Introduction Despite increases in the number of ex-service personnel seeking treatment for post-traumatic stress disorder (PTSD), there remain a number of barriers to help-seeking which prevents many veterans from accessing psychological therapies. Tele-therapy provides one potential method of increasing the number of veterans accessing support. This review aimed to systematically review the literature in order to summarise what lessons have been learned so far from providing trauma-focused tele-therapies to veterans with PTSD. Methods A systematic literature review was conducted from which 41 papers were reviewed. Studies were included if they involved the use of trauma-focused therapies carried out using tele-therapy technologies. Only studies using tele-therapy interventions via video or telephone with populations of ex-military personnel with PTSD were included. Results In the majority of cases tele-therapy was found to be as effective in reducing PTSD symptoms as in-person interventions. Similarly, there were few differences in most process outcomes such as dropout rates, with tele-therapy helping to increase uptake in some cases. Veterans using tele-therapy reported high levels of acceptability and satisfaction. Some challenges were reported in terms of therapeutic alliance, with some studies suggesting that veterans felt less comfortable in using tele-therapy. Several studies suggested it was harder for clinicians to read non-verbal communication in tele-therapy, but this did not affect their ability to build rapport. Technological issues were encountered, but these were not found to impede therapy processes or outcomes. Discussion Tele-therapy provides a viable alternative to in-person therapies and has the potential to increase access to therapy for veterans. Tele-therapy should continue to be evaluated and scrutinised in order to establish the most effective methods of delivery.

Professionals who work in mental health settings are at risk of developing psychological distress themselves. The term “compassion fatigue” has been used to describe the negative effects of working in a psychologically distressing environment on a person’s ability to feel compassion for others. A number of studies have investigated predictors and correlates of compassion fatigue. However, as yet there is no consensus on which psychosocial factors are most commonly related to compassion fatigue. This review examines research on common correlates and predictors of compassion fatigue in mental health professionals. A literature search yielded 32 studies describing compassion fatigue in a range of mental health professionals and in relation to a variety of psychosocial factors. Quality of papers was variable. The review highlights several factors that were commonly associated with compassion fatigue (e.g., trauma history of mental health professionals, empathy). Some potential protective factors were also indicated, including certain behavioral and cognitive coping styles and mindfulness. Findings and implications are discussed, and directions for future studies are indicated. In particular, we highlight the need for longitudinal studies to investigate compassion fatigue’s development over time and to test models of the etiology of compassion fatigue.

Police officers who work with victims of rape and sexual assault are exposed to severely traumatic material. This study aimed to investigate whether these specialist officers had developed compassion fatigue, secondary traumatic stress and burnout, and whether these variables were associated with trait and situational empathy, an important factor in retaining victim involvement within the prosecution process. The study also piloted a brief training intervention aimed at educating officers about compassion fatigue and ways of reducing and preventing it. A convenience sample of specialist police officers (N = 142) who work with victims of sexual assault completed measures of compassion fatigue, secondary traumatic stress and burnout, as well as two empathy measures, rating trait empathy and 'in vivo' empathy in response to a video vignette. Cross-sectional analysis showed that longer-serving specialist officers had greater compassion fatigue, secondary traumatic stress and burnout, but that neither measure of empathy was related to compassion fatigue or secondary traumatic stress, although high burnout was related to low trait empathy. The training was well received, and pre and post-test measures showed that officers' knowledge of the constructs increased. Given the potential risks to their well-being and work performance, officers would benefit from further support to cope with and prevent emotional distress. Higher empathy might protect against burnout. Longitudinal research is needed to better understand the relationships between empathy, compassion fatigue, secondary traumatic stress and burnout.

Background: Research shows that veterans with mental health difficulties are reluctant to engage with treatment due to a number of practical and psychological barriers. Tele-therapy has been proposed as an alternative method of delivering therapy to ensure hard-to-reach groups receive the care they need.Objective: This study aimed to explore the acceptability of using tele-therapy for treating PTSD in a sample of UK veterans.Methods: Sixteen participants who had engaged with tele-therapy for PTSD were contacted following the cessation of their treatment, including those who had not completed the full course of therapy. Semi-structured qualitative interviews were conducted and the transcripts were analysed using thematic analysis.Results: Five key themes emerged: Effect of your own environment, Importance of good therapeutic alliance, Technicalities and practicalities, Personal accountability and Measuring change. Effect of your own environment was described with sub-themes of control over your own environment, lack of support between sessions and snap back to reality. The Importance of good therapeutic alliance encompassed putting a face to the name, impersonal feeling and no different from being in the room. Technicalities and practicalities depicted good preparation is key, the flexibility of Skype, technical aspects and session length and timing. Personal accountability detailed finding the time and space, managing attendance and engagement and moving forward. Measuring change illustrated negative past experiences with therapy, improving self-recognition and managing symptoms.Discussion: Tele-therapy appeared to be acceptable within this sample of veterans with many reporting overall positive experiences and improvements to their health. Future research is needed to foster a more supportive environment during and after therapy.

Prevalence rates of anger and aggression are often higher in military personnel. Therefore, it is important to understand more about why this is, and the factors with which it is associated. Despite this, there is little evidence relating to anger and aggression in UK veterans who are seeking treatment for mental health difficulties such as post-traumatic stress disorder (PTSD). This study investigated the prevalence rates of anger and aggression in this population, as well as the associations between anger and aggression, and various sociodemographic, functioning and mental health variables. A cross-sectional design was used, with participants completing a battery of self-report questionnaires. 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. Findings showed that 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.