Combat Stress and The Royal Navy and Royal Marines Charities Partnership to Deliver Mental Health Support

The Royal Navy and Royal Marines Charity has worked in partnership with Combat Stress for many years to support Royal Navy veterans with complex mental health conditions.

In 2020 the RNRMC began a three-year funding agreement with Combat Stress as part of the RNRMC’s Health and Wellbeing Support Programme. This partnership ensures that Royal Navy veterans, like Jim, will continue to receive vital support. Jim had wanted to join the Royal Navy since he was nine years old. When he was 18 that dream came true, but unfortunately his time in the services was not what he imagined.

After joining the Navy, Jim was quickly identified as a promising rugby player and spent much of his time on the rugby pitch. Playing rugby took him to several ships and shore bases over the course of 18 months, but Jim’s life was about to change forever. “In March 1992, after joining the HMS Illustrious, my life was totally changed when I was the victim of a random unprovoked attack shortly after going ashore,” he said. “My attacker, who pushed me through a plate glass window, was later charged with attempted murder. I sustained life-changing physical and mental injuries.
“Due to the nature of my injuries, I had to remain awake, un-anesthetised during surgery and I watched as the medical staff brought a priest in to administer the last rites as they didn’t think I would make it. “But I did, and once my physical injuries were stabilised, I was moved by the Royal Navy to a mental health ward where in June of 1992 I was diagnosed with PTSD. “I spent four weeks undertaking a PTSD awareness course. One element of the course was art therapy and I found painting helped me – in fact, I was encouraged to continue painting and remain busy in order to keep my PTSD at bay. I was also told not to think or talk about my trauma.

“For over 25 years I continued to paint as a way of coping and never spoke about the attack.
“After the course, I was sent back to HMS Dryad, and despite all I had been through, was encouraged to get back to rugby; however, when it came to my first match back, I was convinced I would sustain further injuries and didn’t play. “Shortly afterwards, I was offered a medical discharge which could take several months to arrange, or I could take an honorable discharge based on the exceptional circumstances which would take just 24 hours. I took the second option allowing me to leave as quickly as I could. “I left and got on with life, often travelling extensively with work in order to remain busy. I followed the instruction to keep busy, but I know now this was the wrong choice and wasn’t working.

“I used to relive seeing the priest at the end of my bed at night – just like during surgery. I also used to feel like the blood was pumping out of the scar on my head, just as it did after I’d been attacked. “It was when I was confronted by my daughter, telling me she’d come into my bedroom one night to tell me to turn the telly off that I knew I had to do something. The television wasn’t on –it was me shouting and screaming in my sleep. I knew I used to do this – I had to move into a mess of my own in the Navy because of it – but when I knew it was affecting my family, I decided to do something.”

Jim went to his GP initially and explained that he had been diagnosed with PTSD. However, he didn’t receive the support that he needed. Then in 2017 he reached out to Combat Stress. Finally, Jim started his journey towards recovery. “It wasn’t easy. I was embarrassed to call the helpline. I thought I’d been dealing with my problems but really, I’d just been told to keep busy and push everything to the back of my mind. I felt like a failure.

By working with the specialist team at Combat Stress Jim began to learn management techniques and coping strategies for his mental health issues such as hyperarousal and flashbacks. “I learnt about grounding, mindfulness and did much more art therapy. I received CBT & EMDR treatment which has significantly helped with the reliving. I no longer see the priest. Thanks to CBT/EMDR and the art therapists, I understand why I have these memories and have begun to process them. “I also found the education sessions invaluable – learning about how memories work and how the brain processes them really helped me. The peer support has also played important part of my recovery too, supporting me as I returned back to a Royal Navy shore base and the place of trauma. “Combat Stress also encouraged me to reengage with the veteran community. I hadn’t engaged in anything military since leaving the Navy.

“In 2019 I was selected to attend the Cenotaph on Remembrance Sunday. Since leaving Combat Stress, I had further medical support and discovered through a brain scan that I sustained brain injuries as a result of my attack. This injury was contributing to the sensation of blood pumping, but with medication, this is manageable. “What I learnt at Combat Stress has made a massive difference to me. I know now I needed to process my memories, not just bury them or push them away. I owe my life to the team who were on duty at the Royal Naval Hospital Stonehouse – thank you! Also, a huge thanks to Combat Stress for improving my health and knowledge, enabling me to look forward to a better future.”

If you would like to find out more about Combat Stress or how to access their support, please visit their website, or call their 24 hour helpline on 0800 138 1619.

Reference

Navy News. (2021) Jim’s Journey Out of the Darkness. Navy News. July 2021, pp.33.

What is National PTSD Awareness Day?

Introduction

National PTSD Awareness Day is a day dedicated to creating awareness regarding PTSD (Post Traumatic Stress Disorder).

Background

It is acknowledged annually on the 27th of June. The US Senate officially designated this day in 2010. In 2014 the Senate designated the whole month of June as PTSD Awareness Month.

In the US, 6.8% of adults will experience PTSD in their lifetimes with women twice as likely as men to experience it (10.4% to 5%) frequently as a result of sexual trauma. Veterans are another group highly likely to experience PTSD during their lives, with Vietnam War veterans at 30%, Gulf War veterans at 10%, and Iraq War veterans at 14%.

On this day, organisations that work with employees, consumers, and patients at risk for the condition work to get information about symptoms and treatments for it out to the public in the hopes that when more people know about the disease more people who suffer from it will get treatment. The US Department of Defence is one of the major organisations involved as June is full of days relating to the military.

What is Togetherall?

Formerly called Big White Wall, it is an online mental health platform tool that offers anonymous and immediate peer support to serving personnel, veterans, and families.

It has helped approximately 14,000 members of the military community since it was set up more than nine years ago.

Visit togetherall.com.

Book: The PTSD Workbook

Book Title:

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms.

Author(s): Mary Beth Williams and Soili Poijula.

Year: 2016.

Edition: Third (3rd).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that can occur after exposure to a terrifying event. But whether you are a veteran of war, a victim of domestic violence or sexual violence, or have been involved in a natural disaster, crime, car accident, or accident in the workplace, your symptoms may be getting in the way of you living your life.

PTSD can often cause you to relive your traumatic experience in the form of flashbacks, memories, nightmares, and frightening thoughts. This is especially true when you are exposed to events or objects that remind you of your trauma. Left untreated, PTSD can lead to emotional numbness, insomnia, addiction, anxiety, depression, and even suicide. So, how can you start to heal and get your life back?

In The PTSD Workbook, Third Edition, psychologists and trauma experts Mary Beth Williams and Soili Poijula outline techniques and interventions used by PTSD experts from around the world to conquer distressing trauma-related symptoms. In this fully revised and updated workbook, you’ll learn how to move past the trauma you’ve experienced and manage symptoms such as insomnia, anxiety, and flashbacks.

Based in cognitive behavioural therapy (CBT), this book is extremely accessible and easy-to-use, offering evidence-based therapy at a low cost. This new edition features chapters focusing on veterans with PTSD, the link between cortisol and adrenaline and its role in PTSD and overall mental health, and the mind-body component of PTSD. Clinicians will also find important updates reflecting the new DSM-V definition of PTSD.

This book is designed to give you the emotional resilience you need to get your life back together after a traumatic event.

Barriers & Facilitators who Impact Veterans’ Engagement with Mental Health Support

Research Paper Title

The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment.

Background

It is often claimed that military veterans are reticent to seek help for mental disorders, even though delayed treatment may impair recovery and impact the wellbeing of those close to the veteran.

This paper aims to explore the barriers and facilitators to accessing professional mental health support for three groups of veterans who met criteria for a probable mental health disorder and:

  1. Do not recognise a probable mental disorder;
  2. Recognise they are affected by a mental disorder but are not seeking professional support; or
  3. Are currently seeking professional mental health support.

Methods

Qualitative telephone interviews were conducted with 62 UK military veterans. Thematic analysis identified core themes along an illustrative journey towards professional mental health support.

Results

Distinct barriers and facilitators to care were discussed by each group of veterans depicting changes as veterans moved towards accessing professional mental health support. In contrast to much of the literature, stigma was not a commonly reported barrier to care; instead care-seeking decisions centred on a perceived need for treatment, waiting until a crisis event occurred. Whilst the recognition of treatment need represented a pivotal moment, the data identified numerous key steps which had to be surmounted prior to care-seeking.

Conclusions

As care-seeking decisions within this sample appeared to centre on a perceived need for treatment future efforts designed to encourage help-seeking in UK military veterans may be best spent targeting the early identification and management of mental health disorders to encourage veterans to seek support before reaching a crisis event.

Reference

Rafferty, L.A., Wessely, S., Stevelink, S.A.M. & Greenberg, N. (2021) The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment. European Journal of Pscyhotraumatology. 10(1).1700613. doi: 10.1080/20008198.2019.1700613.

Is there Satisfaction with Telehealth PTSD Treatment?

Research Paper Title

Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth.

Background

Telehealth is an increasingly popular treatment delivery modality for mental healthcare, including evidence-based treatment for complex and intense psychopathologies such as post-traumatic stress disorder (PTSD). Despite the growing telehealth literature, there is a need for more confirmatory research on satisfaction with PTSD telehealth treatment, particularly among veterans, for whom the most rapid and permanent expansion of telehealth services has been implemented through the Department of Veterans Affairs.

Methods

The current paper integrates data from two concurrent PTSD treatment outcome studies that compared prolonged exposure therapy delivered both in person and via telehealth for veterans (N = 140). Using two different measures of satisfaction (the Charleston Psychiatric Outpatient Satisfaction Scale-Veteran Affairs Version (CPOSS) and the Service Delivery Perception Questionnaire (SDPQ)), the researchers hypothesized that PTSD improvement would predict satisfaction, but that delivery modality (in person vs telehealth) would not.

Results

Results only partially supported the hypotheses, in that PTSD symptom improvement was associated with greater satisfaction, and in-person treatment modality was associated with satisfaction as measured by the CPOSS (but not the SDPQ). Subgroup differences by sex were found, such that male veterans, typically with combat-related trauma, were more satisfied with their PTSD treatment compared to female veterans, who were most frequently seen in this study for military sexual trauma.

Conclusions

Altogether, results illustrate a need for additional satisfaction studies with diverse samples and large sample sizes. Future research may benefit from examining satisfaction throughout treatment, identifying predictors of greater PTSD improvement, and further examining demographic subgroups.

Reference

White, C.N., Kauffman, B.Y. & Acierno, R. (2021) Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth. Journal of Telemedicine and Telecare. doi: 10.1177/1357633X20987704. Online ahead of print.

Mile Marker (2017)

Introduction

A veteran of Afghanistan and Iraq, Korey Rowe is on the road of recovery from PTSD along with his former Rakkasan Brothers. “Mile Marker” investigates new techniques used to treat PTSD and takes a look into veterans’ lives today.

Outline

“Mile Marker”, focuses on a two-tour veteran of Afghanistan and Iraq, Korey Rowe, along with his former Rakkasan Brothers on their long road to recovery from PTSD. The Rakkasans were the invading force for both Middle Eastern Theatre Wars where Korey and his unit were the tip of the spear, twice. This film investigates new and controversial techniques and methods for treating PTSD but more than that, it is a look into the lives of veterans in America today. Travelling 8,000 miles across the United States and back, Korey departs from his home in California, to check in with his former battle buddies across America, who served with him 15 years ago in the 187th Infantry Regiment of the 101st Airborne Air Assault Division. Along the way, he interviews psychologists and specialists from the National Center for PTSD in White River Junction, Vermont for a balanced understanding of the underlying symptoms and associated triggers for those with PTSD. This is an authentic portrayal of veterans…

Production & Filming Details

  • Director(s): Korey Rowe.
  • Producer(s):
    • Dylan Avery … associate producer.
    • Roland Rojas … producer.
    • Jessie Whitney … associate producer.
  • Writer(s): Valerie Boyer.
  • Music:
  • Cinematography: Dylan Avery.
  • Editor(s): Korey Rowe.
  • Production: Otsego Media and Prism Pictures.
  • Distributor(s):
  • Release Date: 2017.
  • Running Time: 94 minutes.
  • Rating: 16+.
  • Country: US.
  • Language: English.

Video Link

Identifying Two Novel Distinct Epigenetic Biotypes for PTSD

Research Paper Title

Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males.

Background

Post-traumatic stress disorder (PTSD) is a heterogeneous condition evidenced by the absence of objective physiological measurements applicable to all who meet the criteria for the disorder as well as divergent responses to treatments.

Methods

This study capitalised on biological diversity observed within the PTSD group observed following epigenome-wide analysis of a well-characterised Discovery cohort (N = 166) consisting of 83 male combat exposed veterans with PTSD, and 83 combat veterans without PTSD in order to identify patterns that might distinguish subtypes.

Results

Computational analysis of DNA methylation (DNAm) profiles identified two PTSD biotypes within the PTSD+ group, G1 and G2, associated with 34 clinical features that are associated with PTSD and PTSD comorbidities.

The G2 biotype was associated with an increased PTSD risk and had higher polygenic risk scores and a greater methylation compared to the G1 biotype and healthy controls.

The findings were validated at a 3-year follow-up (N = 59) of the same individuals as well as in two independent, veteran cohorts (N = 54 and N = 38), and an active duty cohort (N = 133).

In some cases, for example Dopamine-PKA-CREB and GABA-PKC-CREB signalling pathways, the biotypes were oppositely dysregulated, suggesting that the biotypes were not simply a function of a dimensional relationship with symptom severity, but may represent distinct biological risk profiles underpinning PTSD.

Conclusions

The identification of two novel distinct epigenetic biotypes for PTSD may have future utility in understanding biological and clinical heterogeneity in PTSD and potential applications in risk assessment for active duty military personnel under non-clinician-administered settings, and improvement of PTSD diagnostic markers.

Reference

Yang, R., Gautam, A., Getnet, D., Daigle, B.J., Miller, S., Misganaw, B., Dean, K.R., Kumar, R., Muhie, S., Wang, K., Lee, I., Abu-Amara, D., Flory, J.D., PTSD Systems Biology Consortium, Hood, L., Wolkowitz, O.M., Mellon, S.H., Doyle 3rd, F.J., Yehuda, R., Marmar, C.R., Ressler, K.J., Hammamieh, R. & Jett, M. (2020) Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males. Molecular Psychiatry. doi: 10.1038/s41380-020-00966-2. Online ahead of print.

Does the Peer Support Role Enhance Veteran Engagement?

Research Paper Title

Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker.

Background

Many UK military veterans experiencing mental health and well-being difficulties do not engage with support services to get the help they need. Some mental health clinics employ Peer Support Workers (PSWs) to help veteran patients engage, however it is not known how the role influences UK veteran engagement.

Therefore the aim of this research was to gain insight into the role of peer support in UK veteran engagement with mental health and well-being services.

Method

A qualitative study based on 18 semi-structured interviews with veterans, PSWs and mental health clinicians at a specialist veteran mental health and well-being clinic in Scotland.

Results

Four themes of the PSW role as positive first impression, understanding professional friend, helpful and supportive connector, and an open door were identified across all participants. The PSWs’ military connection, social and well-being support and role in providing veterans with an easily accessible route to dis-engage and re-engage with the service over multiple engagement attempts were particularly crucial.

Conclusions

The Peer Support role enhanced veteran engagement in the majority of instances. Study findings mirrored existing peer support literature, provided new evidence in relation to engaging UK veterans, and made recommendations for future veteran research and service provision.

Reference

Weir, B., Cunningham, M., Abraham, L. & Allanson-Oddy, C. (2017) Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker. Journal of Mental Health. 28(6), pp.647-653.

Epigenetic Biotypes of Post-Traumatic Stress Disorder

Research Paper Title

Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males.

Background

Post-traumatic stress disorder (PTSD) is a heterogeneous condition evidenced by the absence of objective physiological measurements applicable to all who meet the criteria for the disorder as well as divergent responses to treatments.

Methods

This study capitalised on biological diversity observed within the PTSD group observed following epigenome-wide analysis of a well-characterised Discovery cohort (N = 166) consisting of 83 male combat exposed veterans with PTSD, and 83 combat veterans without PTSD in order to identify patterns that might distinguish subtypes.

Results

Computational analysis of DNA methylation (DNAm) profiles identified two PTSD biotypes within the PTSD+ group, G1 and G2, associated with 34 clinical features that are associated with PTSD and PTSD comorbidities.

The G2 biotype was associated with an increased PTSD risk and had higher polygenic risk scores and a greater methylation compared to the G1 biotype and healthy controls.

The findings were validated at a 3-year follow-up (N = 59) of the same individuals as well as in two independent, veteran cohorts (N = 54 and N = 38), and an active duty cohort (N = 133). In some cases, for example Dopamine-PKA-CREB and GABA-PKC-CREB signaling pathways, the biotypes were oppositely dysregulated, suggesting that the biotypes were not simply a function of a dimensional relationship with symptom severity, but may represent distinct biological risk profiles underpinning PTSD.

Conclusions

The identification of two novel distinct epigenetic biotypes for PTSD may have future utility in understanding biological and clinical heterogeneity in PTSD and potential applications in risk assessment for active duty military personnel under non-clinician-administered settings, and improvement of PTSD diagnostic markers.

Reference

Yang, R., Gautam, A., Getnet, D., Daigle, B.J., Miller, S., Misganaw, B., Dean, K.R., Kumar, R., Muhie, S., Wang, K., Lee, I., Abu-Amara, D., Flory, J.D., PTSD Systems Biology Consortium, Hood, L., Wolkowitz, O.M., Mellon, S.H., Doyle 3rd, F.J., Yehuda, R., Marmar, C.R., Ressler, K.J., Hammamieh, R. & Jett, M. (2020) Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males. Molecular Psychiatry. doi: 10.1038/s41380-020-00966-2. Online ahead of print.