medical Center

San Diego Veterans Healthcare System

Central Texas Veterans Healthcare System

Information provided by (Responsible Party):

VA Office of Research and Development

No Study Results Posted on ClinicalTrials.gov for this Study

About Study Results Reporting on ClinicalTrials.gov

Recruitment Status :	Recruiting
Estimated Primary Completion Date :	November 30, 2021
Estimated Study Completion Date :	November 30, 2021

Publications of Results:

Nash WP, Marino Carper TL, Mills MA, Au T, Goldsmith A, Litz BT. Psychometric evaluation of the Moral Injury Events Scale. Mil Med. 2013 Jun;178(6):646-52. doi: 10.7205/MILMED-D-13-00017.

Other Publications:

Nash WP, Litz BT. Moral injury: a mechanism for war-related psychological trauma in military family members. Clin Child Fam Psychol Rev. 2013 Dec;16(4):365-75. doi: 10.1007/s10567-013-0146-y. Review.

Gray MJ, Schorr Y, Nash W, Lebowitz L, Amidon A, Lansing A, Maglione M, Lang AJ, Litz BT. Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries. Behav Ther. 2012 Jun;43(2):407-15. doi: 10.1016/j.beth.2011.09.001. Epub 2011 Oct 1.

Adler AB, Litz BT, Castro CA, Suvak M, Thomas JL, Burrell L, McGurk D, Wright KM, Bliese PD. A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers. J Trauma Stress. 2008 Jun;21(3):253-63. doi: 10.1002/jts.20342.

Batterham PJ, Ftanou M, Pirkis J, Brewer JL, Mackinnon AJ, Beautrais A, Fairweather-Schmidt AK, Christensen H. A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research. Psychol Assess. 2015 Jun;27(2):501-512. doi: 10.1037/pas0000053. Epub 2014 Dec 15. Review.

Bryan CJ, Morrow CE, Etienne N, Ray-Sannerud B. Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depress Anxiety. 2013 Jan;30(1):55-60. doi: 10.1002/da.22002. Epub 2012 Oct 17.

Cameron IM, Crawford JR, Lawton K, Reid IC. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract. 2008 Jan;58(546):32-6. doi: 10.3399/bjgp08X263794.

Fontana A, Rosenheck R, Brett E. War zone traumas and posttraumatic stress disorder symptomatology. J Nerv Ment Dis. 1992 Dec;180(12):748-55.

Friedman MJ. Posttraumatic stress disorder among military returnees from Afghanistan and Iraq. Am J Psychiatry. 2006 Apr;163(4):586-93.

Frost ND, Laska KM, Wampold BE. The evidence for present-centered therapy as a treatment for posttraumatic stress disorder. J Trauma Stress. 2014 Feb;27(1):1-8. doi: 10.1002/jts.21881. Review.

Gerger H, Munder T, Barth J. Specific and nonspecific psychological interventions for PTSD symptoms: a meta-analysis with problem complexity as a moderator. J Clin Psychol. 2014 Jul;70(7):601-15. doi: 10.1002/jclp.22059. Epub 2013 Dec 18.

Germer CK, Neff KD. Self-compassion in clinical practice. J Clin Psychol. 2013 Aug;69(8):856-67. doi: 10.1002/jclp.22021. Epub 2013 Jun 17.

Green BL, Goodman LA, Krupnick JL, Corcoran CB, Petty RM, Stockton P, Stern NM. Outcomes of single versus multiple trauma exposure in a screening sample. J Trauma Stress. 2000 Apr;13(2):271-86.

Hofmann SG, Grossman P, Hinton DE. Loving-kindness and compassion meditation: potential for psychological interventions. Clin Psychol Rev. 2011 Nov;31(7):1126-32. doi: 10.1016/j.cpr.2011.07.003. Epub 2011 Jul 26. Review.

Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006 Mar 1;295(9):1023-32.

Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. US Army Med Dep J. 2008 Jul-Sep:7-17.

Hoge CW, Grossman SH, Auchterlonie JL, Riviere LA, Milliken CS, Wilk JE. PTSD treatment for soldiers after combat deployment: low utilization of mental health care and reasons for dropout. Psychiatr Serv. 2014 Aug 1;65(8):997-1004. doi: 10.1176/appi.ps.201300307.

Jordan BK, Marmar CR, Fairbank JA, Schlenger WE, Kulka RA, Hough RL, Weiss DS. Problems in families of male Vietnam veterans with posttraumatic stress disorder. J Consult Clin Psychol. 1992 Dec;60(6):916-26.

Kaloupek DG, Chard KM, Freed MC, Peterson AL, Riggs DS, Stein MB, Tuma F. Common data elements for posttraumatic stress disorder research. Arch Phys Med Rehabil. 2010 Nov;91(11):1684-91. doi: 10.1016/j.apmr.2010.06.032. Review.

Kok BE, Coffey KA, Cohn MA, Catalino LI, Vacharkulksemsuk T, Algoe SB, Brantley M, Fredrickson BL. How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone. Psychol Sci. 2013 Jul 1;24(7):1123-32. doi: 10.1177/0956797612470827. Epub 2013 May 6. Erratum in: Psychol Sci. 2016 Jun;27(6):931.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13.

Popiel A, Zawadzki B. Trauma Related Guilt Inventory - psychometric properties of the Polish adaptation (TRGI-PL). Psychiatr Pol. 2015;49(5):1089-99. doi: 10.12740/PP/36754. English, Polish.

Savarese VW, Suvak MK, King LA, King DW. Relationships among alcohol use, hyperarousal, and marital abuse and violence in Vietnam veterans. J Trauma Stress. 2001 Oct;14(4):717-32.

Lang AJ, Schnurr PP, Jain S, He F, Walser RD, Bolton E, Benedek DM, Norman SB, Sylvers P, Flashman L, Strauss J, Raman R, Chard KM. Randomized controlled trial of acceptance and commitment therapy for distress and impairment in OEF/OIF/OND veterans. Psychol Trauma. 2017 Aug;9(Suppl 1):74-84. doi: 10.1037/tra0000127. Epub 2016 Jun 20.

Litz BT, Engel CC, Bryant RA, Papa A. A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. Am J Psychiatry. 2007 Nov;164(11):1676-83.

McFall M, Fontana A, Raskind M, Rosenheck R. Analysis of violent behavior in Vietnam combat veteran psychiatric inpatients with posttraumatic stress disorder. J Trauma Stress. 1999 Jul;12(3):501-17.

Pivar IL, Field NP. Unresolved grief in combat veterans with PTSD. J Anxiety Disord. 2004;18(6):745-55.

Rodriguez P, Holowka DW, Marx BP. Assessment of posttraumatic stress disorder-related functional impairment: a review. J Rehabil Res Dev. 2012;49(5):649-65. Review.

Vogt D, Smith BN, King LA, King DW, Knight J, Vasterling JJ. Deployment risk and resilience inventory-2 (DRRI-2): an updated tool for assessing psychosocial risk and resilience factors among service members and veterans. J Trauma Stress. 2013 Dec;26(6):710-7.

Vogt DS, Proctor SP, King DW, King LA, Vasterling JJ. Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans. Assessment. 2008 Dec;15(4):391-403. doi: 10.1177/1073191108316030. Epub 2008 Apr 24.

Toblin RL, Riviere LA, Thomas JL, Adler AB, Kok BC, Hoge CW. Grief and physical health outcomes in U.S. soldiers returning from combat. J Affect Disord. 2012 Feb;136(3):469-75. doi: 10.1016/j.jad.2011.10.048. Epub 2011 Dec 9.

Teten AL, Miller LA, Bailey SD, Dunn NJ, Kent TA. Empathic deficits and alexithymia in trauma-related impulsive aggression. Behav Sci Law. 2008;26(6):823-32. doi: 10.1002/bsl.843.

Taft CT, Street AE, Marshall AD, Dowdall DJ, Riggs DS. Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans. J Fam Psychol. 2007 Jun;21(2):270-7.

Straus MA, Douglas EM. A short form of the Revised Conflict Tactics Scales, and typologies for severity and mutuality. Violence Vict. 2004 Oct;19(5):507-20.

Steenkamp MM, Litz BT. Psychotherapy for military-related posttraumatic stress disorder: review of the evidence. Clin Psychol Rev. 2013 Feb;33(1):45-53. doi: 10.1016/j.cpr.2012.10.002. Epub 2012 Oct 13. Review.

Sheehan KH, Sheehan DV. Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol. 2008 Mar;23(2):70-83. doi: 10.1097/YIC.0b013e3282f2b4d6. Review.

Shea MT, Vujanovic AA, Mansfield AK, Sevin E, Liu F. Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF National Guard and Reserve veterans. J Trauma Stress. 2010 Feb;23(1):100-7. doi: 10.1002/jts.20497.

Schnurr PP, Lunney CA. Exploration of gender differences in how quality of life relates to posttraumatic stress disorder in male and female veterans. J Rehabil Res Dev. 2008;45(3):383-93.

Santiago PN, Ursano RJ, Gray CL, Pynoos RS, Spiegel D, Lewis-Fernandez R, Friedman MJ, Fullerton CS. A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: intentional and non-intentional traumatic events. PLoS One. 2013 Apr 11;8(4):e59236. doi: 10.1371/journal.pone.0059236. Print 2013. Review.

Samper RE, Taft CT, King DW, King LA. Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male vietnam veterans. J Trauma Stress. 2004 Aug;17(4):311-5.

Pace TW, Negi LT, Adame DD, Cole SP, Sivilli TI, Brown TD, Issa MJ, Raison CL. Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology. 2009 Jan;34(1):87-98. doi: 10.1016/j.psyneuen.2008.08.011. Epub 2008 Oct 4.

Neria Y, Litz BT. BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF. J Loss Trauma. 2004 Jan 1;9(1):73-87.

Moher D, Schulz KF, Altman DG; CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Clin Oral Investig. 2003 Mar;7(1):2-7. Epub 2003 Jan 31.

Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston V, Orsillo SM, Haug R, Turner C, Bernardy N. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007 Feb 28;297(8):820-30.

Schnurr PP, Hayes AF, Lunney CA, McFall M, Uddo M. Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder. J Consult Clin Psychol. 2006 Aug;74(4):707-13.

Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, Maguen S. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009 Dec;29(8):695-706. doi: 10.1016/j.cpr.2009.07.003. Epub 2009 Jul 29. Review.

McDonald SD, Calhoun PS. The diagnostic accuracy of the PTSD checklist: a critical review. Clin Psychol Rev. 2010 Dec;30(8):976-87. doi: 10.1016/j.cpr.2010.06.012. Epub 2010 Jul 6. Review.

Maguen S, Luxton DD, Skopp NA, Gahm GA, Reger MA, Metzler TJ, Marmar CR. Killing in combat, mental health symptoms, and suicidal ideation in Iraq war veterans. J Anxiety Disord. 2011 May;25(4):563-7. doi: 10.1016/j.janxdis.2011.01.003. Epub 2011 Jan 22.

Maguen S, Metzler TJ, Bosch J, Marmar CR, Knight SJ, Neylan TC. Killing in combat may be independently associated with suicidal ideation. Depress Anxiety. 2012 Nov;29(11):918-23. doi: 10.1002/da.21954. Epub 2012 Apr 13.

Stein NR, Mills MA, Arditte K, Mendoza C, Borah AM, Resick PA, Litz BT; STRONG STAR Consortium. A scheme for categorizing traumatic military events. Behav Modif. 2012 Nov;36(6):787-807. doi: 10.1177/0145445512446945. Epub 2012 Jun 7.

Maguen S, Madden E, Bosch J, Galatzer-Levy I, Knight SJ, Litz BT, Marmar CR, McCaslin SE. Killing and latent classes of PTSD symptoms in Iraq and Afghanistan veterans. J Affect Disord. 2013 Mar 5;145(3):344-8. doi: 10.1016/j.jad.2012.08.021. Epub 2012 Sep 7.

Magruder KM, Frueh BC, Knapp RG, Johnson MR, Vaughan JA 3rd, Carson TC, Powell DA, Hebert R. PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA primary care clinics. J Trauma Stress. 2004 Aug;17(4):293-301.

Eftekhari A, Ruzek JI, Crowley JJ, Rosen CS, Greenbaum MA, Karlin BE. Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA Psychiatry. 2013 Sep;70(9):949-55. doi: 10.1001/jamapsychiatry.2013.36.

Kearney DJ, Malte CA, McManus C, Martinez ME, Felleman B, Simpson TL. Loving-kindness meditation for posttraumatic stress disorder: a pilot study. J Trauma Stress. 2013 Aug;26(4):426-34. doi: 10.1002/jts.21832. Epub 2013 Jul 25.

Weathers FW, Keane TM, Davidson JR. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety. 2001;13(3):132-56. Review.