Projects

A selection of current and past funded projects in the Litz Lab can be found below:

Psychotherapies for Loss, Moral Injury, and PTSD

Current Project: Psychosocial Rehabilitation after Moral Injury and Loss with Adaptive Disclosure – Enhanced

Adaptive disclosure – enhanced (AD-E) is a trauma-focused, manualized, experiential psychotherapy for posttraumatic stress disorder (PTSD), specifically designed to take into account combatant roles within the military culture among service members and war Veterans. AD-E is an expanded version of adaptive disclosure (AD; Litz, Lebowitz, Gray, & Nash, 2017, see publications), which was modified to target moral injury and traumatic loss through the additions of letter-writing (e.g., to the deceased), loving kindness meditation, and an expanded emphasis on a healing and repair plan via homework. A randomized controlled clinical trial (under review) was conducted on 174 Veterans (clinicaltrials.gov identifier: NCT03056157). AD-E was compared with present-centered therapy to improve functioning and reduce PTSD. This study was funded by the VA Office of Research and Development (RX002135-01A2).

Past Project: Adaptive Disclosure: A Combat-Specific PTSD Treatment

In this non-inferiority (NI) trial (clinicaltrials.gov identifier: NCT01628718), AD was compared to cognitive processing therapy (CPT, a first-line evidence-based PTSD psychotherapy) in Marines and Sailors seeking treatment for PTSD. The primary endpoint of this study was PTSD symptom severity change from pre- to posttreatment, using the Clinician Administered PTSD Scale for DSM-IV. Secondary endpoints were depression and functioning. AD was confirmed to be no less effective than CPT (Litz et al., 2021, see publications). This study was funded by the Department of Defense Office of the Congressionally Directed Medical Research Programs (PT090530P1).

Moral Injury

Current Project: The Prevalence and Functional Impact of Moral Injury in Veterans

Moral injury is the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, bearing witness to, or being the victim of acts that transgress deeply held moral beliefs and expectations. Until recently, there had been no gold standard measure of moral injury and no information about the prevalence of this problem among Veterans. This study aims to: (1) be the first nationally representative, epidemiological survey study of reports of exposure to potentially morally injurious events and subsequent moral injury in US Veterans. The study will use the moral injury outcome scale (Litz et al., 2022, see below) to measure moral injury; (2) determine the incremental validity of moral injury relative to PTSD and depression in explaining functional problems in Veterans; and (3) examine risk and resilience in, as well as the clinical care needs of, Veterans with moral injury. This project is funded by the VA Office of Research and Development (13638196).

Past Project: The Development of a Measure of Moral Injury: The results of the Moral Injury Outcome Scale (MIOS) Consortium

Although there is broad interest in moral injury, the outcome associated with PMIE exposure, there has been no operational definition of the putative syndrome and no standard assessment scheme or measure, which has hampered research and care in this area. This international study sought to define the syndrome of moral injury and develop and validate the Moral Injury Outcome Scale (MIOS) in three stages. The first stage involved conducting interviews with service members, Veterans, and clinicians/Chaplains across multiple countries, inquiring about the lasting impact of potentially morally injurious experiences. The findings resulted in the development of a 14-item MIOS that was invariant and reliable across countries and has two subscales: Shame-Related (SR) and Trust-Violation-Related (TVR) Outcomes (Litz et al., 2022). MIOS consortium activities were supported in part by VA Office of Research and Development, US Department of Veterans Affairs; Department of Veterans’ Affairs Australia, Phoenix Australia – Center for Posttraumatic Mental Health; and the Canadian Center of Excellence on PTSD and Related Mental Health Conditions.

Measurement-Based Care and Practice-Based Advances in the Study of PTSD

Current Project: Enhancing Measurement-Based Behavioral Health Care in the Military Health System

PTSD and other behavioral health problems affect service member functioning and mission readiness, family functioning and well-being, lead to early separation from the service, and cause lifespan risk for sustained psychiatric and functioning problems among veterans. However, the results of clinical trials of service members with PTSD using the psychotherapies included in best practice recommendations for providers leave room for improvement, and the most important questions about: (1) which types of service members are most likely to have good outcomes with which treatment approach; (2) how treatment can be personalized to match the real-world needs of service members to avoid dropout and failure; and (3) when providers and service members should decide that a shift in treatment approach is needed after a period of non-response, remain unaddressed. The primary goal of this study is to help address these questions by bolstering the existing Behavioral Health Data Portal so that behavioral health data will be more clinically actionable, and provider, clinic, and system data can be used to improve treatment outcomes in service members. This study is funded by the Military Health System Department of Defense, Research and Development Directorate (WS00673553).

Current Project: Promoting Measurement-Based Care and Practice-Based Research in PTSD

 We are conducting an operational program improvement project in partnership with Dr. Elliot Fielstein who directs data and clinical analytics in the VA Office of Mental Health Services. These activities entail extracting PTSD assessment data from the VA’s Corporate Data Warehouse to generate clinical benchmarks for a Measurement-based Care Outcomes Dashboard (MCOD) that is under development for PTSD specialty care. The MCOD entails a patient and clinician facing dashboard that tracks test scores and presents benchmarks for change to promote measurement-based care (which entails repeated assessments of outcome for shared decision-making about care), and to create a process that allows clinicians to aggregate outcome data in their caseload over time for quality improvement and research purposes.

Current Project: Assessing Functional Goals in Treatment-Seeking Veterans with PTSD Using a Rehabilitative Framework

Treatment for PTSD in the Veterans Health Administration (VHA) prioritizes PTSD symptom reduction above all other treatment-relevant priorities, even though Veterans with PTSD tend to have multiple problems spanning across diagnoses and domains of functioning (e.g., occupational and interpersonal functioning). Additionally, the VHA mission and the VA/Department of Defense PTSD best practice guidelines underscore the need to address the whole Veteran using a person-centered care approach. Therefore, PTSD care needs to target functional problems that are most relevant to Veterans. The first step toward personalizing treatment to target idiographic goals is to reliably assess person-centered functional goals in a standardized and easily administered fashion. This study investigates the efficacy and feasibility of implementing goal attainment setting, a personalized treatment to target idiographic goals, in Veterans seeking treatment for PTSD. The PI for this study is Natasha Benfer who is funded by a 1-year grant from VA Boston Healthcare System’s Rehabilitation Promoting Prevention and Improved Resilience (REPPAIR) Research Center.

Program Evaluation of the Veteran’s Hub

Current Project: Program evaluation of the Veteran’s Hub, a program to help heal moral injury and lifespan trauma

The “Hub” is a unique therapeutic community founded at CTF-Soledad State Prison in May 2021 that allows incarcerated Veterans to be self-governing within their own yard. The overall aim of the Hub is to leverage the shared identity and values of Veterans to help them support rehabilitative behaviors, generate a sense of purpose and shared positive identity, and find adaptive ways of healing and repairing various cumulative lifespan traumas and moral injuries, with the ultimate goal of helping them rehabilitate for re-entry into the community. However, the psychosocial, rehabilitative, and therapeutic effectiveness of the Hub has not been systematically and objectively evaluated. This goal of this study is to conduct an objective and independent evaluation of the efficacy of the Hub for incarcerated Veterans. This project is funded by a grant from the Veterans Transition Center (VTC) of California.