Exploring the impact of the adaptive disclosure technique on reducing the severity of post-traumatic stress disorder symptoms in Veterans: A study protocol for a randomized controlled trial
Abstract: BACKGROUND: Post-traumatic stress disorder (PTSD) presents significant mental health challenges for veterans, leading to substantial physical, cognitive, and psychological difficulties, including heightened risks of social issues and suicidal ideation. Adaptive Disclosure (AD) is a novel, emotion-focused Cognitive Behavioral Therapy (CBT) approach developed by the military for combat-related PTSD. This technique involves exposure therapy and an empty-chair technique, allowing patients to verbalize unresolved issues. Despite its short, six-session duration, AD appears well-tolerated and effective in reducing PTSD symptoms. Given the limited global studies and their absence in Iran, this study will be conducted to investigate AD's impact on reducing PTSD symptom severity in veterans. METHODS: This randomized clinical trial will explore AD's effect on PTSD symptom severity. A total of 58 participants (29 per group) will be recruited via available sampling from Shahid Rajaee and Salman Hospitals in Yasuj. Participants must be veterans aged 18 or older, with diagnosed PTSD, sufficient insight for AD (assessed via Mental Status Exam), and informed consent. Exclusions include severe mental disorders (e.g., psychotic or bipolar type I), recent suicidal/homicidal ideation (within 3 months), or concurrent systematic trauma-focused therapies. The intervention group will receive six weekly 90-min AD sessions. The control group will receive no intervention during this period. Immediately after the intervention, both groups will complete the research questionnaire. Following the study, the control group will also be offered education on the Adaptive Disclosure technique. The primary outcome, severity of post-traumatic stress disorder symptoms, will be measured using the Post-Traumatic Stress Disorder Checklist- Civilian Version (PCL-C), a 17-item self-report scale. Data will be analyzed with SPSS version 27. Ethical approval has been secured from Yasuj University of Medical Sciences (Supplementary File 2). DISCUSSION: The results are expected to offer vital insights into AD's effectiveness for veterans with PTSD. If successful, this approach could inform policymakers for healthcare guidelines and aid psychiatric nurses in symptom alleviation. This research will significantly contribute to the scientific community by providing the first empirical evidence of AD's efficacy in an Iranian veteran population, expanding knowledge on culturally relevant treatments for combat-related PTSD, and potentially informing clinical practices nationally and internationally. TRIAL REGISTRATION: IRCT number IRCT20160815029377N4. Registered on 03/05/2025.