By Brett T. Litz PhD, Leslie Lebowitz PhD, Matt J. Gray PhD, William P. Nash M.D.
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Extra info for Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury
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. 464), particularly “a more realistic view of the amount of responsibility and control during the event” (p. 468). , pre- or peri-event fear or anger, postevent remorse), probes for these contextual details during the imaginal exposure, and reflects back the patient’s acknowledgments of the context during processing.
The results were as follows: 40% of the events entailed a life threat either to the self or others, 30% were rated as entailing traumatic loss, 35% Background and Evidence 23 entailed being exposed to the grotesque aftermath of violence, and 22% were moral injuries perpetrated by the self or others. Tellingly, in this study, the best predictor of the prototypical reexperiencing symptoms of PTSD was a morally injurious perpetration event. We wish to emphasize that the fear conditioning model has brought tremendous advances to the trauma and PTSD field in the last 20 or so years.
This model is doctrine in the medical model of PTSD. The essential necessary precondition is exposure to life-threatening trauma, which triggers an unconditioned “fight–flight–freeze” response, initiating activity in the hypothalamic–pituitary–adrenal axis, the locus coeruleus and noradrenergic systems, and the neurocircuitry of the fear system. This hardwired response to life threat is richly encoded in memory and conditioned to a variety of peri- and postevent stimuli. , 2011). In discreet life-threatening contexts such as motor vehicle accidents, this model is compelling and valid from a variety of perspectives.