ObjectiveCombat Stress, a UK national charity for veterans with mental health problems, has been funded by the National Health Service (NHS) to provide a national specialist service to deliver treatment for post-traumatic stress disorder (PTSD). This paper reports the efficacy of a PTSD treatment programme for UK veterans at 6 months follow-up.DesignA within subject design.SettingUK veterans with a diagnosis of PTSD who accessed Combat Stress.Participants246 veterans who received treatment between late 2012 and early 2014.InterventionAn intensive 6-week residential treatment programme, consisting of a mixture of individual and group sessions. Participants were offered a minimum of 15 individual trauma-focused cognitive behavioural therapy sessions. In addition, participants were offered 55 group sessions focusing on psychoeducational material and emotional regulation.Main outcome measuresClinicians completed measures of PTSD and functional impairment and participants completed measures of PTSD, depression, anger and functional impairment.ResultsWe observed significant reductions in PTSD scores following treatment on both clinician completed measures (PSS-I: −13.0, 95% CI −14.5 to −11.5) and self-reported measures (Revised Impact of Events Scale (IES-R): −16.5, 95% CI −19.0 to −14.0). Significant improvements in functional impairment were also observed (eg, Health of the Nation Outcome Scales (HONOS): −6.85, 95% CI −7.98 to −5.72). There were no differences in baseline outcomes between those who completed and those who did not complete the programme, or post-treatment outcomes between those we were able to follow-up at 6 months and those lost to follow-up.ConclusionsIn a naturalistic study we observed a significant reduction in PTSD scores and functional impairment following treatment. These improvements were maintained at 6 month follow-up. Our findings suggest it may be helpful to take a closer look at combining individual trauma-focused cognitive behaviour therapy and group sessions when treating veterans with PTSD. This is the first UK study of its kind, but requires further evaluation.

Little is known about the experience of post-traumatic growth (PTG) within UK veterans. To address this, our study aims to understand the lived experience of PTG from the perspective of UK veterans who have received treatment for post-traumatic stress disorder. The study uses Interpretative Phenomenological Analysis to explore qualitative interviews conducted with a sample of veterans who reported experiences of PTG in a quantitative measure. The themes drawn from the interviews describe the veterans' lived experiences of growth following trauma and their understanding of how it occurred. Similarities and differences with the dimensions of a widely used PTG quantitative measure are outlined, and a possible veteran experience of growth and how it develops is described. The conclusions provide a basis for further investigation into the experience, acceptability and clinical application of PTG within a UK veteran-specific population.

ObjectivesMilitary-related trauma can be difficult to treat. Evaluating longer term responses to treatment and identifying which individuals may need additional support could inform clinical practice. We assessed 1-year outcomes in UK veterans treated for post-traumatic stress disorder (PTSD).DesignWithin-participant design.SettingThe intervention was offered by Combat Stress, a mental health charity for veterans in the UK.ParticipantsThe sample included 401 veterans who completed a standardised 6-week residential treatment. Of these, 268 (67%) were successfully followed up a year after the end of treatment.MethodsA range of health outcomes were collected pretreatment and repeated at standard intervals post-treatment. The primary outcome was severity of PTSD symptoms, and secondary outcomes included measures of other mental health difficulties (depression, anxiety and anger), problems with alcohol, and social and occupational functioning.ResultsSignificant reductions in PTSD severity were observed a year after treatment (PSS-I: −11.9, 95% CI −13.1 to −10.7). Reductions in the secondary outcomes were also reported. Higher levels of post-treatment functional impairment (0.24, 95% CI 0.08 to 0.41) and alcohol problems (0.18, 95% CI 0.03 to 0.32) were associated with poorer PTSD treatment response at 12 months.ConclusionsThis uncontrolled study suggests the longer term benefits of a structured programme to treat UK veterans with PTSD. Our findings point to the importance of continued support targeted for particular individuals post-treatment to improve longer term outcomes.

Background Romantic partners living alongside veterans with Post Traumatic Stress Disorder (PTSD) appear at increased risk of secondary traumatic stress (sPTSD) and common mental health difficulties (CMD) compared to the general population. The severity of symptoms implies the need for structured, bespoke and evidence-based interventions. Objective The aim of this study was to explore the feasibility of offering a community support programme (The Together Programme, TTP) for military partners. TTP was developed based upon a number of US programmes and consisted of 10 hours of group-based support delivered over a five-week course. 56 participants engaged in TTP over a year at nine locations across the UK and were followed up three months later. Methods Measures of CMD, sPTSD, alcohol use and relationship satisfaction were used to assess benefits. Data were also collected on attendance and participant feedback. Results Significant reductions were observed for symptoms of sPTSD and CMD at follow up. 51/56 (90.1%) participants completed TTP. 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. Conclusions 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.

Pearson et al. / My Invisible PTSD Pg. 2 understanding the barriers or facilitators to accessing treatment (Murphy, Hunt, Luzon & Greenberg, 2013). Research suggests that a common barrier to seeking treatment is stigma (Iversen et al., 2011). Additionally, self-stigmatising beliefs are a common barrier for veterans who report not seeking help, as doing so would cause them to feel weak (Sharpe et al., 2015). The role of stigmatizing beliefs in help-seeking has largely been investigated quantitatively, finding a strong, negative relationship between self-stigma and help-seeking in the veteran population (Coleman, Stevelink, Hatch, Denny, & Greenberg, 2017; Murphy, Palmer & Busuttill, 2016). There is a paucity of research investigating the factors that enable veterans to seek help. However, studies suggest that some factors that compel veterans to seek treatment include: family and friends, psychoeducation, severity of symptoms, and level of distress (Sayer et al., 2009; Pilkington, Msetfi & Watson, 2011; Kim, Britt, Klocko, Riviere, & Adler, 2011). Yet research is sparse into the experiences of these veterans who do access treatment for PTSD and what their lives are like beyond treatment; do they experience recovery and, if so, what supports this process or makes it more challenging? (Iversen et al., 2009). Young and Ensing (1999) defined recovery as an individual's unique journey to overcoming "stuckness," improving their quality of life, and redefining themselves following distress. This research also highlights the importance of spirituality and supportive relationships when seeking help for mental health difficulties, along with a return to basic functioning (e.g., taking care of oneself, eating) as symbolic of being "recovered" (Young & Ensing, 1999). In comparison, some researchers link recovery with post-traumatic growth (PTG), which has been described as the positive changes that some people experience following exposure to traumatic events, such as enhanced personal strength or spiritual change (Tedeschi & Calhoun, 2004). Research suggests that there is a relationship between improvements in symptoms of PTSD and depression with regard to higher levels of PTG (Murphy et al., 2016). Brewin, Garnett, and Andrews (2011) undertook a mixed-methods analysis of veteran's views on their lives post-treatment; they found themes that link with the idea of PTG such as enhanced relationships. However, the study is limited, as the aim was not for thorough exploration of veterans' recovery experiences, thus factors which may have brought about change were not studied. Further research is needed into the actual experiences of veterans who seek treatment and how they define their experience of recovery. The present study aims to qualitatively investigate three main questions: how do veterans make sense of their lives following a diagnosis of PTSD? What factors facilitated their pathway to recovery? And what challenges have they experienced during their process of recovery? Methods The qualitative methodology Interpretive Ph...

Background Research has demonstrated that partners living alongside veterans with mental health difficulties are at high risk of developing mental health difficulties themselves and secondary trauma. A variety of interventions have been developed to support partners. 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. Objective 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) which had been piloted across UK cities. This programme involved tailored psycho educational materials adapted to the needs of veteran’s partners living alongside PTSD. Further the potential mechanisms of change for participants engaged with the programme were explored as well as the impact of treatment on their relationships. Methods Eight female partners were recruited from an original sample of 57 partners who were intimate relationships with treatment seeking veterans with mental health difficulties. These participants had completed TTP. Qualitative data was collected using a semi structured interview and explored using Interpretative Phenomenological Analysis. Results Three key themes emerged from the data, these were self-growth, changing role in relationships and connecting with others. The themes included several sub themes. Self-growth sub-themes were mastering the ‘inner judge’, ‘confidence in ability to cope’ and ‘taking care of my needs’. Changing role in relationship sub-themes were ‘acceptance and understanding’ and ‘improved communication in relationship’. Connecting with others was described by the sub-themes of ‘knowing I am not alone’, ‘peer support’ and ‘hope’. Conclusions This study suggeststhere were three key areas where thestructured evidence-based support programme 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.