Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review.

Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce.Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD.Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted.Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD.Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation.HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD).There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans.Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.

Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence.

OBJECTIVE: Research exploring the enablers and barriers that exist for military veterans seeking to address their poor mental health has produced ambiguous results. To identify the enablers and barriers correctly, this study systematically reviews the literature, including research that included alcohol and had a clearly defined veteran population. METHODS: Six databases were searched. Inclusion criteria specified that empirical studies related to veterans that had ceased military service and were seeking help for poor mental health and/or alcohol difficulties. Critical Appraisal Skills Programme and AXIS appraisal tools were used to assess quality and bias. A narrative synthesis approach was adopted for analysis. From 2044 studies screened, 12 were included featuring 5501 participants. RESULTS: Forty-four enablers and barriers were identified, with thirty-two being statistically significant. Post-traumatic stress disorder had the greatest number of enabler/barrier endorsements to veterans seeking help. Depression, anxiety, experience and attitudes also acted as enablers/barriers. Most studies were of fair methodological quality. Limitations included that samples were skewed towards US army veterans. Little research exists concerning those that have ceased military service. CONCLUSIONS: Veteran help-seeking is likely enabled by poor mental health symptomology and comorbidity, which suggests veterans reach a crisis point before they seek help. Further research on alcohol misuse and attitude formation is required. The field would also benefit from alternative study designs including qualitative studies with non-US participants.

Understanding the lived experiences of healthcare professionals during the COVID-19 pandemic: an interpretative phenomenological analysis.

Background: Little research has examined the impact of working within the context of COVID-19 on UK healthcare professionals (HCPs) mental health and well-being, despite previous pandemic findings indicating that HCPs are particularly vulnerable to suffering PTSD and other mental health difficulties due to the nature of healthcare work. Specifically, it appears that no research has employed qualitative methodologies to explore the effects of working amidst COVID-19 on mental health for HCPs in the UK. Objective: To qualitatively examining the lived experiences of HCPs in Northern Ireland, working during the early stages of the pandemic and lockdown period (14.04.20 and 29.04.20). Method: Interpretative phenomenological analysis (IPA) was used to explore the experiences of healthcare professionals, who were working during the COVID-19 outbreak. Ten HCPs were recruited via a social media campaign and snowball sampling. All interviews were conducted via telephone and transcribed verbatim. Results: Three superordinate themes with subordinate themes were elicited through the analysis. Theme one centred on specific challenges of HCPs working during the pandemic, such as redeployment, isolation from loved ones, infection concerns, lack of PPE and impact on patient interpersonal care. Theme two offered insights into the mental health and wellbeing of HCPs, while many experienced feelings of fear, sadness and hypervigilance, all also demonstrated a marked resilience. Finally, many felt undervalued and misunderstood, and wished to press upon the general public seriousness of the disease. Conclusion: To the authors' knowledge this is the first study to explore in depth, the unique experiences of frontline HCPs in Northern Ireland, offering a detailed account of the challenges confronted in these unprecedented circumstances and highlighting support needs within this cohort.

Antecedentes: Pocas investigaciones han examinado el impacto de trabajar en el contexto COVID-19 en la salud mental y bienestar de los profesionales de salud del Reino Unido (HCPs por sus siglas en inglés), a pesar que los hallazgos de pandemias previas señalan que los HCPs son particularmente vulnerables a sufrir TEPT y otras dificultades de salud mental debido a la naturaleza del trabajo sanitario. Específicamente, pareciera que ninguna investigación ha utilizado metodologías cualitativas para explorar los efectos de trabajar en medio de COVID-19 en la salud mental de los HCPs en el Reino Unido.Objetivo: Examinar cualitativamente las experiencias vividas de los HCPs en Irlanda del Norte, trabajando durante las primeras etapas de la pandemia y el periodo de confinamiento (14.04.20 y 29.04.20).Método: Se utilizó un Análisis fenomenológico interpretativo (IPA por sus siglas en inglés) para explorar las experiencias de los profesionales de la salud, que estuvieron trabajando durante el brote de COVID-19. Fueron reclutados diez HCPs a través de una campaña por medios sociales y un muestreo de bola de nieve. Todas las entrevistas se realizaron por teléfono y se transcribieron literalmente.Resultados: A través del análisis se obtuvieron tres temas superiores con temas subordinados. El tema uno se centró en los desafíos específicos de los HCPs que trabajaban durante la pandemia, como el redespliegue, estar aislados de los seres queridos, preocupaciones de infectarse, falta de EPP y el impacto en la atención interpersonal del paciente. El tema dos ofreció concientización sobre la salud mental y bienestar de los HCPs, aunque muchos experimentaron sentimientos de miedo, tristeza e hipervigilancia, todos también demostraron una marcada resiliencia. Finalmente, muchos se sintieron subvalorados y poco comprendidos y desearon presionar al público en general sobre la gravedad de la enfermedad.Conclusión: Según el conocimiento de los autores, este es el primer estudio que explora en profundidad, las experiencias únicas de los HCPS de primera línea en Irlanda del Norte, ofreciendo un recuento detallado de los desafíos enfrentados en estas circunstancias sin precedentes y destaca las necesidades de apoyo dentro de esta cohorte.