Effectiveness of our Treatment Programmes
On an on-going basis, we consider how effective our programmes are and what makes them more effective.
|2018||Describing the feasibility of using case management in a specialist forensic substance misuse intervention for UK veterans: A case study.||
|2016||Long-term responses to treatment in UK veterans with military-related PTSD: an observational study||
|2016||An adapted imaginal exposure approach to traditional methods used within trauma-focused Cognitive Behavioural Therapy, trialled with a veteran population||
|2016||Post-traumatic growth among the UK veterans following treatment for post-traumatic stress disorder.||
|2015||Exploring Outcome Predictors in UK Veterans Treated for PTSD||
Accessibility of Treatment
Our programmes should be available to all veterans who need them so we look at who is accessing our services, how this is changing and what may influence this.
|2019||Exploring the acceptability of delivering Cognitive Processing Therapy (CPT) to UK veterans with PTSD over Skype: A qualitative study||
|2018||Exploring the feasibility and acceptability of using tele-therapy for UK veterans with PTSD.||
|2017||Systematic review of lessons learned from delivering tele-therapy to veterans with PTSD||
|2017||Pathways into mental health care for UK veterans: a qualitative study||
|2015||Exploring Patterns in Referrals to Combat Stress for UK Veterans with Mental Health Difficulties between 1994 and 2014||
|2014||Exploring positive pathways to care for members of the UK Armed Forces receiving treatment for PTSD: a qualitative study||
|2014||PTSD, stigma and barriers to help-seeking within the UK Armed Forces||
Exploring the needs of the Veteran Community
To make sure our treatments are tailored to the needs of veterans, we conduct research to help us understand their specific problems and how they differ to other people who experience mental health problems
- Veterans with PTSD symptoms rarely experience them in isolation, more commonly they are co-morbid with a range of other difficulties.
This study used latent profile analysis (LPA) to explore the variations of PTSD symptom profiles. Then, further analysis examined whether variables such as childhood adversity or mental health difficulties predicted membership of those PTSD profiles.
Six different PTSD profiles were found, including Low, Moderate and Severe. The Severe symptom profile was the largest one, accounting for 37.57% of the sample.
Higher rates of common mental health difficulties were associated with more severe PTSD symptom profiles.
The findings suggests the importance of moving away from a ‘one-size fits all’ approach to treatments, towards interventions tailored to meet the specific PTSD and co-morbid symptoms profiles.
Vestibular functions include those involving the parts of the inner ear and brain that help control balance and eye movements.
This study aimed to assess the long-term impact of vestibular dysfunction in veterans who had suffered a mild traumatic brain injury (mTBI).
Based on self-report measures, vestibular dysfunction was found to have affected 69% of veterans in this sample (N = 162) and was equally prevalent in those experiencing blunt (59%) or blast (47%) injuries.
Vestibular dysfunction was most prevalent in those who had experienced combined blunt and blast injuries (83%). It was found to be linked with post-concussive symptoms and functional disability.
- Moral injury has been defined as defined as ‘perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations’.
It has been found to adversely affect US veteran mental health. The aim of this study was to examine UK AF veterans’ experiences of moral injury, and the perceptions and challenges faced by clinicians in treating moral injury-related mental health difficulties.
Six veterans who reported moral injury exposure and four clinicians who had treated veterans with moral injury were recruited from Combat Stress. And completed semi-structured interviews.
Moral injury was perceived by clinicians to be common in UK AF veterans and, where present, had a considerable negative impact on mental health. Moreover, moral injury was thought to be poorly understood among UK AF veteran clinical care teams.
This study provides some of the first insight into the impact of moral injury on UK AF veteran well-being.
This paper aimed to investigate the relationship between body mass index (BMI), physical health problems, mental health disorders and sociodemographic characteristics in UK veterans engaged in psychological treatment.
Information regarding veteran BMI, demographic characteristics, physical health conditions and mental health problems was collected and analysed.
Of the 384 veterans surveyed, 37.5% were overweight (BMI 26–30) and 35.5% were obese. Obesity in this sample was 2-4 times higher than that of the general UK population.
Higher scores on measures of anger, common mental health problems, systemic functioning and mobility were significantly associated with greater BMI.
The findings highlight a need for mental health services to offer treatments that effectively integrate physical and mental healthcare.
- Little is known about ex-serving personell who access secodary mental health care.
- Previous research suggests that between 23% and 40% of former military members who meet the criteria for a psychiatric difficulty access mental health services when needed.
This narrative review aimed to identify rates of mental health care utilisation, as well as the factors associated with it.
Modest rates of secondary mental health care utilisation were found in former military members. Prevalence rates ranged from 12.5% an inpatient episode, to 63.2% for an outpatient appointment.
PTSD and comorbid mental health problems were most consistently associated with higher mental health care utilisation. Easily accessible interventions aimed at facilitating higher rates of help seeking in ex-serving personnel are recommended.
This paper aimed to explore patterns of alcohol misuse in treatment-seeking veterans compared to the UK Armed Forces personnel population and the general public.
It also investigated what factors were associated with increased or decreased severity of alcohol misuse.
Results suggested that treatment-seeking veterans report different patterns of alcohol misuse compared to the UK Armed Forces and the general public. This group was more likely to report alcohol dependence and alcohol-related harm.
Mental health problems, functional impairment and being single were all related to greater alcohol misuse. Being older and not in work were related to reduced alcohol misuse.
Knowing more about the common alcohol-related problems in this group can help inform and improve mental health interventions.
- This editorial introduced a special issue of the Healthcare journal looking at PTSD in veterans, edited by the Combat Stress research team.
The editorial outlines the current challenges facing the significant minority of veterans who have difficulties in their transition to civilian life, such as mental health difficulties, accessing and utilising support, and the potential role of Complex PTSD (C-PTSD).
Original papers in this issue included a qualitative study of Nature-Based Therapy, a paper which linked PTSD to risk-taking behaviours in veterans, and a study looking at anger, aggression and PTSD.
Also included were papers investigating potential for juror bias when faced with veterans with PTSD involved in the judicial system, a study linking PTSD and functional impairment, and a meta-analysis of current PTSD interventions.
- This study investigated the prevalence rates of anger and aggression in UK help-seeking veterans, as well as their associations with different sociodemographic, functioning and mental health variables.
- Prevalence rates for significant anger and aggression were 74% and 28% respectively. Both women and those over 55 were less likely to report difficulties.
- Those with high levels of PTSD and other mental health difficulties were more likely to report anger and aggression.
- Other factors related to anger and aggression included unemployment due to ill health, and a perceived lack of family support.
- Veterans who are seeking support for mental health are likely to be experiencing significant difficulties with anger and aggression, especially if they have comorbid mental health difficulties. The associations between anger, aggression, and other variables, has implications for the assessment and treatment of military veterans
- Research suggests that both mild Traumatic Brain Injury (mTBI) and PTSD have high prevalence rates in populations of ex-service personnel.
- However, there are challenges in accurately defining the long-term impact of mTBI and how this relates to and overlaps with mental health difficulties, particularly PTSD.
- Studies of US and UK veterans have demonstrated a high degree of overlap between mTBI and symptoms of PTSD and depression.
- Further research has found that mTBI alone did not predict well-being or functional impairment in military veterans, unless these were comorbid with PTSD.
- Overall, there is a compelling case for the need for further research to disentangle the symptoms of mTBI and PTSD, and to investigate the longer-term consequences of these difficulties being co-morbid.
- The aim of this paper was to explore the risk factors associated with suicidal ideation in a sample of treatment-seeking veterans.
- Using a cross-sectional design, participants (N=144) completed questionnaires regarding their military experiences, pre-enlistment factors and health. Data were then linked to risk assessments extracted from clinical records.
- After controlling for relevant variables, suicidal ideation was significantly higher in veterans who were unemployed, were early service leavers, or had a history of childhood adversity.
- In addition, taking longer than 5 years to seek help was associated with a reduced risk of suicidal ideation.
- This type of research is crucial to inform the effort to reduce suicide in military populations and has implications for service planning and knowing how to support this client group.
- A network analysis of PTSD symptoms was conducted, focusing on associations between different symptoms and how they interact with each other. This was the first network analysis to be done with UK veterans.
- The analysis was used to identify core symptoms of PTSD and how they connect to different elements of day to day functioning.
- The core PTSD symptoms identified were recurrent thoughts, nightmares, negative emotional state, detachment, and exaggerated startle response.
- Slightly different core symptoms have been found in samples of US veterans, although negative emotional state is most commonly found.
- Some connections were found between everyday functioning, e.g. impairments in close relationships, home management, and PTSD symptoms.
- Identifying core PTSD symptoms could have implications for treatment, as targeting the core symptoms could speed up recovery by breaking down the network of other, interacting symptoms.
- Past research suggests that military veterans can be more likely to engage in risk-taking behaviours, such as heavy smoking, alcohol misuse, dangerous driving and fighting.
- We measured levels of self-reported risk-taking in a sample of veterans who were seeking help for mental health difficulties.
- Findings showed that, of a sample of 403 veterans, 86.8% reported engaging in at least one risk-taking behaviour in the past month, with fighting the most commonly reported (77.9%).
- Veterans were more likely to report risk-taking if they were younger, in a relationship, had a brain injury, or if they had mental health difficulties such as depression, anxiety and PTSD (particularly hyperarousal and negative moods).
- Findings will help in determining possible risk factors for risk-taking in veterans. Future research could corroborate these findings and assist in the development of effective risk assessments and interventions.
- We reviewed the key issues relating to Mild Traumatic Brain Injury (mTBI) in military veterans.
- Prevalence rates of mTBI in UK veterans have ranged from 4.2%-9.5% for those in combat roles.
- Post-Concussional Syndrome (PCS) describes some of the long-term effects of mTBI, e.g. dizziness, insomnia. However, PCS is no longer recognised as a formal diagnosis in the DSM-V and might be a product of psycological distress.
- In a small minority of cases, mTBIs can develop into more serious, long-lasting difficulties.
- There is a need for clarity regarding the diagnosis of mTBI, especially when in the context of psychological distress.
- Data was collected from 403 veterans who contacted Combat Stress
- We found that 82% had PTSD, 74% had anger difficulties, 72% had anxiety and depression, and 43% misused alcohol.
- 32% of the veterans who had PTSD also had other over-lapping health problems, whereas only 5% had just PTSD on its own.
- 403 veterans contacting Combat Stress completed a questionnaire
- A comparison was made between veterans living in England, Wales, Scotland and Northern Ireland
- Help-seeking veterans residing in Northern Ireland tended to be older, have experienced less childhood adversity, joined the military after the age of 18 and taken longer to seek help
- Additionally, veterans from Northern Ireland had higher levels of obesity, sensory, mobility and systemic problems and, a greater number of physical health conditions
- Scottish and Welsh veterans were more likely to smoke and misuse alcohol
- No differences were found for mental health presentations across nations.
- We looked at the ideal scores veterans needed to get on questionnaires to classify as potentially having PTSD.
- 242 veterans completed 2 short questionnaires as well as an interview with a qualified clinician about their symptoms
- Comparing the short questionnaires against the interview, we found that higher scores were needed to accurately screen for PTSD in veterans
- As part of our desire to promote the needs of help-seeking veterans in the UK, we published an editorial on what we know, so far, about veterans from research.
- This editorial highlights the problems veterans face after leaving the services, things that lead to poor mental health, the barriers veterans experience in seeking help and what treatment seeking veterans look like so we can better meet their needs.
- A report on 3,120 veterans from combat stress with mental health difficulties
- Veterans with mental health difficulties are more likely to reside in areas of higher deprivation.
- Veterans living in Scotland appeared to be at the greatest risk of deprivation, followed by English and Welsh veterans. Northern Ireland had the least risk.
- The locations veterans resided in were geographically spread across the UK, but more veterans resided in urban areas
- Those not in a relationship were more likely to have higher levels of deprivation
- Being an Early Service Leaver and taking longer to seek help was linked to higher levels of deprivation.
- Study looking into how mental illness and living in deprivation is linked in England
- Neighbourhood data from the government was linked to 1,967 veterans
- 41% of veterans were in the most deprived areas
- 21% were in the least deprived areas
- Those who took longer to seek help, were single, male, younger and had a war pension were at a higher risk
- Help seeking veterans were found to have an increased risk of living in deprived areas
- A comparison of substance misuse between UK veterans and the general public
- 2331 individuals with alcohol misuse problems were referred for specialist support
- They were assessed for difficulties, dependency levels, withdrawal symptoms, other substance misuse and service utilisation
- No differences in severity were found between veterans and the general public
- However, it was found that veterans were referred at an older age and admitted to hospital for longer than non-veterans
- Interviews were completed with 8 veterans from Combat Stress
- Veterans were asked about their experience of positive changes since completing the treatment programme (post-traumatic growth)
- It was found that veterans felt they their experience had allowed them to accept negative events, develop an appreciation of the world, connect with other and re-evaluated their sense of purpose
- It was also found that veterans had positively developed in areas of understanding reactions, developing an open mindset and committing to change
- These findings suggest that the ITP treatment programme can encourage positive growth in veterans.
- Out of 123 veterans seeking help with Combat Stress, 63% reported having a traumatic brain injury.
- No relationship was found between having a traumatic brain injury and post-concussion symptoms.
- However, a link was found between having a traumatic brain injury and depression or anger problems.
Partners and Carers
The needs of the families and friends are often very important in providing support to veterans on their pathway to recovery. We are interested in the experiences of those close to veterans and what can be done to help them.
- The aim of this study was to explore the feasibility of offering a community support programme (The Together Programme, TTP) for military partners.
- TTP consisted of 10 hours of group-based support delivered over a five-week course.
- 57 participants engaged in TTP over a year at nine locations across the UK and 44 were followed up three months later.
- Significant reductions were observed for symptoms of sPTSD and CMD at follow up. 51/57 (89.1%) participants completed TTP. Significant improvements in relationship satisfaction was also observed.
- The majority of participants reported positive experiences. However, several individuals stated wanting more sessions and that barriers such as work, and family commitments made it difficult to attend.
- Whilst limitations exist, the data presented suggests cautious optimism for the efficacy of offering a structured programme of support to address the needs of military partners living alongside PTSD.
Research has demonstrated that partners living alongside veterans with mental health difficulties are at high risk of developing mental health difficulties.
Research to date has relied on quantitative methodologies to evaluate the efficacy of such interventions with less emphasis on learning about the experiences of individuals on the courses.
The aim of this qualitative paper was to understand the experiences of partners who engaged in a five-week structured support intervention, ‘The Together Programme’ (TTP).
Eight female partners were recruited from an original sample of 57 partners who were intimate relationships with treatment seeking veterans with mental health difficulties.
Semi structured interviews were completed and explored using Interpretative Phenomenological Analysis.
Three key themes emerged from the data, these were self-growth, changing role in relationships and connecting with others.
This study suggests these key areas had an impact on participants experiences. These were factors that helped participants to normalise their experiences and increase participants understanding and interpersonal skills that promote changes in relationship functioning with the veteran.
- This study was designed to explore the experiences and needs of female partners of veterans
- Eight veteran partners participated in an interview with a researcher
- Experiences and needs were common challenges faces, desired support and barriers to seeking help
- Common challenges faced were feelings of inequality in the relationship, loss of congruence with own identity, volatile environments and emotional distress and isolation
- Desired types of support from the partners included a practical focus on improving, sharing with fellow experts and care tailored to the partner
- Barriers to seeking help were found to be: practical barriers and ambivalence about the involvement of others in treatments.
- 100 veteran partners were surveyed for mental health needs and barriers to seeking help
- 45% met criteria for alcohol problems, 39% for depression, 37% for generalised anxiety disorder and 17% for symptoms of probable PTSD
- Partners were more likely to endorse barriers such as stigma as opposed to practical barriers as reasons for not seeking help.
Art therapy can help make it easier for veterans to express themselves, especially when they find it hard to talk about thoughts and feelings. Research has shown that art therapy can help reduce stress, anxiety and increase awareness and self-esteem.
|2017||Using art therapy to overcome avoidance in veterans with chronic post-traumatic stress disorder||
|2016||Factors that influence engagement in an inpatient art therapy group for veterans with Post Traumatic Stress Disorder||
|2014||The invisible wound: Veterans’ art therapy||
These are some of the research partners we work with:
- The Royal British Legion
- The Disabilites Trust Foundation
- Forces in Mind
- University of East London
- Kings College London
- Bournemouth University
- University of Kent
- University of Exeter
- Ulster University
- University of Oxford
- British Association of Art Therapists
- Anglia Ruskin University
- Edinburgh Napier University
- University of Melbourne