Moral Injury, Post-traumatic Stress Disorder, Traumatic Loss
Conditions
Keywords
Moral Injury, Post-traumatic Stress Disorder, Traumatic Loss, Adaptive Disclosure, Veterans
Brief summary
The aim of this study was to determine the efficacy of Adaptive Disclosure for Moral Injury and Loss (AD-MIL), a combat-specific psychotherapy for war-related PTSD stemming from Moral Injury (MI) and traumatic loss (TL) with Iraq and Afghanistan War Veterans with PTSD. AD-MIL will be compared to Present Centered Therapy (PCT). AD-MIL is a modified version of Adaptive Disclosure (AD), which has been modified and extended to solely treat MI and TL by targeting psychological and behavioral obstacles to occupational, relationship, and family functioning, as well as quality of life. PCT is a manualized evidenced-based PTSD treatment used to address functioning problems in several large-scale PTSD trials. The primary end-point was psychosocial functioning (improvements in social, educational and occupational functions). Secondary end-points included PTSD, depression, moral emotions (anger, shame, and guilt), alcohol use, self-compassion, and mindful/valued living.
Detailed description
The investigators conducted a multi-site randomized trial comparing Adaptive Disclosure for Moral Injury and Loss (AD-MIL; an expanded version of Adaptive Disclosure) for war-related PTSD stemming from Moral Injury (MI) and traumatic loss (TL) to Present Centered Therapy (PCT; Frost et al., 2014). The primary endpoint was psychosocial functioning. The investigators had six hypotheses: A: Functional and behavioral changes: A.1. Immediately post-treatment, and 3- and 6-months post-treatment, Veterans with PTSD randomized to AD-MIL will have greater reductions in social, educational, and occupational disability. A.2. COVID-19 aim. In the extended time period for the trial, at the post-treatment, or post-treatment and 3-months post-treatment intervals (depending on when the participant was randomized), Veterans with PTSD randomized to AD-MIL will have greater reductions in social, educational and occupational disability (the investigators also explored whether there would be greater PTSD and depression symptom reduction in this interval). B: Mental health changes: B.3. AD-MIL will lead to greater reductions in PTSD symptom severity and a smaller percentage of PTSD cases. B.4. AD-MIL will lead to greater reductions in depressive symptoms. B.5. AD-MIL will lead to greater reductions in shame and guilt B.6. AD-MIL will lead to greater reductions in psychological distress. Exploratory hypotheses: AD-MIL will lead to greater reductions in aggressive behaviors, suicidal ideation, and alcohol use, and greater increases in compassion for the self and others and social connectedness. BACKGROUND PTSD is a functionally disabling condition among war Veterans. Approximately 20% of Veterans of post-9-11 operations have clinically significant PTSD and suffer from a variety of co-morbid mental and physical health conditions. They also have extensive functional impairments, aggressive and risky behaviors, and reduced quality of life. Although considerable gains have been made in the VA's dissemination of PTSD treatments that are highly effective with civilian trauma, these therapies have been shown to work considerably less well for war trauma. The investigators have argued that this is partly due to a lack of attention to the military culture and warrior ethos and the unique harms of war trauma, namely, moral injury (MI) and traumatic loss (TL). In addition, PTSD treatments have failed to demonstrate an impact on functioning and quality of life, problems that are no less impacted by the warzone trauma. Instead, symptom change is typically the sole metric of success, and functional deficits are rarely considered. The investigators argue that PTSD symptoms should be conceptualized and targeted as part of the fabric of the whole Veteran and his or her context. The investigators aimed to fill a care-gap in the VA by creating an evidence-based treatment for war-related PTSD stemming from MI and TL, focusing on improving psychosocial functioning. The investigators extended Adaptive Disclosure to treat MI and TL (AD-MIL) by: (1) facilitating emotional-processing of TL and MIs and a healing and action plan by letter writing tasks to the lost person or, depending on the nature of the MI, the person or persons harmed by transgressive acts (MI stemming from personal actions or the failure to act) or the person or persons who were the transgressors (MI stemming from being the victim of others' transgressions or bearing witness to grave transgressive acts); (2) skills training and behavioral contracting to improve functioning and targeting MI- and TL-related psychological and behavioral obstacles to habilitative engagements in occupational, relationship, and family roles; and (3) teaching self- and other-compassion and mindfulness. If found to be effective, AD-MIL will fill a care-gap in the VA, reduce PTSD patients' suffering, and help Veterans reclaim or establish positive relationships, work roles, and self-care routines. METHOD Overview: The VA sites were Boston, Minneapolis, San Francisco, San Diego, and Central Texas. The coordinating/lead site was VA Boston led by the study PI, Brett Litz, PhD. The trial followed the consensus recommendations for clinical trials in the VA (VA ORD, 2008): (1) clearly defined target symptoms: functional and clinical outcomes were operationalized; (2) reliable and valid measures: assessment tools were selected for their content relevance and psychometric properties; (3) use of blind evaluators of outcome: the evaluator was independent and blind to treatment condition. This assessor reminded participants to help maintain their blind; (4) assessor training: the independent evaluator was carefully trained to criteria and monitored on an ongoing basis; (5) manualized, replicable, specific treatment programs; (6) there was unbiased assignment to treatment arms and (7) treatment adherence: sessions were be recorded, and a random percentage was used to assess treatment integrity. Adherence to the therapy manuals was monitored by senior supervisors. The investigators followed the CONSORT guidelines for randomization and participant tracking. Participants: The trial required 148 Veterans (including women and members of diverse ethnic and racial groups) with PTSD as a result of military trauma. Recruitment: Veterans were recruited and treated at the Minneapolis, San Diego, San Francisco, and Waco VAs. Co-Investigators (Co-Is): (a) provided materials describing the nature of the study and the target populations sought, distributing said materials via formal (e.g., staff meetings) and informal (e.g., bulletin boards) channels; (b) attended clinical staff meetings; (c) gave talks to describe various treatments in staff grand rounds and other contexts (e.g., to trainees); and (d) provided feedback to staff about referred patients. Assessor Training and Adherence: A co-investigator, Dr. Matt Gray (University of Wyoming) trained the assessors prior to beginning enrollment. Training included reading and viewing training materials, observation of CAPS-5 administration, and supervised administration of at least three CAPS-5s. Dr. Gray has expertise in CAPS-5 training and fidelity monitoring. The assessor was considered trained on CAPS-5 when they matched Dr. Gray on three interviews. To establish matching, Dr. Gray co-rated interviews conducted by the assessor. A match occurred when the assessor and Dr. Gray agreed on the diagnosis and were within 2 severity points on all of the symptom clusters (PTSD criteria B, C, D, and E). All assessments were audiotaped to ensure that a standardized approach was used across patients (provided that the participant consents). Dr. Gray reviewed a random 10% of the assessments. All recordings were stored on a restricted-access encrypted drive. Selected recordings were transported to Dr. Gray via Federal Express that allows tracking. Random Assignment: Veterans were assigned to PCT or AD-MIL based on a randomized permuted block scheme, blocked by gender and minority status. Block size for gender and minority status was based on the distribution of these variables at each site. The Boston site used constrained randomization (i.e., biased coin design) if unexpected imbalance arose in gender and minority distribution across treatment groups. Treatment Fidelity Monitoring: Half-time therapists with Ph.Ds. in clinical or counseling psychology and VA internship experiences treating Veterans with PTSD were trained to deliver AD-MIL and PCT. Training involved a review of the respective manuals and supporting materials, intensive one-on-one training and supervision, and weekly and ad hoc supervision (Dr. Litz for AD-MIL; Dr. Harris for PCT). All sessions were audiotaped. Two random session recordings from a random 20% of the cases were rated to ensure fidelity to each treatment approach. ANALYSES Data Analysis: The longitudinal and clustered nature of the design produced a multilevel or nested data structure (Raudenbush & Bryk, 2002), with a likelihood of between-subject variability in treatment trajectory over time (e.g., random slopes). In this study, Veterans and therapists were nested (clustered) within performance sites. The lower level (level-1) data consisted of the repeated measures for each individual at each assessment. Level-1 data is nested within upper level (level-2) person-level variables (e.g., study site). Using SAS 9.4 and R/R Studio, the investigators explored the change trajectory of endpoints over the course of pre-treatment, during-treatment, and post-treatment time intervals. Specifically, the investigators used the linear mixed model regression framework to assess the differential treatment effects of endpoint symptom burden over time. The investigators examined observed measurement scores and specified linear mixed models that best fit the time-change trends (e.g., linear, piecewise). The investigators tested for the presence of random variation, such as between-site cluster effects and between-subject random slopes of treatment effect. The investigators determined the best fit linear mixed effects model as a combination of most appropriate representation of time and empirically-evidenced random and fixed effects. The linear mixed effects models incorporated clinically relevant time-invariant and time-varying predictors and used Maximum Likelihood Estimation to produce estimates that were unbiased in the presence of random missingness and dropout. These provided an Intent-To-Treat (ITT) analysis that incorporated all available data. Per-protocol and completer subset analyses were performed under the same paradigm. Additionally, a subset of subjects who began therapy during the COVID-19 pandemic were identified and analyzed separately; they comprised subjects which began therapy following December 31st, 2020. The tenability of the At-Random missingness assumption was assessed and a sensitivity analysis of the results was conducted to determine robustness of the inferences. Clinical significance: The investigators used a variation of the two-stage Jacobson & Truax (J&T; 1991) method to establish a reasonable cutoff between dysfunctional and functional scores. The investigators first established the cutoff A, defined as the point 2 SDs beyond the range of the pre-therapy mean (cutoff A = M(baseline) - 2 SD(baseline)). Next, the investigators generated a reliable change index (RCI) for each participant to ensure that changes were not due to artifact of measurement error (\[x2 - x1\]/Sdiff where x1 represents the participant's pre-treatment total score, x2 represents the participant's post-treatment or follow-up total score, and Sdiff is the standard error of difference between the two test scores. Sdiff was calculated from the test-retest reliability of measures. An RCI larger than 1.96 reflects real change. Individuals were classified as recovered (passed both cutoff A and RC criteria), improved (passed RC criterion but not cutoff A), unchanged (passed neither criterion), or deteriorated (passed RC criterion but symptom scores increased) for each follow-up interval. Chi-square analyses were used to compare proportions per arm at each follow-up.
Interventions
BEHAVIORALAdaptive Disclosure for Moral Injury and Loss
AD-MIL is a manualized, 12-session individual psychotherapy designed to improve functioning and to reduce PTSD symptoms by facilitating Veterans doing corrective things in their life to heal and repair traumatic loss and moral injuries. The change agents are: (1) emotional-processing of traumatic loss and moral injuries and motivating a healing and action plan by writing therapeutic letters (e.g., to a lost unit member, to victims of personal transgressions, to people who transgressed); (2) skills training and behavioral contracting to improve functioning and targeting moral injury- and traumatic loss-related psychological and behavioral obstacles to positive and potentially habilitative engagements in occupational, relationship, and family roles; and (3) teaching self- and other-compassion and mindfulness. The goal is to redress the functional impact of moral emotions (anger, shame).
BEHAVIORALPresent Centered Therapy
Participants randomized to the PCT arm will receive 12 sessions of therapy focused on day-to-day functional problems with no focus on trauma or re-visiting past experiences
Sponsors
Minneapolis Veterans Affairs Medical Center
San Francisco Veterans Affairs Medical Center
San Diego Veterans Healthcare System
Central Texas Veterans Health Care System
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Served in an active-duty role within the military since September 2001 (Veterans may be eligible whether or not they were deployed to a warzone) 2. Met the DSM-5 diagnostic criteria for PTSD as a result of military trauma (per Clinician Administered PTSD Scale for DSM-5 \[CAPS-5\]) and reported non-negligible levels of associated functional impairment (Sheehan Disability Scale \[SDS\] score = 10) 3. Prospective enrollees must have been willing to commit to 12 consecutive weekly therapy sessions lasting up to 90 minutes in duration and to complete assessment materials.
Exclusion criteria
1. Bipolar or psychotic disorders. 2. Current drug or alcohol dependence (other than caffeine or tobacco dependence). Prospective enrollees who had maintained sobriety for at least 6 weeks immediately prior to the time of enrollment may have been eligible. 3. Evidence of traumatic brain injury severe enough to influence the ability to understand and respond to study procedures 4. Suicidal or homicidal ideation severe enough to warrant immediate attention 5. Concurrent enrollment in any treatment that involves: (1) systematic disclosure of troubling trauma-related memories or (2) present-focused psychosocial skills training for PTSD or (3) supportive therapy/case management on a \> monthly basis or (4) any individual therapy or (5) newly (\< 6 weeks) prescribed pharmacological treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Assessments occurred at baseline, every treatment session, post treatment, and approximately 3 and 6 months after post treatment. | The Sheehan Disability Scale (SDS; Sheehan, 1983; Sheehan et al., 1996) is a composite of three self-rated items regarding the degree to which symptoms disrupted work/school, social life, and family life/responsibilities on an 11-point scale ranging from Not at all to Extremely, with an option for Not applicable. The possible range of scores is 0 to 30. Higher scores indicate greater disability. |
| Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment. | The Patient Health Questionnaire (PHQ-9) is widely used and well-validated measure of symptoms of depression (Kroenke et al., 2001). It scores each of the nine DSM criteria for depression on a scale of 0 (not at all) to 3 (nearly every day). The range of possible scores is 0 to 27. A higher score indicates more frequent depression symptoms. |
| Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) is closely modeled on the CAPS-IV, a structured diagnostic interview and gold standard for assessing PTSD. It has excellent psychometric properties and diagnostic efficiency (Weathers et al., 2001). The CAPS-5 uses a single 4-point ordinal rating scale to measure symptom severity. These ratings combine information about symptom frequency and intensity obtained by the interviewer. CAPS-5 scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity. |
| Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment. | The PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item self-report checklist based on the 20 DSM-5 symptoms post-traumatic stress disorder (PTSD). The PCL-5 has been validated as a means of monitoring symptom change during treatment. The 20 items are scored are scored in the past month on a scale from 0 (not at all) to 4 (extremely), generating a total symptom severity score between 0 and 80, with higher scores indicating greater PTSD symptom severity. |
| Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment. | The Sheehan Disability Scale (SDS; Sheehan, 1983; Sheehan et al., 1996) is a composite of three self-rated items regarding the degree to which symptoms disrupted work/school, social life, and family life/responsibilities on an 11-point scale ranging from Not at all to Extremely, with an option for Not applicable. The investigators used a prorated total mean score for the dimensional ratings such that only social and family ratings will be included for Veterans who were not employed or attending school at the time. The possible range of scores is 0 to 30. Higher scores indicate greater disability. |
| Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Brief Inventory of Psychosocial Functioning (B-IPF; Marx, 2013) was used to assess functional gains. It is a 7-item scale indexing overall level of functioning in seven life domains: romantic relationship, relationship with children, family relationships, friendships and socializing, work, training and education, and activities of daily living. The investigators used a prorated total percentage for the dimensional ratings, such that Veterans who were not in romantic relationships, had no children, or were not in employed or in school did not have those domains included in their percentage. Possible scores on the B-IPF range from 0% to 100%, with higher scores indicating more issues in psychosocial functioning. |
| Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Baseline and post-treatment. | The investigators used the Jacobson and Truax methodology to index individual participant clinically significant change in functional impairment, assessed through the Sheehan Disability Scale (SDS). Individuals were classified as experiencing probable recovery if they passed the Criterion Cutoff and the RCI criteria; improved if they passed the RCI criterion, but their post-treatment or follow-up score did not pass the Criterion Cutoff; unchanged if they failed to pass the RCI; or deteriorated if they passed the RCI criterion but symptom scores increased. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Baseline and post treatment. | The investigators used the Jacobson and Truax methodology to index individual participant clinically significant change in PTSD symptom burden, which the investigators assessed through the PTSD Checklist for DSM-5 (PCL-5). Individuals were classified as experiencing probable recovery if they passed the Criterion Cutoff and the RCI criteria; improved if they passed the RCI criterion, but their post-treatment or follow-up score did not pass the Criterion Cutoff; unchanged if they failed to pass the RCI; or deteriorated if they passed the RCI criterion but symptom scores increased. |
| Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) is closely modeled on the CAPS-IV, a structured diagnostic interview and gold standard for assessing PTSD. It has excellent psychometric properties and diagnostic efficiency (Weathers et al., 2001). The CAPS-5 uses a single 4-point ordinal rating scale to measure symptom severity. These ratings combine information about symptom frequency and intensity obtained by the interviewer. CAPS-5 scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity. |
| Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The (lack of) Justification subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief; Kubany et al., 1996) is a 4-item measure that assesses guilty thoughts about the justification of one's actions related to a specific traumatic event. Possible scores range from 0 to 4, with higher scores indicating increased guilt. |
| Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Baseline and post treatment. | The investigators used the Jacobson and Truax methodology to index individual participant clinically significant change in PTSD symptom severity and diagnosis, which the investigators assessed through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Individuals were classified as experiencing probable recovery if they passed the Criterion Cutoff and the RCI criteria; improved if they passed the RCI criterion, but their post-treatment or follow-up score did not pass the Criterion Cutoff; unchanged if they failed to pass the RCI; or deteriorated if they passed the RCI criterion but symptom scores increased. |
| Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) is closely modeled on the CAPS-IV, a structured diagnostic interview and gold standard for assessing PTSD. It has excellent psychometric properties and diagnostic efficiency (Weathers et al., 2001). The CAPS-5 uses a single 4-point ordinal rating scale to measure symptom severity. These ratings combine information about symptom frequency and intensity obtained by the interviewer. A patient is determined to have met the DSM-5 criteria for PTSD if they have endorsed at least one symptom from the B cluster, at least one symptom from the C Cluster, and at least two symptoms from the E cluster, along with experiencing the symptoms for at least one month and reporting clinically significant distress or functional impairment. |
| Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment. | The PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item self-report checklist based on the 20 DSM-5 symptoms post-traumatic stress disorder (PTSD). The PCL-5 has been validated as a means of monitoring symptom change during treatment. The 20 items are scored are scored in the past month on a scale from 0 (not at all) to 4 (extremely), generating a total symptom severity score between 0 and 80, with higher scores indicating greater PTSD symptom severity. |
| Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment. | The Patient Health Questionnaire (PHQ-9) is widely used and well-validated measure of symptoms of depression (Kroenke et al., 2001). It scores each of the nine DSM criteria for depression on a scale of 0 (not at all) to 3 (nearly every day). The range of possible scores is 0 to 27. A higher score indicates more frequent depression symptoms. |
| Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Hindsight-Bias subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief; Kubany et al., 1996) is a 7-item measure that assesses guilty thoughts about the preventability and responsibility of a traumatic event. Possible scores range from 0 to 4, with higher scores indicating increased guilt. |
| Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Wrongdoing subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief; Kubany et al., 1996) is a 5-item measure that assesses guilty thoughts about wrongdoing tied to a specific traumatic event. Possible scores range from 0 to 4, with higher scores indicating increased guilt. |
| Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI; Øktedalen et al., 2014) is a 12-item self-report instrument designed to assess individuals' negative self-evaluations in the context of their traumatic experiences. Possible scores range from 0 to 36, with higher scores indicating more negative self-evaluations. The measure has demonstrated good construct validity (Øktedalen et al., 2014). |
| Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Schwartz Outcome Scale-10 (SOS-10; Blais et al., 1999) is a 10-item general mental health outcome measure meant to capture psychological health and distress. Possible scores range from 0 to 60 with higher scores indicating better psychological health and lower distress. The SOS-10 has demonstrated good psychometric properties (Blais et al., 1999). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Dimensions of Anger Reactions (DAR; Forbes et al., 2004) is a widely used measure of state anger. The measure consists of a 7-item inventory intended to capture anger disposition. Possible scores range from 0 to 56, with higher scores indicating higher state anger. |
| Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Santa Clara Brief Compassion Scale (SCBSC; Hwang, et al., 2008) is a 5-item short form of the Compassionate Love Scale for Humanity (CLS). Possible scores range from 1 to 7, with higher scores indicating more compassion for humanity. |
| Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Social Connectedness Scale (SCS; Lee and Robbins, 1995) was used to assess interpersonal closeness. The SCS is an 8-item scale that focuses on individual experiences in a social world (i.e., with peers, friends, and society) and the degree of difficulty in maintaining a sense of closeness. Possible scores range from 8 to 42, with higher scores indicating more social connection. |
| Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Self Compassion Scale (SCS; Neff, 2003) is a 26-item measure that includes 6 subscales (including Self-Kindness, Self-Judgment, Common Humanity, Isolation, Mindfulness, and Over-Identification) and measures overall self-compassion. The possible range of scores is 1 to 5, with higher scores indicating higher self-compassion. The SCS has shown good internal consistency reliability as well as good test-retest reliability (Neff, 2003). |
| Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | Alcohol abuse was evaluated with the Quick Drinking Screen (QDS; Sobell et al., 2003), a 4-item probe of frequency and quantity of alcohol consumption in the last month. The QDS has very good psychometric characteristics (Sobell et al., 2003). The outcome for this measure used in this study was average drinks per week, calculated by using items 1 and 2 from the screen. |
| Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after posttreatment. | The Depressive Symptoms Index - Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997) is a 4-item scale that focuses on ideation, plans, perceived control over ideation, and impulses for suicide. A review of measures of suicidal ideation and behaviors found that the DSI-SS had excellent internal consistency and concurrent validity (Batterham et al., 2014). Possible scores range from 0 to 12, with higher scores indicating greater severity of suicidal ideation. |
| Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Physical Assault subscale of the Revised Conflict Tactics Scale (CTS2; Straus & Douglas, 2004; Straus et al., 1996) was used to measure occurrence of physically aggressive behavior. The subscale consists of 12 items, rated on a scale from 0 (never) to 6 (more than 20 times), with higher scores indicating greater use of aggressive behaviors in the past month. To calculate the annual frequency score, values of 3 through 6 were transformed as follows: 3 = 4, 4 = 8, 5 = 15, 6 = 25. These values were then summed, with higher scores indicating greater frequency. |
| Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment. | The Psychological Aggression subscale of the Revised Conflict Tactics Scale (CTS2; Straus et al., 1996) was used to measure psychologically aggressive behavior. The subscales consists of 8 items, rated on a scale from 0 (never) to 6 (more than 20 times), with higher scores indicating greater use of aggressive behaviors in the past month. To calculate the annual frequency score, values of 3 though 6 were transformed as follows: 3 = 4, 4 = 8, 5 = 15, 6 = 25. These values were then summed, with higher scores indicating greater frequency. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited through clinician referral at four VA locations: San Francisco, San Diego, Minneapolis, and Central Texas between January 2018 and November 2021. The first participant was enrolled on January 3rd, 2018 and the last on November 19th, 2021.
Pre-assignment details
304 participants were recruited for the study. 96 did not meet inclusion/exclusion criteria, 20 declined to participate, and 14 were excluded for other reasons (e.g., difficult to contact). A total of 174 were randomized.
Participants by arm
| Arm | Count |
|---|---|
| Adaptive Disclosure for Moral Injury and Loss AD-MIL is a manualized, 12-session individual psychotherapy designed to improve functioning and to reduce PTSD symptoms by facilitating Veterans doing corrective things in their life to heal and repair traumatic loss and moral injuries. The change agents are: (1) emotional-processing of traumatic loss and moral injuries and motivating a healing and action plan by writing therapeutic letters (e.g., to a lost unit member, to victims of personal transgressions, to people who transgressed); (2) skills training and behavioral contracting to improve functioning and targeting moral injury- and traumatic loss-related psychological and behavioral obstacles to positive and potentially habilitative engagements in occupational, relationship, and family roles; and (3) teaching self- and other-compassion and mindfulness. The goal is to redress the functional impact of moral emotions (anger, shame). | 89 |
| Present Centered Therapy Participants randomized to the PCT arm received 12 sessions of therapy focused on improving day-to-day functioning (with no focus on trauma or re-visiting past experiences). PCT is a manualized evidenced-based PTSD treatment used in several large-scale PTSD trials that focuses on improving functioning. It incorporates the essential therapeutic elements common to different types of psychotherapies, including supportive empathic listening and unconditional positive regard. The therapist plays an active role, but does not impart any systematic training. The focus is to create an understanding of how the symptoms of PTSD are related to day-to-day difficulties and to help patients develop new, more adaptive functional responses to these stressors with a problem-focused and problem- solving approach. In prior trials, PCT showed equivalent change to active therapies at the last follow-up. The VA offers PCT as an evidence-based therapy for PTSD. | 85 |
| Total | 174 |
Baseline characteristics
| Characteristic | Total | Adaptive Disclosure for Moral Injury and Loss | Present Centered Therapy |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 174 Participants | 89 Participants | 85 Participants |
| Age, Continuous | 39.02 years STANDARD_DEVIATION 8.61 | 38.82 years STANDARD_DEVIATION 8.61 | 39.24 years STANDARD_DEVIATION 8.61 |
| Brief Inventory of Psychosocial Functioning (B-IPF) | 60.20 Percentage of total possible score STANDARD_DEVIATION 20.79 | 59.37 Percentage of total possible score STANDARD_DEVIATION 22.14 | 61.06 Percentage of total possible score STANDARD_DEVIATION 19.39 |
| Clinician-administered PTSD scale for DSM-5 (CAPS-5) | 35.89 Score on a scale STANDARD_DEVIATION 12.71 | 36.08 Score on a scale STANDARD_DEVIATION 11.88 | 35.69 Score on a scale STANDARD_DEVIATION 13.6 |
| COVID-19 Aim: Clinician-administered PTSD scale for DSM-5 (CAPS-5) | 40.33 Score on a scale STANDARD_DEVIATION 8.93 | 39.76 Score on a scale STANDARD_DEVIATION 8.89 | 40.86 Score on a scale STANDARD_DEVIATION 9.15 |
| COVID-19 Aim: Patient Health Questionnaire-9 (PHQ-9) | 15.88 Score on a scale STANDARD_DEVIATION 5.88 | 17.31 Score on a scale STANDARD_DEVIATION 5.38 | 14.95 Score on a scale STANDARD_DEVIATION 6.14 |
| COVID-19 Aim: PTSD Checklist for DSM-5 (PCL-5) | 49.73 Score on a scale STANDARD_DEVIATION 10.4 | 48.53 Score on a scale STANDARD_DEVIATION 8.84 | 50.62 Score on a scale STANDARD_DEVIATION 11.57 |
| COVID-19 Aim: Sheehan Disability Scale (SDS) | 20.70 Score on a scale STANDARD_DEVIATION 5.31 | 21.78 Score on a scale STANDARD_DEVIATION 4.52 | 19.82 Score on a scale STANDARD_DEVIATION 5.83 |
| Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | 1.03 Score on a scale STANDARD_DEVIATION 1.64 | 1.14 Score on a scale STANDARD_DEVIATION 1.62 | 0.93 Score on a scale STANDARD_DEVIATION 1.65 |
| Dimensions of Anger Reactions (DAR) | 31.27 Score on a scale STANDARD_DEVIATION 12.5 | 30.27 Score on a scale STANDARD_DEVIATION 12.9 | 32.32 Score on a scale STANDARD_DEVIATION 12.06 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 40 Participants | 19 Participants | 21 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 124 Participants | 66 Participants | 58 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 10 Participants | 4 Participants | 6 Participants |
| Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 1.67 Score on a scale STANDARD_DEVIATION 1.05 | 1.66 Score on a scale STANDARD_DEVIATION 1.06 | 1.68 Score on a scale STANDARD_DEVIATION 1.04 |
| Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | 13.48 Score on a scale STANDARD_DEVIATION 8.73 | 12.74 Score on a scale STANDARD_DEVIATION 7.94 | 14.23 Score on a scale STANDARD_DEVIATION 9.46 |
| (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief). | 1.94 Score on a scale STANDARD_DEVIATION 0.97 | 1.88 Score on a scale STANDARD_DEVIATION 0.98 | 2.00 Score on a scale STANDARD_DEVIATION 0.96 |
| Patient Health Questionnaire-9 (PHQ-9) | 16.75 Score on a scale STANDARD_DEVIATION 5.45 | 16.88 Score on a scale STANDARD_DEVIATION 5.43 | 16.62 Score on a scale STANDARD_DEVIATION 5.5 |
| Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | 3.31 Score on a scale STANDARD_DEVIATION 21.76 | 5.25 Score on a scale STANDARD_DEVIATION 30.27 | 0.96 Score on a scale STANDARD_DEVIATION 3.31 |
| Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | 27.70 Score on a scale STANDARD_DEVIATION 29.68 | 28.94 Score on a scale STANDARD_DEVIATION 31.45 | 26.41 Score on a scale STANDARD_DEVIATION 27.87 |
| PTSD Checklist for DSM-5 (PCL-5) | 50.46 Score on a scale STANDARD_DEVIATION 11.17 | 49.26 Score on a scale STANDARD_DEVIATION 11.43 | 51.66 Score on a scale STANDARD_DEVIATION 10.85 |
| Quick Drinking Screen (QDS) | 1.94 Drinks per week STANDARD_DEVIATION 2.99 | 1.92 Drinks per week STANDARD_DEVIATION 3.17 | 1.97 Drinks per week STANDARD_DEVIATION 2.82 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 9 Participants | 4 Participants | 5 Participants |
| Race (NIH/OMB) Black or African American | 19 Participants | 10 Participants | 9 Participants |
| Race (NIH/OMB) More than one race | 17 Participants | 5 Participants | 12 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 5 Participants | 3 Participants | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 19 Participants | 12 Participants | 7 Participants |
| Race (NIH/OMB) White | 104 Participants | 54 Participants | 50 Participants |
| Region of Enrollment United States | 174 Participants | 89 Participants | 85 Participants |
| Santa Clara Brief Compassion Scale (SCBSC) | 4.92 Score on a scale STANDARD_DEVIATION 1.7 | 4.84 Score on a scale STANDARD_DEVIATION 1.76 | 5.00 Score on a scale STANDARD_DEVIATION 1.64 |
| Schwartz Outcome Scale-10 (SOS-10) | 25.18 Score on a scale STANDARD_DEVIATION 9.14 | 24.94 Score on a scale STANDARD_DEVIATION 9.87 | 25.43 Score on a scale STANDARD_DEVIATION 8.38 |
| Self-Compassion Scale (SCS) | 2.58 Score on a scale STANDARD_DEVIATION 0.57 | 2.66 Score on a scale STANDARD_DEVIATION 0.57 | 2.49 Score on a scale STANDARD_DEVIATION 0.56 |
| Sex/Gender, Customized Gender Female | 37 Participants | 19 Participants | 18 Participants |
| Sex/Gender, Customized Gender Male | 135 Participants | 69 Participants | 66 Participants |
| Sex/Gender, Customized Gender Prefer not to answer | 1 Participants | 1 Participants | 0 Participants |
| Sex/Gender, Customized Gender Transgender | 1 Participants | 0 Participants | 1 Participants |
| Sheehan Disability Scale (SDS) | 20.48 Score on a scale STANDARD_DEVIATION 5.1 | 20.52 Score on a scale STANDARD_DEVIATION 5.14 | 20.43 Score on a scale STANDARD_DEVIATION 5.1 |
| Social Connectedness Scale (SCS) | 23.73 Score on a scale STANDARD_DEVIATION 8.97 | 23.89 Score on a scale STANDARD_DEVIATION 9.69 | 23.57 Score on a scale STANDARD_DEVIATION 8.22 |
| Valued Living Questionnaire (VLQ) | 39.08 Composite score on a scale STANDARD_DEVIATION 18.2 | 37.39 Composite score on a scale STANDARD_DEVIATION 19.42 | 40.72 Composite score on a scale STANDARD_DEVIATION 16.89 |
| Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 1.72 Score on a scale STANDARD_DEVIATION 1 | 1.71 Score on a scale STANDARD_DEVIATION 1 | 1.74 Score on a scale STANDARD_DEVIATION 1.01 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 89 | 0 / 85 |
| other Total, other adverse events | 7 / 89 | 10 / 85 |
| serious Total, serious adverse events | 1 / 89 | 2 / 85 |
Outcome results
Primary
Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS)
The Sheehan Disability Scale (SDS; Sheehan, 1983; Sheehan et al., 1996) is a composite of three self-rated items regarding the degree to which symptoms disrupted work/school, social life, and family life/responsibilities on an 11-point scale ranging from Not at all to Extremely, with an option for Not applicable. The possible range of scores is 0 to 30. Higher scores indicate greater disability.
Time frame: Assessments occurred at baseline, every treatment session, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 4 | 16.16 Score on a scale | Standard Deviation 7 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 6 | 14.86 Score on a scale | Standard Deviation 7.27 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Baseline | 20.52 Score on a scale | Standard Deviation 5.14 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 7 | 14.33 Score on a scale | Standard Deviation 6.76 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 2 | 16.93 Score on a scale | Standard Deviation 6.12 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 8 | 12.57 Score on a scale | Standard Deviation 6.83 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 9 | 11.90 Score on a scale | Standard Deviation 6.54 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 3 | 16.16 Score on a scale | Standard Deviation 6.45 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 10 | 11.51 Score on a scale | Standard Deviation 6.41 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 1 | 17.39 Score on a scale | Standard Deviation 5.67 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 11 | 11.02 Score on a scale | Standard Deviation 6.34 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | 3 month follow-up | 13.21 Score on a scale | Standard Deviation 7.83 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 12 | 9.76 Score on a scale | Standard Deviation 6.44 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | 6 month follow-up | 11.22 Score on a scale | Standard Deviation 6.87 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 5 | 14.58 Score on a scale | Standard Deviation 6.73 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | 6 month follow-up | 15.66 Score on a scale | Standard Deviation 7.39 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 1 | 18.04 Score on a scale | Standard Deviation 5.49 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 12 | 14.04 Score on a scale | Standard Deviation 7.91 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | 3 month follow-up | 15.38 Score on a scale | Standard Deviation 7.71 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 2 | 18.25 Score on a scale | Standard Deviation 6.47 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 3 | 17.36 Score on a scale | Standard Deviation 6.46 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 4 | 17.50 Score on a scale | Standard Deviation 6 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 5 | 16.02 Score on a scale | Standard Deviation 6.97 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 6 | 16.16 Score on a scale | Standard Deviation 7.39 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 7 | 15.32 Score on a scale | Standard Deviation 7.42 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 8 | 15.21 Score on a scale | Standard Deviation 7.03 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 9 | 14.16 Score on a scale | Standard Deviation 7.85 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 10 | 13.65 Score on a scale | Standard Deviation 7.66 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Session 11 | 13.88 Score on a scale | Standard Deviation 7.42 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Baseline | 20.43 Score on a scale | Standard Deviation 5.1 |
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores, t(1519 )= -2.19, d = 0.15.p-value: 0.0395% CI: [-3.34, -0.18]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to- treat data for SDS scores, t(160)= -15.74, d = 2.97.p-value: <0.00195% CI: [-10.12, -6.11]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores, t(160) = -12.72, d = 1.86.p-value: <0.00195% CI: [-8.35, -6.11]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores, t(1510) = -0.90, d = 0.05.p-value: 0.4995% CI: [-2.13, 0.86]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores, t(1510) = 2.11, d = 0.11.p-value: <0.00195% CI: [0.06, 2.17]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores, t(1510) = 3.45, d = 0.18p-value: <0.00195% CI: [0.75, 2.81]Mixed Models Analysis
Primary
Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort
The Sheehan Disability Scale (SDS; Sheehan, 1983; Sheehan et al., 1996) is a composite of three self-rated items regarding the degree to which symptoms disrupted work/school, social life, and family life/responsibilities on an 11-point scale ranging from Not at all to Extremely, with an option for Not applicable. The investigators used a prorated total mean score for the dimensional ratings such that only social and family ratings will be included for Veterans who were not employed or attending school at the time. The possible range of scores is 0 to 30. Higher scores indicate greater disability.
Time frame: Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 2 | 18.47 Score on a scale | Standard Deviation 5.75 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 8 | 13.73 Score on a scale | Standard Deviation 5.26 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 10 | 10.77 Score on a scale | Standard Deviation 4.51 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Baseline | 21.78 Score on a scale | Standard Deviation 4.52 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 1 | 17.22 Score on a scale | Standard Deviation 5.07 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 3 | 16.75 Score on a scale | Standard Deviation 5.51 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 4 | 16.59 Score on a scale | Standard Deviation 6.56 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 5 | 13.00 Score on a scale | Standard Deviation 5.9 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 6 | 12.88 Score on a scale | Standard Deviation 4.98 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 7 | 13.53 Score on a scale | Standard Deviation 5.85 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 9 | 11.29 Score on a scale | Standard Deviation 5.11 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 11 | 9.93 Score on a scale | Standard Deviation 5.28 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 12 | 9.08 Score on a scale | Standard Deviation 5.94 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | 3 month follow-up | 19.00 Score on a scale | Standard Deviation 5.29 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 9 | 12.67 Score on a scale | Standard Deviation 6.64 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 7 | 14.22 Score on a scale | Standard Deviation 6.32 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 5 | 14.39 Score on a scale | Standard Deviation 6.32 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 12 | 13.18 Score on a scale | Standard Deviation 7.99 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 10 | 13.00 Score on a scale | Standard Deviation 8.06 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 6 | 16.24 Score on a scale | Standard Deviation 5.27 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Baseline | 19.82 Score on a scale | Standard Deviation 5.83 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 11 | 11.53 Score on a scale | Standard Deviation 7.21 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 1 | 18.15 Score on a scale | Standard Deviation 4.66 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 2 | 19.50 Score on a scale | Standard Deviation 4.63 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 8 | 14.06 Score on a scale | Standard Deviation 5.4 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 3 | 17.00 Score on a scale | Standard Deviation 6.56 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | 3 month follow-up | 15.56 Score on a scale | Standard Deviation 7.06 |
| Present Centered Therapy | Change in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) for the COVID-19 Cohort | Session 4 | 18.00 Score on a scale | Standard Deviation 5.58 |
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores for the COVID-19 cohort, t(373) = -0.32, d = 0.03.p-value: 0.7595% CI: [-4.68, 3.36]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores for the COVID-19 cohort, t(37) = -6.01, d = 1.97.p-value: <0.00195% CI: [-12.12, -6.12]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores for the COVID-19 cohort, t(37) = -6.11, d = 2.01.p-value: <0.00195% CI: [-11.16, -5.76]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores for the COVID-19 cohort, t(373) = -0.59, d = 0.06.p-value: 0.5695% CI: [-10.08, 5.52]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores for the COVID-19 cohort, t(373) = 1.25, d = 0.13.p-value: 0.2295% CI: [-0.24, 10.92]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SDS scores for the COVID-19 cohort, t(373) = 3.18, d = 0.33.p-value: 0.00295% CI: [2.52, 10.69]Mixed Models Analysis
Primary
Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF)
The Brief Inventory of Psychosocial Functioning (B-IPF; Marx, 2013) was used to assess functional gains. It is a 7-item scale indexing overall level of functioning in seven life domains: romantic relationship, relationship with children, family relationships, friendships and socializing, work, training and education, and activities of daily living. The investigators used a prorated total percentage for the dimensional ratings, such that Veterans who were not in romantic relationships, had no children, or were not in employed or in school did not have those domains included in their percentage. Possible scores on the B-IPF range from 0% to 100%, with higher scores indicating more issues in psychosocial functioning.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | Baseline | 59.37 Units on a scale | Standard Deviation 22.14 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | Post treatment | 52.68 Units on a scale | Standard Deviation 25.96 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | 3 month follow-up | 43.47 Units on a scale | Standard Deviation 26.98 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | 6 month follow-up | 41.12 Units on a scale | Standard Deviation 25.95 |
| Present Centered Therapy | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | 6 month follow-up | 51.73 Units on a scale | Standard Deviation 25.31 |
| Present Centered Therapy | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | Baseline | 61.06 Units on a scale | Standard Deviation 19.38 |
| Present Centered Therapy | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | 3 month follow-up | 52.87 Units on a scale | Standard Deviation 28.44 |
| Present Centered Therapy | Change in Psychosocial Functioning Assessed Through the Brief Inventory of Psychosocial Functioning (B-IPF) | Post treatment | 55.97 Units on a scale | Standard Deviation 24.77 |
Comparison: In a mixed model analysis of intent-to-treat data for B-IPF scores, t(326) = -0.93, d = 0.10.p-value: 0.3595% CI: [-10.57, 3.79]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for BIPF scores, t(116) = -3.27, d = 0.61.p-value: 0.00195% CI: [-13.83, -3.44]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for B-IPF scores, t(116) = -2.08, d = 0.39.p-value: 0.0495% CI: [-10.21, -0.29]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for B-IPF scores, t(326) = -1.79, d = 0.20.p-value: 0.0895% CI: [-10.86, 0.52]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for B-IPF scores, t(326) = -2.72, d = 0.30.p-value: 0.00795% CI: [-9.72, -1.57]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for B-IPF scores, t(326) = -0.23, d = 0.03.p-value: 0.8295% CI: [-4.44, 3.5]Mixed Models Analysis
Primary
Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort
The PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item self-report checklist based on the 20 DSM-5 symptoms post-traumatic stress disorder (PTSD). The PCL-5 has been validated as a means of monitoring symptom change during treatment. The 20 items are scored are scored in the past month on a scale from 0 (not at all) to 4 (extremely), generating a total symptom severity score between 0 and 80, with higher scores indicating greater PTSD symptom severity.
Time frame: Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 3 | 43.24 Score on a scale | Standard Deviation 13.1 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 7 | 36.40 Score on a scale | Standard Deviation 12.2 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Baseline | 48.53 Score on a scale | Standard Deviation 8.84 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 8 | 33.67 Score on a scale | Standard Deviation 12.11 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 4 | 42.47 Score on a scale | Standard Deviation 13.68 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 9 | 30.50 Score on a scale | Standard Deviation 13.14 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 2 | 41.65 Score on a scale | Standard Deviation 11.33 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 10 | 31.69 Score on a scale | Standard Deviation 14.29 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 5 | 40.50 Score on a scale | Standard Deviation 17.04 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 11 | 30.14 Score on a scale | Standard Deviation 14.72 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 1 | 47.11 Score on a scale | Standard Deviation 12.07 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 12 | 29.15 Score on a scale | Standard Deviation 12.11 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | 3-month follow-up | 30.33 Score on a scale | Standard Deviation 11.59 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 6 | 36.75 Score on a scale | Standard Deviation 15.26 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | 3-month follow-up | 40.47 Score on a scale | Standard Deviation 20.46 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Baseline | 50.62 Score on a scale | Standard Deviation 11.57 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 1 | 46.48 Score on a scale | Standard Deviation 10.87 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 2 | 47.15 Score on a scale | Standard Deviation 12.73 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 3 | 45.22 Score on a scale | Standard Deviation 10.11 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 4 | 45.89 Score on a scale | Standard Deviation 8.81 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 5 | 39.72 Score on a scale | Standard Deviation 12.21 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 6 | 42.00 Score on a scale | Standard Deviation 10.81 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 7 | 37.78 Score on a scale | Standard Deviation 12.83 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 8 | 37.47 Score on a scale | Standard Deviation 14.69 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 9 | 37.44 Score on a scale | Standard Deviation 13.43 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 10 | 35.53 Score on a scale | Standard Deviation 14.89 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 11 | 35.29 Score on a scale | Standard Deviation 14.55 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) for the COVID-19 Cohort | Session 12 | 37.47 Score on a scale | Standard Deviation 14.49 |
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores for the COVID-19 cohort, t(367) = 0.10, d = 0.01.p-value: 0.9295% CI: [-9.6, 10.69]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores for the COVID-19 cohort, t(37) = -4.23, d = 1.39.p-value: <0.00195% CI: [-23.64, -8.52]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores for the COVID-19 cohort, t(37) = -4.77, d = 1.57.p-value: <0.00195% CI: [-23.4, -9.72]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores for the COVID-19 cohort, t(367) = -3.15, d = 0.33.p-value: 0.00295% CI: [-42.6, -9.84]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores for the COVID-19 cohort, t(37) = -2.67, d = 0.28.p-value: 0.0195% CI: [-32.4, -4.92]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for B- IPF scores, the Pre-Post PCT Time slope was -5.25 \[95% CI = -10.21, -0.29\], p-value = 0.04, t(116) = -2.08, d = 0.39.p-value: 0.0495% CI: [-10.21, -0.29]Mixed Models Analysis
Primary
Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) is closely modeled on the CAPS-IV, a structured diagnostic interview and gold standard for assessing PTSD. It has excellent psychometric properties and diagnostic efficiency (Weathers et al., 2001). The CAPS-5 uses a single 4-point ordinal rating scale to measure symptom severity. These ratings combine information about symptom frequency and intensity obtained by the interviewer. CAPS-5 scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | Baseline | 39.76 Score on a scale | Standard Deviation 8.89 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | Post treatment | 24.07 Score on a scale | Standard Deviation 13.51 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | 3 month follow-up | 35.50 Score on a scale | Standard Deviation 7.82 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | Baseline | 40.86 Score on a scale | Standard Deviation 9.15 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | Post treatment | 34.79 Score on a scale | Standard Deviation 11.92 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for the COVID-19 Cohort | 3 month follow-up | 28.33 Score on a scale | Standard Deviation 17.63 |
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores for the COVID-19 cohort, t(49) = -1.69, d = 0.48.p-value: 0.195% CI: [-13.97, 1.22]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores for the COVID-19 cohort, t(32) = -4.71, d = 1.67.p-value: <0.00195% CI: [-18.96, -7.62]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores for the COVID-19 cohort, t(32) = -2.75, d = 0.97.p-value: 0.00195% CI: [-11.96, -1.87]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores for the COVID-19 cohort, t(49) = 0.97, d = 0.28.p-value: 0.3495% CI: [-5.6, 16.05]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores for the COVID-19 cohort, t(49) = 1.40, d = 0.40.p-value: 0.1795% CI: [-2.55, 14.41]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores for the COVID-19 cohort, t(49) = 0.21, d = 0.06.p-value: 0.8395% CI: [-6.04, 7.44]Mixed Models Analysis
Primary
Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort
The Patient Health Questionnaire (PHQ-9) is widely used and well-validated measure of symptoms of depression (Kroenke et al., 2001). It scores each of the nine DSM criteria for depression on a scale of 0 (not at all) to 3 (nearly every day). The range of possible scores is 0 to 27. A higher score indicates more frequent depression symptoms.
Time frame: Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Baseline | 17.31 Score on a scale | Standard Deviation 5.38 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 1 | 15.07 Score on a scale | Standard Deviation 6.37 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 2 | 14.44 Score on a scale | Standard Deviation 5.87 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 3 | 13.79 Score on a scale | Standard Deviation 4.95 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 4 | 13.82 Score on a scale | Standard Deviation 5.44 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 5 | 15.10 Score on a scale | Standard Deviation 5.05 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 6 | 12.60 Score on a scale | Standard Deviation 6.08 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 7 | 12.40 Score on a scale | Standard Deviation 6.73 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 8 | 12.27 Score on a scale | Standard Deviation 6.38 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 9 | 11.20 Score on a scale | Standard Deviation 5.45 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 10 | 11.86 Score on a scale | Standard Deviation 7.15 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 11 | 10.56 Score on a scale | Standard Deviation 5.77 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 12 | 10.47 Score on a scale | Standard Deviation 5.21 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | 3 month follow-up | 18.00 Score on a scale | Standard Deviation 7.55 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 10 | 12.59 Score on a scale | Standard Deviation 5.42 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Baseline | 14.95 Score on a scale | Standard Deviation 6.14 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 7 | 11.90 Score on a scale | Standard Deviation 4.56 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 1 | 16.14 Score on a scale | Standard Deviation 4.13 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 12 | 11.53 Score on a scale | Standard Deviation 4.61 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 2 | 16.02 Score on a scale | Standard Deviation 5.08 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 8 | 12.46 Score on a scale | Standard Deviation 4.93 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 3 | 15.56 Score on a scale | Standard Deviation 5.43 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 11 | 11.84 Score on a scale | Standard Deviation 4.69 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 4 | 14.92 Score on a scale | Standard Deviation 4.08 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 9 | 12.78 Score on a scale | Standard Deviation 5.92 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 5 | 12.28 Score on a scale | Standard Deviation 4.12 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | 3 month follow-up | 14.10 Score on a scale | Standard Deviation 6.02 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) for the COVID-19 Cohort | Session 6 | 12.37 Score on a scale | Standard Deviation 3.47 |
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores for the COVID-19 cohort, t(373) = 0.30, d = 0.03.p-value: 0.7695% CI: [-3.12, 4.2]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores for the COVID-19 cohort, t(37) = -3.14, d = 1.03.p-value: 0.00295% CI: [-6.96, -1.56]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores for the COVID-19 cohort, t(37) = -3.88, d = 1.27.p-value: <0.00195% CI: [-7.32, -2.4]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores for the COVID-19 cohort, t(373) = -1.50, d = 0.16.p-value: 0.1395% CI: [-11.16, 1.44]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores for the COVID-19 cohort, t(373) = -0.87, d = 0.09.p-value: 0.3895% CI: [-7.68, 3]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores for the COVID-19 cohort, t(373) = 1.42, d = 0.15.p-value: 0.2695% CI: [-0.96, 5.88]Mixed Models Analysis
Primary
Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS)
The investigators used the Jacobson and Truax methodology to index individual participant clinically significant change in functional impairment, assessed through the Sheehan Disability Scale (SDS). Individuals were classified as experiencing probable recovery if they passed the Criterion Cutoff and the RCI criteria; improved if they passed the RCI criterion, but their post-treatment or follow-up score did not pass the Criterion Cutoff; unchanged if they failed to pass the RCI; or deteriorated if they passed the RCI criterion but symptom scores increased.
Time frame: Baseline and post-treatment.
Population: The participants analyzed here are participants who had a complete SDS baseline assessment, and a complete SDS post-treatment assessment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Probable Recovery | 56.86 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Improved | 0 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Unchanged | 43.14 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Deteriorated | 0 Percentage of participants |
| Present Centered Therapy | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Deteriorated | 3.57 Percentage of participants |
| Present Centered Therapy | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Probable Recovery | 35.71 Percentage of participants |
| Present Centered Therapy | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Unchanged | 48.21 Percentage of participants |
| Present Centered Therapy | Pre-to-Post-Treatment Clinically Significant Change (CSC) in Functional Impairment Assessed Through the Sheehan Disability Scale (SDS) | Improved | 12.50 Percentage of participants |
Comparison: Odds ratio comparison of the proportions of participants who experienced probable recovery in SDS from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.0395% CI: [1.01, 5.56]Fisher Exact
Comparison: Odds ratio comparison of the proportion of participants who experienced improvement from baseline to post-treatment in SDS in AD-MIL versus PCT.p-value: 0.0195% CI: [0, 0.71]Fisher Exact
Comparison: Odds ratio comparison of the proportion of participants who experienced no change in SDS from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.6995% CI: [0.35, 1.87]Fisher Exact
Comparison: Odds ratio comparison of the proportion of participants who experienced deterioration in SDS from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.50% CI: [0, 5.83]Fisher Exact
Secondary
Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief)
The Hindsight-Bias subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief; Kubany et al., 1996) is a 7-item measure that assesses guilty thoughts about the preventability and responsibility of a traumatic event. Possible scores range from 0 to 4, with higher scores indicating increased guilt.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Baseline | 1.66 Score on a scale | Standard Deviation 1.06 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Post treatment | 0.93 Score on a scale | Standard Deviation 0.95 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 3 month follow-up | 0.98 Score on a scale | Standard Deviation 1.08 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 6 month follow-up | 1.13 Score on a scale | Standard Deviation 1.24 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 6 month follow-up | 1.09 Score on a scale | Standard Deviation 0.83 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Baseline | 1.68 Score on a scale | Standard Deviation 1.04 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 3 month follow-up | 1.31 Score on a scale | Standard Deviation 1.15 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Hindsight-Bias Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Post treatment | 1.51 Score on a scale | Standard Deviation 1.05 |
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Hindsight-Bias scores, t(314) = -3.41, d = 0.39.p-value: <0.00195% CI: [-0.74, -0.2]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Hindsight-Bias scores, t(113) = -6.41, d = 1.20.p-value: <0.00195% CI: [-0.83, -0.44]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Hindsight-Bias scores, t(113) = -1.83, d = 0.34.p-value: 0.0795% CI: [-0.36, 0.02]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Hindsight-Bias scores, t(314) = 3.13, d = 0.06.p-value: 0.00295% CI: [0.13, 0.57]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Hindsight-Bias scores, t(113) = 2.21, d = 0.42.p-value: 0.0395% CI: [0.02, 0.34]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Hindsight-Bias scores, t(113) = -2.22, d = 0.42.p-value: 0.0395% CI: [-0.32, -0.02]Mixed Models Analysis
Secondary
Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief)
The (lack of) Justification subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief; Kubany et al., 1996) is a 4-item measure that assesses guilty thoughts about the justification of one's actions related to a specific traumatic event. Possible scores range from 0 to 4, with higher scores indicating increased guilt.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Baseline | 1.88 Score on a scale | Standard Deviation 0.98 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Post treatment | 1.59 Score on a scale | Standard Deviation 0.92 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 3 month follow-up | 1.70 Score on a scale | Standard Deviation 1.06 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 6 month follow-up | 1.87 Score on a scale | Standard Deviation 1.26 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 6 month follow-up | 1.78 Score on a scale | Standard Deviation 1.21 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Baseline | 2.00 Score on a scale | Standard Deviation 0.96 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 3 month follow-up | 2.08 Score on a scale | Standard Deviation 1.12 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the (Lack of) Justification Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Post treatment | 1.86 Score on a scale | Standard Deviation 1.1 |
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Justification scores, t(314) = -1.35, d = 0.15.p-value: 0.1895% CI: [-0.49, 0.09]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Justification scores, t(113) = -2.44, d = 0.46.p-value: 0.0295% CI: [-0.47, -0.05]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Justification scores, t(113) = -0.69, d = 0.12.p-value: 0.6295% CI: [-0.26, 0.14]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Justification scores, t(314) = 1.34, d = 0.15.p-value: 0.1895% CI: [-0.07, 0.39]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Justification scores, t(113) = 1.49, d = 0.28.p-value: 0.1495% CI: [-0.04, 0.3]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Justification scores, t(113) = -0.38, d = 0.07.p-value: 0.7195% CI: [-0.19, 0.13]Mixed Models Analysis
Secondary
Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief)
The Wrongdoing subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief; Kubany et al., 1996) is a 5-item measure that assesses guilty thoughts about wrongdoing tied to a specific traumatic event. Possible scores range from 0 to 4, with higher scores indicating increased guilt.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Baseline | 1.71 Score on a scale | Standard Deviation 1 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Post treatment | 1.34 Score on a scale | Standard Deviation 0.95 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 3 month follow-up | 1.33 Score on a scale | Standard Deviation 0.97 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 6 month follow-up | 1.42 Score on a scale | Standard Deviation 1.06 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 6 month follow-up | 1.29 Score on a scale | Standard Deviation 0.93 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Baseline | 1.74 Score on a scale | Standard Deviation 1.01 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | 3 month follow-up | 1.51 Score on a scale | Standard Deviation 1.04 |
| Present Centered Therapy | Change in Guilt Cognitions About a Specific Warzone Event Assessed Through the Wrongdoing Subscale of the Brief Trauma Related Guilt Inventory (TRGI-Brief) | Post treatment | 1.65 Score on a scale | Standard Deviation 1.03 |
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Wrongdoing scores, t(314) = 2.46, d = 0.28.p-value: 0.0195% CI: [0.06, 0.57]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for RGI Wrongdoing scores, t(113) = 0.06, d = 0.01.p-value: 0.9595% CI: [-0.17, 0.18]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for RGI Wrongdoing scores, t(113) = -3.32, d = 0.62.p-value: 0.0195% CI: [-0.5, -0.13]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Wrongdoing scores, t(314) = -2.02, d = 0.23.p-value: 0.0495% CI: [-0.41, -0.01]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRGI Wrongdoing scores, t(113) = -2.18, d = 0.03.p-value: 0.0395% CI: [-0.3, -0.02]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for RGI Wrongdoing scores, t(113) = 0.70, d = 0.13.p-value: 0.4895% CI: [-0.09, 0.2]Mixed Models Analysis
Secondary
Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10)
The Schwartz Outcome Scale-10 (SOS-10; Blais et al., 1999) is a 10-item general mental health outcome measure meant to capture psychological health and distress. Possible scores range from 0 to 60 with higher scores indicating better psychological health and lower distress. The SOS-10 has demonstrated good psychometric properties (Blais et al., 1999).
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | Baseline | 24.94 Score on a scale | Standard Deviation 9.87 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | Post treatment | 32.16 Score on a scale | Standard Deviation 12.72 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | 3 month follow-up | 32.43 Score on a scale | Standard Deviation 13.23 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | 6 month follow-up | 31.98 Score on a scale | Standard Deviation 13.37 |
| Present Centered Therapy | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | 6 month follow-up | 28.85 Score on a scale | Standard Deviation 11.6 |
| Present Centered Therapy | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | Baseline | 25.43 Score on a scale | Standard Deviation 8.38 |
| Present Centered Therapy | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | 3 month follow-up | 26.78 Score on a scale | Standard Deviation 10.75 |
| Present Centered Therapy | Change in Psychological Health and Distress Assessed Through the Schwartz Outcome Scale-10 (SOS-10) | Post treatment | 29.53 Score on a scale | Standard Deviation 11.18 |
Comparison: In a mixed model analysis of intent-to-treat data for SOS-10 scores, t(326) = 2.35, d = 0.26.p-value: 0.0295% CI: [0.56, 6.25]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SOS-10 scores, t(116) = -6.53, d = 1.21.p-value: <0.00195% CI: [4.78, 8.9]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SOS-10 scores, t(116) = 3.44, d = 0.64.p-value: 0.00195% CI: [1.47, 5.4]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SOS-10 scores, t(326) = 0.66, d = 0.07.p-value: 0.5195% CI: [-1.5, 3.03]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SOS-10 scores, t(326) = -0.32, d = 0.04.p-value: 0.7595% CI: [-1.89, 1.35]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SOS-10 scores, t(326) = -1.28, d = 0.14.p-value: 0.295% CI: [-2.61, 0.55]Mixed Models Analysis
Secondary
Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) is closely modeled on the CAPS-IV, a structured diagnostic interview and gold standard for assessing PTSD. It has excellent psychometric properties and diagnostic efficiency (Weathers et al., 2001). The CAPS-5 uses a single 4-point ordinal rating scale to measure symptom severity. These ratings combine information about symptom frequency and intensity obtained by the interviewer. A patient is determined to have met the DSM-5 criteria for PTSD if they have endorsed at least one symptom from the B cluster, at least one symptom from the C Cluster, and at least two symptoms from the E cluster, along with experiencing the symptoms for at least one month and reporting clinically significant distress or functional impairment.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either 1) not filling out the measure at a given time point due to clinician error or 2) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Post treatment | 30 Participants |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Baseline | 89 Participants |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 3 month follow-up | 31 Participants |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 6 month follow-up | 19 Participants |
| Present Centered Therapy | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 6 month follow-up | 27 Participants |
| Present Centered Therapy | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 3 month follow-up | 35 Participants |
| Present Centered Therapy | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Baseline | 85 Participants |
| Present Centered Therapy | Change in PTSD Caseness Assessed Through PTSD Diagnoses Using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Post treatment | 45 Participants |
Comparison: Odds ratio comparison of the proportions of participants with a PTSD Diagnosis in CAPS-5 at post-treatment in AD-MIL versus PCT.p-value: 0.0795% CI: [0.22, 1.06]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants with PTSD Diagnosis in CAPS-5 at 3MFU in AD-MIL versus PCT.p-value: 0.3395% CI: [0.28, 1.56]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants with PTSD Diagnosis in CAPS-5 at 6MFU in AD-MIL versus PCT.p-value: 0.0595% CI: [0.15, 1.08]Fisher Exact
Secondary
Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5)
The PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item self-report checklist based on the 20 DSM-5 symptoms post-traumatic stress disorder (PTSD). The PCL-5 has been validated as a means of monitoring symptom change during treatment. The 20 items are scored are scored in the past month on a scale from 0 (not at all) to 4 (extremely), generating a total symptom severity score between 0 and 80, with higher scores indicating greater PTSD symptom severity.
Time frame: Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 4 | 42.06 Score on a scale | Standard Deviation 14.36 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 8 | 33.48 Score on a scale | Standard Deviation 15.67 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 1 | 45.79 Score on a scale | Standard Deviation 13.24 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 9 | 31.83 Score on a scale | Standard Deviation 16.63 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 5 | 41.08 Score on a scale | Standard Deviation 16.14 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 10 | 30.51 Score on a scale | Standard Deviation 16.8 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 3 | 42.46 Score on a scale | Standard Deviation 13.88 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 11 | 29.37 Score on a scale | Standard Deviation 16.44 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 6 | 38.42 Score on a scale | Standard Deviation 15.4 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 12 | 27.33 Score on a scale | Standard Deviation 15.78 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 2 | 42.49 Score on a scale | Standard Deviation 13.91 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | 3 month follow-up | 29.88 Score on a scale | Standard Deviation 18.61 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 7 | 36.64 Score on a scale | Standard Deviation 15.21 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | 6 month follow-up | 31.43 Score on a scale | Standard Deviation 18.8 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Baseline | 49.26 Score on a scale | Standard Deviation 11.43 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | 6 month follow-up | 35.79 Score on a scale | Standard Deviation 15.9 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Baseline | 51.66 Score on a scale | Standard Deviation 10.85 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 1 | 45.60 Score on a scale | Standard Deviation 12.72 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 2 | 44.01 Score on a scale | Standard Deviation 13.6 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 3 | 42.81 Score on a scale | Standard Deviation 13.76 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 4 | 42.68 Score on a scale | Standard Deviation 12.83 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 5 | 40.23 Score on a scale | Standard Deviation 14.53 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 6 | 38.72 Score on a scale | Standard Deviation 14.34 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 7 | 38.43 Score on a scale | Standard Deviation 14.06 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 8 | 37.76 Score on a scale | Standard Deviation 15.83 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 9 | 35.40 Score on a scale | Standard Deviation 15.53 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 10 | 34.32 Score on a scale | Standard Deviation 15.25 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 11 | 34.82 Score on a scale | Standard Deviation 15.51 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Session 12 | 35.48 Score on a scale | Standard Deviation 15.72 |
| Present Centered Therapy | Change in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | 3 month follow-up | 38.40 Score on a scale | Standard Deviation 15.63 |
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores, t(1542) = -3.01, d = 0.13.p-value: 0.00395% CI: [-7.16, -2.1]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores, t(161) = -11.50, d = 1.81.p-value: <0.00195% CI: [-14.43, -10.8]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores, t(161) = -7.40, d = 1.16.p-value: <0.00195% CI: [-9.77, -6.2]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores, t(1542) = -0.45, d = 0.02.p-value: 0.6595% CI: [-4.01, 2.52]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores, t(1542) = 1.94, d = 0.10.p-value: 0.0595% CI: [-0.03, 4.63]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PCL-5 scores, t(1542) = 2.61, d = 0.13.p-value: 0.00195% CI: [0.75, 5.34]Mixed Models Analysis
Secondary
Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) is closely modeled on the CAPS-IV, a structured diagnostic interview and gold standard for assessing PTSD. It has excellent psychometric properties and diagnostic efficiency (Weathers et al., 2001). The CAPS-5 uses a single 4-point ordinal rating scale to measure symptom severity. These ratings combine information about symptom frequency and intensity obtained by the interviewer. CAPS-5 scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Baseline | 36.08 Score on a scale | Standard Deviation 11.88 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Post treatment | 21.78 Score on a scale | Standard Deviation 14.92 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 3 month follow-up | 24.44 Score on a scale | Standard Deviation 14.37 |
| Adaptive Disclosure for Moral Injury and Loss | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 6 month follow-up | 21.16 Score on a scale | Standard Deviation 15.47 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 6 month follow-up | 27.41 Score on a scale | Standard Deviation 13.07 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Baseline | 35.69 Score on a scale | Standard Deviation 13.6 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | 3 month follow-up | 29.63 Score on a scale | Standard Deviation 13.68 |
| Present Centered Therapy | Change in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Post treatment | 30.74 Score on a scale | Standard Deviation 12.41 |
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores, t(348) = -3.65, d = 0.39.p-value: <0.00195% CI: [-10.23, -3.07]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores, t(131) = -9.14, d = 1.60.p-value: <0.00195% CI: [-14.43, -9.32]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores, t(131) = -4.10, d = 0.72.p-value: <0.00195% CI: [-7.74, -2.72]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores, t(348) = 0.87, d = 0.09.p-value: 0.3995% CI: [-1.73, 4.45]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores, t(348) = 0.07, d = 0.001.p-value: 0.9495% CI: [-2.1, 2.26]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CAPS-5 scores, t(348) = -1.15, d = 0.12.p-value: 0.2595% CI: [-3.48, 0.91]Mixed Models Analysis
Secondary
Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI)
The Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI; Øktedalen et al., 2014) is a 12-item self-report instrument designed to assess individuals' negative self-evaluations in the context of their traumatic experiences. Possible scores range from 0 to 36, with higher scores indicating more negative self-evaluations. The measure has demonstrated good construct validity (Øktedalen et al., 2014).
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | Baseline | 12.74 Score on a scale | Standard Deviation 7.94 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | Post treatment | 11.71 Score on a scale | Standard Deviation 8.66 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | 3 month follow-up | 10.59 Score on a scale | Standard Deviation 8.36 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | 6 month follow-up | 10.56 Score on a scale | Standard Deviation 6.69 |
| Present Centered Therapy | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | 6 month follow-up | 11.69 Score on a scale | Standard Deviation 6.7 |
| Present Centered Therapy | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | Baseline | 14.23 Score on a scale | Standard Deviation 9.46 |
| Present Centered Therapy | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | 3 month follow-up | 12.00 Score on a scale | Standard Deviation 8.68 |
| Present Centered Therapy | Change in Shame Tied to a Specific Warzone Event Assessed Through the Internal Shame Subscale of the Trauma-Related Shame Inventory (TRSI) | Post treatment | 12.76 Score on a scale | Standard Deviation 8.31 |
Comparison: In a mixed model analysis of intent-to-treat data for TRSI scores, t(317) = 0.76, d = 0.09.p-value: 0.4595% CI: [-1.12, 2.52]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRSI scores, t(113) = -1.79, d = 0.34.p-value: 0.0895% CI: [-2.52, 0.12]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRSI scores, t(113) = -3.00, d = 0.56.p-value: 0.00395% CI: [-3.15, -0.66]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRSI scores, t(317) = -0.39, d = 0.04.p-value: 0.795% CI: [-1.75, 1.17]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRSI scores, t(317) = -1.11, d = 0.12.p-value: 0.2795% CI: [-1.64, 0.46]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for TRSI scores, t(317) = -0.57, d = 0.06.p-value: 0.5795% CI: [-1.32, 0.72]Mixed Models Analysis
Secondary
Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9)
The Patient Health Questionnaire (PHQ-9) is widely used and well-validated measure of symptoms of depression (Kroenke et al., 2001). It scores each of the nine DSM criteria for depression on a scale of 0 (not at all) to 3 (nearly every day). The range of possible scores is 0 to 27. A higher score indicates more frequent depression symptoms.
Time frame: Assessments occurred at baseline, every treatment session, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 4 | 14.47 Score on a scale | Standard Deviation 5.54 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 8 | 12.34 Score on a scale | Standard Deviation 6.91 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Baseline | 16.88 Score on a scale | Standard Deviation 5.43 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 9 | 11.47 Score on a scale | Standard Deviation 6.18 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 5 | 14.53 Score on a scale | Standard Deviation 5.74 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 10 | 11.26 Score on a scale | Standard Deviation 6.92 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 2 | 14.80 Score on a scale | Standard Deviation 5.6 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 11 | 11.17 Score on a scale | Standard Deviation 6.22 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 6 | 13.85 Score on a scale | Standard Deviation 6.43 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 12 | 9.99 Score on a scale | Standard Deviation 6.3 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 1 | 15.92 Score on a scale | Standard Deviation 6.05 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | 3 month follow-up | 12.22 Score on a scale | Standard Deviation 7.61 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 7 | 12.89 Score on a scale | Standard Deviation 6.2 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | 6 month follow-up | 11.84 Score on a scale | Standard Deviation 7.14 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 3 | 14.56 Score on a scale | Standard Deviation 5.43 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | 6 month follow-up | 13.15 Score on a scale | Standard Deviation 7.28 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 3 | 15.14 Score on a scale | Standard Deviation 5.83 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Baseline | 16.62 Score on a scale | Standard Deviation 5.5 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 1 | 15.70 Score on a scale | Standard Deviation 5.44 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 2 | 15.81 Score on a scale | Standard Deviation 5.55 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 4 | 14.95 Score on a scale | Standard Deviation 5.03 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 5 | 14.30 Score on a scale | Standard Deviation 5.87 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 6 | 13.26 Score on a scale | Standard Deviation 5.25 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 7 | 13.19 Score on a scale | Standard Deviation 5.73 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 8 | 13.32 Score on a scale | Standard Deviation 5.99 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 9 | 12.67 Score on a scale | Standard Deviation 6.11 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 10 | 12.05 Score on a scale | Standard Deviation 5.9 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 11 | 12.29 Score on a scale | Standard Deviation 6.07 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | Session 12 | 11.56 Score on a scale | Standard Deviation 5.75 |
| Present Centered Therapy | Change in Symptoms of Depression Assessed Through the Patient Health Questionnaire (PHQ-9) | 3 month follow-up | 14.17 Score on a scale | Standard Deviation 6.29 |
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores, t(1550) = -1.46, d = 0.07p-value: 0.1495% CI: [-2.29, 0.34]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores, t(161) = -12.41, d = 1.96.p-value: <0.00195% CI: [-6.8, -4.9]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores, t(161) = -10.29, d = 1.62.p-value: <0.00195% CI: [-5.82, -3.94]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores, t(1550) = 0.42, d = 0.02.p-value: 0.6895% CI: [-0.99, 1.53]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores, t(1550) = 3.02, d = 0.15.p-value: 0.00395% CI: [0.48, 2.24]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for PHQ-9 scores, t(1550) = 2.37, d = 0.12.p-value: 0.0295% CI: [0.19, 1.99]Mixed Models Analysis
Secondary
Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5)
The investigators used the Jacobson and Truax methodology to index individual participant clinically significant change in PTSD symptom burden, which the investigators assessed through the PTSD Checklist for DSM-5 (PCL-5). Individuals were classified as experiencing probable recovery if they passed the Criterion Cutoff and the RCI criteria; improved if they passed the RCI criterion, but their post-treatment or follow-up score did not pass the Criterion Cutoff; unchanged if they failed to pass the RCI; or deteriorated if they passed the RCI criterion but symptom scores increased.
Time frame: Baseline and post treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Probable Recovery | 42.86 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Improved | 17.86 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Unchanged | 37.50 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Deteriorated | 1.79 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Deteriorated | 0 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Probable Recovery | 25.45 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Unchanged | 50.91 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Burden Assessed Through the PTSD Checklist for DSM-5 (PCL-5) | Improved | 23.64 Percentage of participants |
Comparison: Odds ratio comparison of the proportions of participants experiencing probable recovery in PCL-5 at post-treatment in AD-MIL versus PCT.p-value: 0.0495% CI: [1.01, 5.84]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants experiencing improvement in PCL-5 at post-treatment in AD-MIL versus PCT.p-value: 0.4995% CI: [0.25, 1.95]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants experiencing no change in PCL-5 at post-treatment in AD-MIL versus PCT.p-value: 0.1895% CI: [0.25, 1.32]Fisher Exact
Secondary
Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
The investigators used the Jacobson and Truax methodology to index individual participant clinically significant change in PTSD symptom severity and diagnosis, which the investigators assessed through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Individuals were classified as experiencing probable recovery if they passed the Criterion Cutoff and the RCI criteria; improved if they passed the RCI criterion, but their post-treatment or follow-up score did not pass the Criterion Cutoff; unchanged if they failed to pass the RCI; or deteriorated if they passed the RCI criterion but symptom scores increased.
Time frame: Baseline and post treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Probable Recovery | 15.25 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Improved | 30.51 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Unchanged | 52.54 Percentage of participants |
| Adaptive Disclosure for Moral Injury and Loss | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Deteriorated | 1.69 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Deteriorated | 10.61 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Probable Recovery | 3.03 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Unchanged | 63.64 Percentage of participants |
| Present Centered Therapy | Pre- to Post-Treatment Clinically Significant Change (CSC) in PTSD Symptom Severity and Diagnosis Assessed Through the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) | Improved | 25.76 Percentage of participants |
Comparison: Odds ratio comparison of the proportions of participants who experienced probable recovery in CAPS-5 from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.0195% CI: [1.29, 63.18]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants who experienced improvement in CAPS-5 from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.495% CI: [0.61, 3.75]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants who experienced no change in CAPS-5 from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.5895% CI: [0.36, 1.7]Fisher Exact
Comparison: Odds ratio comparison of the proportions of participants who experienced deterioration in CAPS-5 from baseline to post-treatment in AD-MIL versus PCT.p-value: 0.0695% CI: [0.003, 1.2]Fisher Exact
Other Pre-specified
Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS)
Alcohol abuse was evaluated with the Quick Drinking Screen (QDS; Sobell et al., 2003), a 4-item probe of frequency and quantity of alcohol consumption in the last month. The QDS has very good psychometric characteristics (Sobell et al., 2003). The outcome for this measure used in this study was average drinks per week, calculated by using items 1 and 2 from the screen.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | Baseline | 1.92 Estimated drinks per week | Standard Deviation 3.17 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | Post treatment | 0.84 Estimated drinks per week | Standard Deviation 1.58 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | 3 month follow-up | 1.27 Estimated drinks per week | Standard Deviation 2.28 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | 6 month follow-up | 0.84 Estimated drinks per week | Standard Deviation 1.87 |
| Present Centered Therapy | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | 6 month follow-up | 2.55 Estimated drinks per week | Standard Deviation 4.81 |
| Present Centered Therapy | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | Baseline | 1.97 Estimated drinks per week | Standard Deviation 2.81 |
| Present Centered Therapy | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | 3 month follow-up | 2.37 Estimated drinks per week | Standard Deviation 4.34 |
| Present Centered Therapy | Change in Alcohol Consumption Assessed Through the Quick Drinking Screen (QDS) | Post treatment | 2.16 Estimated drinks per week | Standard Deviation 3.55 |
Comparison: In a mixed model analysis of intent-to-treat data for QDS scores, t(316) = -1.42, d = 0.16.p-value: 0.1695% CI: [-2.63, 0.43]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for QDS scores, t(114)= -1.35, d = 0.25.p-value: 0.1895% CI: [-1.87, 0.35]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for QDS scores, t(114) = 0.63, d = 0.12.p-value: 0.5395% CI: [-0.71, 1.39]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for QDS scores, t(316) = -0.89, d = 0.12.p-value: 0.3795% CI: [-1.93, 0.73]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for QDS scores, t(114) = -0.08, d = 0.02.p-value: 0.9495% CI: [-1, 0.92]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for QDS scores, t(114) = 1.21, d = 0.23.p-value: 0.2395% CI: [-0.35, 1.48]Mixed Models Analysis
Other Pre-specified
Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC)
The Santa Clara Brief Compassion Scale (SCBSC; Hwang, et al., 2008) is a 5-item short form of the Compassionate Love Scale for Humanity (CLS). Possible scores range from 1 to 7, with higher scores indicating more compassion for humanity.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | Baseline | 4.84 Score on a scale | Standard Deviation 1.76 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | Post treatment | 4.93 Score on a scale | Standard Deviation 1.65 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | 3 month follow-up | 5.12 Score on a scale | Standard Deviation 1.56 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | 6 month follow-up | 4.97 Score on a scale | Standard Deviation 1.73 |
| Present Centered Therapy | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | 6 month follow-up | 4.85 Score on a scale | Standard Deviation 1.54 |
| Present Centered Therapy | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | Baseline | 5.00 Score on a scale | Standard Deviation 1.64 |
| Present Centered Therapy | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | 3 month follow-up | 4.82 Score on a scale | Standard Deviation 1.77 |
| Present Centered Therapy | Change in Compassion for Humanity Assessed Through The Santa Clara Brief Compassion Scale (SCBSC) | Post treatment | 5.02 Score on a scale | Standard Deviation 1.63 |
Comparison: In a mixed model analysis of intent-to-treat data for SCBSC scores, t(318) = -0.25, d = 0.03.p-value: 0.895% CI: [-0.32, 0.25]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCBSC scores, t(115) = 0.57, d = 0.11.p-value: 0.5795% CI: [-0.09, 0.16]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCBSC scores, t(115) = -0.23, d = 0.04.p-value: 0.8295% CI: [-0.14, 0.11]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCBSC scores, t(320) = 0.57, d = 0.06.p-value: 0.5795% CI: [-0.13, 0.23]Mixed Models Analysis
Other Pre-specified
Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS)
The Self Compassion Scale (SCS; Neff, 2003) is a 26-item measure that includes 6 subscales (including Self-Kindness, Self-Judgment, Common Humanity, Isolation, Mindfulness, and Over-Identification) and measures overall self-compassion. The possible range of scores is 1 to 5, with higher scores indicating higher self-compassion. The SCS has shown good internal consistency reliability as well as good test-retest reliability (Neff, 2003).
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | Baseline | 2.66 Score on a scale | Standard Deviation 0.57 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | Post treatment | 2.97 Score on a scale | Standard Deviation 0.76 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | 3 month follow-up | 3.01 Score on a scale | Standard Deviation 0.78 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | 6 month follow-up | 3.13 Score on a scale | Standard Deviation 0.78 |
| Present Centered Therapy | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | 6 month follow-up | 2.67 Score on a scale | Standard Deviation 0.61 |
| Present Centered Therapy | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | Baseline | 2.49 Score on a scale | Standard Deviation 0.56 |
| Present Centered Therapy | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | 3 month follow-up | 2.57 Score on a scale | Standard Deviation 0.68 |
| Present Centered Therapy | Change in Overall Self-Compassion Assessed Through the Self Compassion Scale (SCS) | Post treatment | 2.61 Score on a scale | Standard Deviation 0.64 |
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(319) = 2.93, d = 0.33.p-value: 0.00495% CI: [0.08, 0.43]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(114) = 5.56, d = 1.04.p-value: <0.00195% CI: [0.23, 0.48]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(114) = 1.61, d = 0.30.p-value: 0.1195% CI: [-0.02, 0.22]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(319) = 0.10, d = 0.10.p-value: 0.9295% CI: [-0.13, 0.15]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(319) = 0.31, d = 0.03.p-value: 0.7595% CI: [-0.08, 0.12]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(319) = 0.18, d = 0.02.p-value: 0.8695% CI: [-0.09, 0.11]Mixed Models Analysis
Other Pre-specified
Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS)
The Social Connectedness Scale (SCS; Lee and Robbins, 1995) was used to assess interpersonal closeness. The SCS is an 8-item scale that focuses on individual experiences in a social world (i.e., with peers, friends, and society) and the degree of difficulty in maintaining a sense of closeness. Possible scores range from 8 to 42, with higher scores indicating more social connection.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | Baseline | 23.89 Score on a scale | Standard Deviation 9.69 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | Post treatment | 28.08 Score on a scale | Standard Deviation 11.75 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | 3 month follow-up | 29.56 Score on a scale | Standard Deviation 12.11 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | 6 month follow-up | 29.83 Score on a scale | Standard Deviation 12.17 |
| Present Centered Therapy | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | 6 month follow-up | 27.21 Score on a scale | Standard Deviation 9.1 |
| Present Centered Therapy | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | Baseline | 23.56 Score on a scale | Standard Deviation 8.22 |
| Present Centered Therapy | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | 3 month follow-up | 26.41 Score on a scale | Standard Deviation 10.83 |
| Present Centered Therapy | Change in Social Connectedness Assessed Through the Social Connectedness Scale (SCS) | Post treatment | 24.78 Score on a scale | Standard Deviation 9.16 |
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(316) = 2.49, d = 0.28.p-value: 0.0195% CI: [0.83, 7.13]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(114) = 4.16, d = 0.78.p-value: <0.00195% CI: [2.55, 7.13]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(114) = 0.78, d = 0.15.p-value: 0.4495% CI: [-1.31, 3.02]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(316) = 0.17, d = 0.02.p-value: 0.8895% CI: [-2.32, 2.75]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(316) = 0.60, d = 0.07.p-value: 0.5595% CI: [-1.27, 2.37]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for SCS scores, t(316) = 0.38, d = 0.04.p-value: 0.795% CI: [-1.42, 2.1]Mixed Models Analysis
Other Pre-specified
Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR)
The Dimensions of Anger Reactions (DAR; Forbes et al., 2004) is a widely used measure of state anger. The measure consists of a 7-item inventory intended to capture anger disposition. Possible scores range from 0 to 56, with higher scores indicating higher state anger.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | Baseline | 30.27 Score on a scale | Standard Deviation 12.9 |
| Adaptive Disclosure for Moral Injury and Loss | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | Post treatment | 24.63 Score on a scale | Standard Deviation 13.96 |
| Adaptive Disclosure for Moral Injury and Loss | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | 3 month follow-up | 22.52 Score on a scale | Standard Deviation 14.53 |
| Adaptive Disclosure for Moral Injury and Loss | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | 6 month follow-up | 20.85 Score on a scale | Standard Deviation 14.28 |
| Present Centered Therapy | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | 6 month follow-up | 28.51 Score on a scale | Standard Deviation 13.37 |
| Present Centered Therapy | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | Baseline | 32.32 Score on a scale | Standard Deviation 12.06 |
| Present Centered Therapy | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | 3 month follow-up | 28.96 Score on a scale | Standard Deviation 15.1 |
| Present Centered Therapy | Change in State Anger Assessed Through the Dimensions of Anger Reactions (DAR) | Post treatment | 29.07 Score on a scale | Standard Deviation 15.17 |
Comparison: In a mixed model analysis of intent-to-treat data for DAR scores, t(325) = -1.43, d = 0.16.p-value: 0.1595% CI: [-6.1, 0.97]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DAR scores, t(116) = -4.07, d = 0.76p-value: <0.00195% CI: [-7.83, -2.73]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DAR scores, t(116) = -2.19, d = 0.41.p-value: 0.0395% CI: [-5.16, -0.28]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DAR scores, t(325) = -0.97, d = 0.11.p-value: 0.3395% CI: [-4.17, 1.42]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DAR scores, t(325) = -1.51, d = 0.17.p-value: 0.1395% CI: [-3.54, 0.46]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DAR scores, t(325) = -0.17, d = 0.02.p-value: 0.8795% CI: [-2.12, 1.79]Mixed Models Analysis
Other Pre-specified
Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS)
The Depressive Symptoms Index - Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997) is a 4-item scale that focuses on ideation, plans, perceived control over ideation, and impulses for suicide. A review of measures of suicidal ideation and behaviors found that the DSI-SS had excellent internal consistency and concurrent validity (Batterham et al., 2014). Possible scores range from 0 to 12, with higher scores indicating greater severity of suicidal ideation.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after posttreatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | Baseline | 1.14 Score on a scale | Standard Deviation 1.62 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | Post treatment | 1.00 Score on a scale | Standard Deviation 1.63 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | 3 month follow-up | 0.91 Score on a scale | Standard Deviation 1.61 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | 6 month follow-up | 1.15 Score on a scale | Standard Deviation 1.72 |
| Present Centered Therapy | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | 6 month follow-up | 1.05 Score on a scale | Standard Deviation 1.62 |
| Present Centered Therapy | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | Baseline | 0.93 Score on a scale | Standard Deviation 1.65 |
| Present Centered Therapy | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | 3 month follow-up | 0.94 Score on a scale | Standard Deviation 1.58 |
| Present Centered Therapy | Change in Suicidality Across Assessed Through the Depressive Symptoms Index - Suicidality Subscale (DSI-SS) | Post treatment | 0.85 Score on a scale | Standard Deviation 1.55 |
Comparison: In a mixed model analysis of intent-to-treat data for DSI-SS scores, t(318) = -0.33, d = 0.04p-value: 0.7495% CI: [-0.5, 0.36]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DSI-SS scores, t(114) = -0.77, d = 0.14.p-value: 0.4495% CI: [-0.43, 0.19]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DSI-SS scores, t(114) = -0.34, d = 0.06.p-value: 0.7495% CI: [-0.35, 0.24]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DSI-SS scores, t(114) = -0.57, d = 0.11.p-value: 0.5795% CI: [-0.45, 0.25]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DSI-SS scores, t(114) = -0.23, d = 0.04.p-value: 0.8295% CI: [-0.28, 0.22]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for DSI-SS scores, t(114) = 0.58, d = 0.11.p-value: 0.5795% CI: [-0.17, 0.31]Mixed Models Analysis
Other Pre-specified
Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2)
The Physical Assault subscale of the Revised Conflict Tactics Scale (CTS2; Straus & Douglas, 2004; Straus et al., 1996) was used to measure occurrence of physically aggressive behavior. The subscale consists of 12 items, rated on a scale from 0 (never) to 6 (more than 20 times), with higher scores indicating greater use of aggressive behaviors in the past month. To calculate the annual frequency score, values of 3 through 6 were transformed as follows: 3 = 4, 4 = 8, 5 = 15, 6 = 25. These values were then summed, with higher scores indicating greater frequency.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | Baseline | 5.25 Score on a scale | Standard Deviation 30.27 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | Post treatment | 1.12 Score on a scale | Standard Deviation 3.33 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | 3 month follow up | 0.30 Score on a scale | Standard Deviation 1.28 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | 6 month follow up | 0.24 Score on a scale | Standard Deviation 0.91 |
| Present Centered Therapy | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | 6 month follow up | 1.69 Score on a scale | Standard Deviation 6.81 |
| Present Centered Therapy | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | Baseline | 0.96 Score on a scale | Standard Deviation 3.31 |
| Present Centered Therapy | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | 3 month follow up | 4.10 Score on a scale | Standard Deviation 24.47 |
| Present Centered Therapy | Change in Use of Physically Aggressive Behavior Assessed Through the Physical Assault Subscale on the Revised Conflict Tactics Scale (CTS2) | Post treatment | 1.64 Score on a scale | Standard Deviation 5.19 |
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Physical Assault scores, t(319)= -1.82, d = 0.20.p-value: 0.0795% CI: [-0.48, 0.02]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Physical Assault scores, t(116) = -1.39, d = 0.16.p-value: 0.1795% CI: [-0.31, -0.05]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Physical Assault scores, t(116) = 1.18, d = 0.13.p-value: 0.2495% CI: [-0.07, 0.27]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Physical Assault scores, t(319) = -0.37, d = 0.04.p-value: 0.7195% CI: [-0.23, 0.15]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Physical Assault scores, t(319) = -1.00, d = 0.11.p-value: 0.3295% CI: [-0.21, 0.07]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Physical Assault scores, t(319) = -0.51, d = 0.06.p-value: 0.6195% CI: [-0.17, 0.1]Mixed Models Analysis
Other Pre-specified
Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2)
The Psychological Aggression subscale of the Revised Conflict Tactics Scale (CTS2; Straus et al., 1996) was used to measure psychologically aggressive behavior. The subscales consists of 8 items, rated on a scale from 0 (never) to 6 (more than 20 times), with higher scores indicating greater use of aggressive behaviors in the past month. To calculate the annual frequency score, values of 3 though 6 were transformed as follows: 3 = 4, 4 = 8, 5 = 15, 6 = 25. These values were then summed, with higher scores indicating greater frequency.
Time frame: Assessments occurred at baseline, post treatment, and approximately 3 and 6 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | Baseline | 28.94 Score on a scale | Standard Deviation 31.45 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | Post treatment | 16.69 Score on a scale | Standard Deviation 22.19 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | 3 month follow-up | 13.86 Score on a scale | Standard Deviation 20.4 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | 6 month follow-up | 16.11 Score on a scale | Standard Deviation 23.64 |
| Present Centered Therapy | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | 6 month follow-up | 17.77 Score on a scale | Standard Deviation 17.96 |
| Present Centered Therapy | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | Baseline | 26.41 Score on a scale | Standard Deviation 27.87 |
| Present Centered Therapy | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | 3 month follow-up | 17.84 Score on a scale | Standard Deviation 20.46 |
| Present Centered Therapy | Change in Use of Psychologically Aggressive Behavior Assessed Through the Psychological Aggression Subscale of the Revised Conflict Tactics Scale (CTS2) | Post treatment | 19.47 Score on a scale | Standard Deviation 20.78 |
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Psychological Aggression scores, t(319) = -2.03, d = 0.23.p-value: 0.0495% CI: [-0.72, -0.01]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Psychological Aggression scores, t(116)= -6.40, d = 1.19.p-value: <0.00195% CI: [-1.09, -0.58]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Psychological Aggression scores, t(116) = -3.78, d = 0.70.p-value: 0.00295% CI: [-0.71, -0.22]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Psychological Aggression scores, t(319) = -0.56, d = 0.06.p-value: 0.5895% CI: [-0.37, 0.21]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Psychological Aggression scores, t(319) = -0.96, d = 0.11.p-value: 0.3495% CI: [-0.31, 0.11]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for CTS2 Psychological Aggression scores, t(319) = -0.19, d = 0.02.p-value: 0.8595% CI: [-0.22, 0.18]Mixed Models Analysis
Post Hoc
Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ)
The Valued Living Questionnaire (VLQ; Wilson et al., 2010) value and engagement in 10 domains of living. Respondents rate how important each domain is from 1 (not at all important) to 10 (extremely important; Importance subscale) and their engagement in each domain, on a scale from 1 (not at all consistent with my value) to 10 (completely consistent with my value; Consistency subscale). Importance and Consistency scores are multiplied for each domain, added across domains, and then divided by 10 such that possible scores range from 10-100. Higher scores indicate greater valued living.
Time frame: Assessments occurred at baseline, the sixth treatment session, post treatment, and approximately 3 months after post treatment.
Population: The number of participants analyzed differs at the timepoints due to some participants either: 1) not filling out the measure at a given time point due to clinician error; 2) not being present for one of the timepoints; or 3) leaving the study before a given timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Adaptive Disclosure for Moral Injury and Loss | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | Post treatment | 47.32 Score on a composite scale | Standard Deviation 19.8 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | 6 month follow up | 44.42 Score on a composite scale | Standard Deviation 19.4 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | 3 month follow up | 46.24 Score on a composite scale | Standard Deviation 20.72 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | Baseline | 37.39 Score on a composite scale | Standard Deviation 19.42 |
| Adaptive Disclosure for Moral Injury and Loss | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | Session 6 | 42.42 Score on a composite scale | Standard Deviation 18.02 |
| Present Centered Therapy | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | 6 month follow up | 45.29 Score on a composite scale | Standard Deviation 21.33 |
| Present Centered Therapy | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | Session 6 | 40.51 Score on a composite scale | Standard Deviation 16.31 |
| Present Centered Therapy | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | Post treatment | 43.81 Score on a composite scale | Standard Deviation 18.96 |
| Present Centered Therapy | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | 3 month follow up | 44.10 Score on a composite scale | Standard Deviation 20.33 |
| Present Centered Therapy | Change in Valued/Mindful Living Assessed Through The Valued Living Questionnaire (VLQ) | Baseline | 40.72 Score on a composite scale | Standard Deviation 16.89 |
Comparison: In a mixed model analysis of intent-to-treat data for VLQ scores, t(408) = 3.16, d = 0.32.p-value: 0.00295% CI: [1.48, 6.35]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for VLQ scores, t(121) = 4.66, d = 0.85.p-value: <0.00195% CI: [2.41, 5.92]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for VLQ scores, t(121) = 0.63, d = 0.11.p-value: 0.7895% CI: [-1.44, 1.94]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for VLQ scores, t(408) = -0.34, d = 0.01.p-value: 0.7395% CI: [-0.34, 0.24]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for VLQ scores, t(408) = 0.56, d = 0.06.p-value: 0.5895% CI: [-0.15, 0.27]Mixed Models Analysis
Comparison: In a mixed model analysis of intent-to-treat data for VLQ scores, t(408) = 1.07, d = 0.11.p-value: 0.2895% CI: [-0.1, 0.31]Mixed Models Analysis