Browsing Faculty of Health and Social Care by Publisher "British Medical Journal"
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Accelerated resolution therapy: an innovative mental health intervention to treat post traumatic stress disorderPost-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces’ fighting capability.
Conducting qualitative research in the British Armed Forces: theoretical, analytical and ethicalThe aim of qualitative research is to produce empirical evidence with data collected through means such as interviews and observation. Qualitative research encourages diversity in the way of thinking and the methods used. Good studies produce a richness of data to provide new knowledge or address extant problems. However, qualitative research resulting in peer review publications within the Defence Medical Services (DMS) is a rarity. This article aims to help redress this balance by offering direction regarding qualitative research in the DMS with a focus on choosing a theoretical framework, analysing the data and ethical approval. Qualitative researchers need an understanding of the paradigms and theories that underpin methodological frameworks, and this article includes an overview of common theories in phenomenology, ethnography and grounded theory, and their application within the military. It explains qualitative coding: the process used to analyse data and shape the analytical framework. A popular four phase approach with examples from an operational nursing research study is presented. Finally, it tackles the issue of ethical approval for qualitative studies and offers direction regarding the research proposal and participant consent. The few qualitative research studies undertaken in the DMS have offered innovative insights into defence healthcare providing information to inform and change educational programmes and clinical practice. This article provides an extra resource for clinicians to encourage studies that will improve the operational capability of the British Armed Forces. It is anticipated that these guidelines are transferable to research in other Armed Forces and the military Veterans population
Evaluating serious stress in military veterans, their carers and families: a protocolIn 2018, the Armed Forces Covenant Fund Trust (ACFT) allocated approximately £4M to seven UK projects to address serious stress in military veterans, their carers and families. These programmes commenced between May and October 2019 and will conclude in August 2021. This paper outlines the protocol for the evalu- ation of the Serious Stress programme and the novel support provided to grant holders. Entry into the programmes was through multiple routes, including self-referrals with an antic- ipated sample of approximately 2000 partic- ipants. A common outcomes framework was designed to measure outcomes. Grant holders accepted ownership for data collection and quality and were supported through accompa- nying guidance material. Veterans were often reluctant to seek support, and the anonymous and confidential nature of the evaluation plus the study team’s mili- tary background helped address this. Partic- ipants’ voices were a key part in developing the protocol, leading to results to inform policy and highlight success, efficiency and cost effectiveness, and providing markers for future development. The study provided a reservoir of informa- tion. Interim reports indicated compliance with performance indicators and provided timely evidence. Shared learning provided grant holders with an indication of what was helping the beneficiaries and what needed to be improved. The combination of all data sets provided the ACFT with a resource to demonstrate success and insight into projects where improvement was required, and indi- cators of how to redress these problems. The study protocol provided a platform for building lasting partnerships.
Fieldwork and the practical implications for completing qualitative research in the British Armed ForcesThis article provides direction regarding the practical implications of undertaking qualitative research within the British Army, and in particular the Defence Medical Services (DMS). Qualitative researchers must gather sufficient data to answer their research question, and guidance on using DMS healthcare professionals as the research sample is offered, including dealing with the 'gatekeepers' who control access, and the principles for creating a conducive environment to gather reliable data. Data collection is often through intensive interviewing where communication skills and personal awareness are vital to a successful study. Aids to a productive study include memo writing and listing factors that may later provide an insight into how the interviewees characterise and describe particular activities, events and groups. Guidance is offered to develop an interview schedule with questions related to each other in a seamless, meaningful way. Both the researcher's and participant's conscious and unconscious biases must be acknowledged. In this narrow and specialist field, DMS researchers need extensive knowledge of clinical practice and the military's distinctive language, characterised with nuances and abbreviations. These words portray meanings and perspectives that signpost the participants' view of their empirical world. Early identification, without having to seek clarification, means that the researcher can examine hidden assumptions in the sample's own language