Department of Psychology, University of Exeter, Exeter, UK
King's College London, London, UK.
BMJ Open. 2024 May 15;14(5):e082562. doi: 10.1136/bmjopen-2023-082562.
Exposure to potentially morally injurious events is increasingly recognised as a concern across a range of occupational groups, including UK military veterans. Moral injury-related mental health difficulties can be challenging for clinicians to treat and there is currently no validated treatment available for UK veterans. We developed Restore and Rebuild (R&R) as a treatment for UK veterans struggling with moral injury-related mental health difficulties. This trial aims to examine whether it is feasible to conduct a pilot randomised controlled trial (RCT) of R&R treatment compared with a treatment-as-usual (TAU) control group.
We will use a feasibility single-blind, single-site RCT design. The target population will be UK military veterans with moral injury-related mental health difficulties. We will recruit N=46 veteran patients who will be randomly allocated to R&R (n=23) or TAU (n=23). Patients randomised to R&R will receive the 20-session one-to-one treatment, delivered online. Veterans allocated to TAU, as there are currently no manualised treatments for moral injury-related mental health problems available, will receive the one-to-one treatment (online) typically provided to veterans who enter the mental health service for moral injury-related mental health difficulties. We will collect outcome measures of moral injury, post-traumatic stress disorder (PTSD), alcohol misuse, common mental disorders and trauma memory at pretreatment baseline (before randomisation), end of treatment, 12 weeks and 24 weeks post-treatment. The primary outcome will be the proportion of patients who screen positive for PTSD and moral injury-related distress post-treatment.
This trial will establish whether R&R is feasible, well-tolerated and beneficial treatment for veterans with moral injury-related mental health difficulties. If so, the results of the trial will be widely disseminated and R&R may improve access to effective care for those who struggle following moral injury and reduce the associated negative consequences for veterans, their families and wider society.
ISRCTN99573523.
暴露于潜在的道德伤害事件正日益被认为是包括英国退伍军人在内的一系列职业群体关注的问题。与道德伤害相关的心理健康问题对临床医生来说是一个挑战，目前英国退伍军人还没有经过验证的治疗方法。我们开发了 Restore and Rebuild（R&R）作为一种治疗英国退伍军人与道德伤害相关的心理健康问题的方法。本试验旨在检验与常规治疗（TAU）对照组相比，对 R&R 治疗进行试点随机对照试验（RCT）是否可行。
我们将采用可行性单盲、单站点 RCT 设计。目标人群将是英国退伍军人，他们有与道德伤害相关的心理健康问题。我们将招募 46 名退伍军人患者，他们将被随机分配到 R&R（n=23）或 TAU（n=23）组。接受 R&R 治疗的患者将接受 20 次一对一的在线治疗。分配到 TAU 的退伍军人，由于目前没有针对与道德伤害相关的心理健康问题的规范化治疗方法，将接受通常用于因与道德伤害相关的心理健康问题而进入心理健康服务的退伍军人的一对一治疗（在线）。我们将在治疗前基线（随机分组前）、治疗结束时、治疗后 12 周和 24 周收集道德伤害、创伤后应激障碍（PTSD）、酒精使用障碍、常见精神障碍和创伤记忆的结局测量指标。主要结局指标将是治疗后 PTSD 和与道德伤害相关的困扰筛查阳性的患者比例。
这项试验将确定 R&R 是否对有道德伤害相关心理健康问题的退伍军人是一种可行的、耐受性好的、有益的治疗方法。如果是这样，试验的结果将广泛传播，R&R 可能会改善那些在道德伤害后挣扎的人的有效治疗机会，并减少对退伍军人、他们的家庭和更广泛的社会的相关负面影响。
ISRCTN99573523。
